Academic journal article International Perspectives on Sexual and Reproductive Health

Indonesian Couples' Pregnancy Ambivalence and Contraceptive Use

Academic journal article International Perspectives on Sexual and Reproductive Health

Indonesian Couples' Pregnancy Ambivalence and Contraceptive Use

Article excerpt

CONTEXT: Most studies on pregnancy ambivalence are based on data from women and depend on the women's perceptions To measure their partner's pregnancy intentions. Because these perceptions may not be accurate, data collected directly from men are needed to understand the role of couple dynamics in fertility behavior.

METHOD: Matched couple data from the 2002-2003 Indonesia Demographic and Health Survey were used to examine contraceptive use, fertility desires and attitudes about becoming pregnant in the next few weeks--whether it would be a big problem, a small problem or no problem. Concordance between partners on these issues was evaluated. Inconsistent fertility desires and responses to the problem question are used to define ambivalence within couples. Multivariate logistic regression analyses were used to assess whether couples' pregnancy ambivalence was associated with contraceptive use.

RESULTS: Seventy-one percent of husbands and 54% of wives reported that a pregnancy in the next few weeks would be "no problem"; couples' concordance on this question was 64% among contraceptive users and 61% among nonusers. In the multivariate analysis, couples who were discordant on the issue of a pregnancy in the near future had 26% lower odds of using contraceptives than couples in which both partners agreed a pregnancy would be a big or small problem. Contraceptive use was also less likely for couples in which one partner wanted to delay or stop child-bearing and the other wanted more children or was undecided (odds ratio, 0.4).

CONCLUSIONS: Husbands and wives influence each other's fertility attitudes and family planning use. Both husbands' and wives' pregnancy attitudes should be taken into account at the time of screening and method selection.

International Perspectives on Sexual and Reproductive Health, 2010, 36(1):36-43

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Pregnancy ambivalence can be understood as vague or conflicting altitudes about fertility intentions, and may be manifested in inconsistency between stated fertility desires and contraceptive behaviors. Pregnancy ambivalence may be found among both contraceptive users and nonusers and occurs in countries with both high and low contraceptive prevalence. (1), (2) For example, women who are not using contraceptives but report that they want to delay or stop childbearing may be ambivalent about the next pregnancy; these women are often classified as having an unmet need for contraception and targeted for family planning services. These women may be ambivalent about contraception as well. (3) Pregnancy ambivalence has also been described among women who become pregnant while using contraceptives but do not classify the pregnancy as unwanted or mistimed, as would be expected. (1)

Such findings suggest that conventional categories of pregnancy attitudes (wanted, mistimed or unwanted) may be oversimplified and do not account for ambivalence toward future pregnancies or the inability to form definite fertility intentions. (4-6) As a result, ambivalent attitudes toward pregnancy or contraception may be biasing estimates of the proportion of women with unintended pregnancies or an unmet need for contraception. (2), (3)

Previous research from the United Stales has demonstrated that women expressing ambivalent attitudes about pregnancy are less likely to be current contraceptive users. When they use contraceptives, these women tend to use less effective methods and to use their chosen method less effectively. (1), (7-11) The inconsistent or ineffective use of contraceptive methods or the use of less effective methods can lead to negative health outcomes, such as unintended pregnancies and induced abortion. (12-14) Thus, recognizing pregnancy ambivalence is important for family planning policy and programming efforts.

To date, most studies on pregnancy ambivalence are based on women's reports of family planning use and fertility desires; the overwhelming majority are from the United States, with a few from Sub-Saharan and North Africa. …

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