Objective: We examined whether the experience of a “pregnancy scare” is related to subsequent changes in contraceptive use that increase the risk of unintended pregnancy. Methods: We used data from the Relationship Dynamics and Social Life (RDSL) study, which interviewed a random, population-based sample of 1003 young women weekly for 2.5 years. We used multivariate regression models to predict the effect of experiencing a pregnancy scare on change in contraceptive use. Results: We found pregnancy scares are associated with changes in contraceptive use that increase the risk of pregnancy. Experiencing a pregnancy scare is related to discontinued contraceptive use, change from consistent to inconsistent use of contraception, and change from a more effective to a less effective method of contraception. We also found pregnancy scares are associated with continued inconsistent use of contraception. Conclusions: Our findings suggest that the experience of a pregnancy scare does not serve as a “wake-up call” to start using contraception, to start using it consistently, or to switch to a more effective method to reduce the risk of unintended pregnancy. Instead, contraceptive use after a pregnancy scare typically remains the same or worsens. Implications: Clinicians should be aware that young women who have experienced pregnancy scares may be at increased risk of unintended pregnancy, relative to young women who did not experience a pregnancy scare.

Introduction

The rate of unintended pregnancy in the United States remains persistently high [1], and is unlikely to decrease without new policy or interventions. In particular, a more comprehensive understanding of the precursors of unintended pregnancy is essential to formulate new approaches that reduce the unintended pregnancy rate [2]. This study explores one possible pathway — the relationship between experiencing a pregnancy scare and subsequent changes in contraceptive use. The term “pregnancy scare” describes when a woman who wants to avoid pregnancy believes she is pregnant, but later learns that she is not. According to national surveys, more than half of young women experience a pregnancy scare [3,4]. Women from less advantaged backgrounds are more likely to experience a pregnancy scare than those from more advantaged backgrounds [5], and the demographic correlates of pregnancy scares are similar to the demographic correlates of unintended pregnancy [5,6]. Furthermore, experiencing a pregnancy scare is strongly associated with subsequent unintended pregnancy, independent of background factors [5,7]. Although it seems possible that a pregnancy scare would be a “wakeup call” to start using contraception or to switch to a more effective method, the positive association between a pregnancy scare and later unintended pregnancy does not support this theory. Or, if a pregnancy scare is in fact a “wake-up call”, any improvement in contraceptive use is only temporary. It could even be that experiencing a pregnancy scare increases pregnancy desire, or increases tolerance of an undesired pregnancy, so that women become less likely to use contraception or more likely to switch to a less-effective method. That is, even women who wanted to avoid pregnancy quickly adjust their feelings to be more positive about pregnancy when they think they are probably pregnant, and those feelings remain positive to some degree even after they realize they are not actually pregnant. Of course, there is also the possibility that experiencing a pregnancy scare is not related to any change in contraceptive use at all. In this study we estimate the effect of experiencing a pregnancy scare on subsequent changes in: (1) contraceptive use; (2) consistency of contraceptive use; and (3) effectiveness of the contraceptive method used.