Ambivalence vs. indifference towards pregnancy in young women
Awarded 2009
Small Research Grants
Jeanelle Sheeder, PhD, MSPH
University of Colorado

Background: American adolescents are at higher risk for pregnancy than adolescents in other industrialized nations. Most know how to obtain and use contraceptives and deny they want babies. However, many do not use contraception because they are either ambivalent or indifferent about pregnancy. These states can develop in two different situations: when young women feel that pregnancy would have both good and bad effects on their lives, or when they think that particular consequences of pregnancy would have little effect (good or bad) on their lives. It is therefore extremely important to further understand what distinguishes ambivalence from indifference and how these states contribute to contraceptive use. This proposal is part of a long-term research agenda with the goal of improving our understanding of pregnancy ambivalence and indifference. In specific aim 1, we will prospectively distinguish ambivalence from indifference towards pregnancy among young women who are sexually active and not currently using contraception. In specific aim 2, we will compare contraceptive choices in these young women to determine if there are differences between young women who are ambivalent or indifferent and if other sociodemographic factors may contribute to these states. Methods: Subjects were recruited from two clinics in Adolescent Medicine at The Children’s Hospital in Denver, Colorado; the adolescent family planning (AFP) clinic and the Colorado Adolescent Maternity (CAMP) young mothers’ clinic. The AFP clinic is a Title X clinic that provides contraceptive and family planning services to approximately 1,000 demographically diverse, 12 – 22 year old patients each year. The CAMP serves a similarly diverse population of young mothers of the same age range with approximately 250 newly delivered mothers each year. Mothers and their infants are seen at joint appointments according to the American Academy of Pediatrics schedule of visits. The Children’s Hospital uses an electronic medical record system significantly facilitating data collection. Adolescents attending either clinic who state that they are currently sexually active and not using contraception were approached for participation by trained clinic staff. They were eligible if they were English-speaking, between 14 and 22 years of age. Eligible patients were asked to give a urine sample for pregnancy testing. Patients with a positive test received the usual counseling and referred appropriately. Patients with a negative test had the study explained by a trained research assistant and asked if they would like to participate. Results: We enrolled 134, 14-24 year old young women in the study. They were racially and ethnically diverse ( 38.8% Black, 32.1% Hispanic, and 23.9% White). Participants completed the Pregnancy Attitudes Scale. According to the Pregnancy Attitudes Scale, 48.5% did not desire pregnancy, 6.1% were ambivalent about pregnancy, 45.4% were indifferent about pregnancy, and 0% desired pregnancy. Although we were able to distinguish between ambivalent and indifferent participants, the percentage of ambivalent participants was smaller than expected. When asked if they would continue the pregnancy if they found out they were pregnant today, 43.8% of those who did not desire pregnancy stated they would, 86.2% of indifferent participants would, but 25.0% of ambivalent would. Interestingly, the remaining 75% of ambivalent participants reported that they didn’t know if they would continue a pregnancy compared to only 10.3% of indifferent participants and 40.6% of participants that reported they did not desire pregnancy (p=0.003). At the enrollment visit, 22.4% received an Implanon implant: 22%, 11% received an Intrauterine device, 16% received a DMPA injection, 35% received oral contraceptives, the contraceptive ring or patch, and 12% left with no contraception. Of participants classified as not desiring pregnancy, 59.4% chose a long-acting method (implant or IUD), 40.0% of indifferent participants chose a long-acting method, and 25.0% of participants classified as ambivalent chose a long-acting method. However, because the percentage of ambivalent participants was smaller than expected it was not possible to statistically distinguish them from indifferent participants. Conclusions: Due to lower than expected rates of participants who were classified as ambivalent, we were unable to distinguish them from indifferent participants with regard to contraceptive choice. Ambivalent participants were more unsure if they would continue a pregnancy than indifferent participants or than those who did not desire pregnancy. Further study of these adolescents at high-risk of pregnancy is needed to be able to distinguish indifference from ambivalence towards pregnancy in this population.

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