Considering parenting preferences in a binary, “intended versus unintended” or “planned vs. unplanned” frame, leaves out a spectrum of thoughts, feelings, and attitudes regarding parenting and pregnancy. Feelings about parenting and acceptability regarding pregnancy may be viewed with some combination of ambivalence, uncertainty, or indifference. Each of these attitudes are worth considering and are not inherently problematic. Human beings have internal motivations that inform actions, decisions and behaviors. Rather than problematizing the choices, PATH seeks to support someone as they clarify and express the internal motivations that drive their choices.
PATH focuses on desire to have a child rather than on pregnancy for several reasons. Perhaps most importantly, questioning that focuses on desire for pregnancy excludes people without a uterus and people who are not capable of or interested in pregnancy for themselves. The excluded person may want to have a child, but would be excluded from the conversation if the question was about desire for pregnancy. Also, in general, someone’s attitude regarding the acceptability of pregnancy is directly related to their thoughts and feelings about having a child.
Certainly a person’s sentiment about pregnancy could influence their thoughts or feelings about having a child and PATH allows for that with the last question. An example of this could be that a person unsure or concerned about fertility may not strongly avoid pregnancy, in part, in order to gain reassurance about fertility. This apparent ambivalence can be addressed within a PATH framework so as to support rather than judge the person who is simultaneously holding two seemingly inconsistent desires. A binary frame does not allow for consideration of this nuance. If the nuance is not invited into the conversation, it is unlikely that someone’s internal motivations will be clarified.
Add to this the fact that attitudes change over time. Even when someone expresses a strong desire to avoid or to get pregnant during one visit, these desires may shift as health, relationships, financial situations, and life opportunities change.
The framework we describe is versatile. The nuance with which the questions are asked is intentional, and allows for patients with lived experiences entirely different from provider experiences to be heard, affirmed, and supported by compassionate health care professionals.