Decision-making in case of an unintended pregnancy: an overview of what is known about this complex process

Abstract

Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a ‘sense of knowing’ is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.

Keywords:

• Decision-making
• unwanted pregnancy
• unintended pregnancy
• abortion
• narrative-review

Acknowledgments

We thank the members of the “Concerning Maternity” research network, for providing their thoughts and feedback on the initial analysis, helping to shape the findings and results of the review.

Authors’ contributions

Dalmijn: Conceptualization, Methodology, Formal analysis, Writing – Original Draft, Visualization Visse: Conceptualization, Methodology, Writing – Review & Editing, Supervision van Nistelrooij: Conceptualization, Methodology, Writing – Review & Editing, Supervision

Disclosure statement

The authors report there are no competing interest to declare.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Additional information

Funding

This research was conducted by Fiom, Center of expertise in unwanted pregnancy and ancestry in the Netherlands. It was supervised by Radboud University, faculty Philosophy, Theology and Religious Studies, the Netherlands. Fiom is funded by the Ministry of Health, Welfare and Sport in the Netherlands. They had no involvement in any part of this research.