Efforts to improve reproductive health for adolescents and young adults have traditionally focused on preventing pregnancy. In line with this goal, clinical care typically promotes consistent birth control use for all young people at risk of becoming pregnant. 

As well-intentioned as these efforts may be, blanket efforts to reduce pregnancy in young people are problematic. Young people’s feelings about pregnancy can vary based on social context and their personal circumstances.  

Defining pregnancy as a binary between intended and unintended doesn’t capture this range of feelings. When people are given more options, they express ambivalence. A new paper led by Sarah Nathan, PhD, explores the pregnancy preferences of young women age 15-24, using the Desire to Avoid Pregnancy Scale, which captures more nuances.  

The researchers found that young women had a broad range of desires to avoid pregnancy. While more than half of the young women expressed a strong desire to avoid pregnancy, 20% indicated being open to pregnancy. Almost a third fell in the middle, indicating uncertainty, ambivalence, or fatalism about becoming pregnant.  

Women’s relationships and family structures contributed to their feelings—women who had a main partner, particularly those with high-quality relationships, expressed greater openness to pregnancy than those without a partner. Youth who already had 1 child were more open than those without children and those with two children.  The more important religion was in a young women’s life, the greater openness she expressed to pregnancy. Having a positive depression screen or a mother with more education were linked to less desire to become pregnant. Self-identified Black, Indigenous, and other people of color were also more open to the prospect of pregnancy than white women. 

Young people have diverse preferences about pregnancy that are based in their unique family, social, and cultural situations. Public health efforts and clinical counseling that promote birth control use among all youth may not be effective, may violate people’s reproductive autonomy and contribute to mistrust of the health care system. Efforts should aim to understand individual desires and needs around pregnancy and childbearing to support youth reproductive health.