Planned vs Unplanned Pregnancy
What's wrong with the term "Unplanned"?
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. Questions that focus on desire for pregnancy exclude people without a uterus and people who are not capable of or interested in carrying a pregnancy themselves. In these cases a person may want to have a child, but would be excluded from the conversation if the question was about desire for pregnancy.
Allowing Room for Complex Emotions
Some people hold complex thoughts and feelings about pregnancy. A person may not desire children anytime soon but also share that it is not important for them to prevent pregnancy. There are many reasons for this, one of which is to "test" 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.
Flawed Public Health Data around "Unplanned" Pregnancies
The term “unplanned pregnancy” is defined by the National Survey on Family Growth as a pregnancy that was reported by the patient as either desired at some future time but not at the time pregnancy occurs or never at all. This obviously does not capture ambivalence or complex feelings around pregnancy. This, along with recall bias, can lead to flaws in epidemiological data collection.
Additionally, there is a general consensus that “unplanned” pregnancies lead to worse outcomes despite little high-quality evidence for a causal link. The existing data around this concept is highly impacted by the lack of quality health care access in the US.
The PATH framework 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.