Not Sure or Okay Either Way

While it is not uncommon for clients to express indifference or indecision about if and/or when they may want to become pregnant, it can present a challenge for providers when engaging in reproductive life goals counseling. 

Clients with incongruent pregnancy desires may indicate that they do not want to become pregnant, do not wish to use contraception, and/or would welcome a pregnancy if it happened all in the same conversation.

To provide person-centered counseling, providers should understand that unclear or incongruent pregnancy desires are acceptable and that assisting the client in achieving their reproductive goals does not mean reaching a decision between preventing or seeking pregnancy.

Understanding Ambivalent or Incongruent Pregnancy Desires

Beliefs and feelings around pregnancy can be complex and conflicting regardless of age, race, or income status. Planning pregnancy is not always a meaningful or realistic goal. According to an article from Perspectives on Sexual and Reproductive Health, “structured planning lack[s] the flexibility to accommodate women with ambivalent, indifferent or fluctuating desires.”

Cultural Expectations around Pregnancy & Parenthood

Societal and cultural expectations around pregnancy and parenthood influence reproductive life goals and can lead to incongruent desires. In some cultures, and for some individuals, becoming pregnant is always celebrated, regardless of whether or not it was a planned or desired pregnancy. A qualitative study of women wanting to prevent pregnancy found that for those that stated they would be happy if they became pregnant, “deep emotions were at the forefront when answering questions regarding feelings about a future pregnancy. For incongruent women, the idea of not only their own children but of children in general was seen as joyous.”

Economic Pressures

Conversely, societal norms dictate that pregnancy should be prevented until financial and relationship security are attained. For many, particularly those from marginalized populations, this type of social and economic security is often not able to be achieved during childbearing years, largely due to structural racism and other factors out of individual control. People in this situation may feel unsure about their reproductive life goals and maintain the mindset that if it’s meant to happen, it will happen.

Doubting Effectiveness of Birth Control

Additionally, feeling a lack of reproductive control related to accessing birth control, disbelief in its effectiveness, finding a comfortable method, concern over fertility or otherwise, can be a deterrent to forming pregnancy or prevention intentions.

Oftentimes, it is a combination of internal feelings and external factors that lead to ambivalent or incongruent pregnancy desires. Because of the complex and conflicting nature of pregnancy intentions, it may be challenging for clients to articulate their reasoning.

Counseling for Unclear or Incongruent Pregnancy Desires

Some providers find it challenging to counsel clients with unclear or incongruent pregnancy desires because they were trained to provide counseling and guidance to reduce “unintended” pregnancy. By reframing this mindset and focusing on aiding clients in achieving reproductive autonomy instead, counseling clients with unclear or incongruent pregnancy desires can become more straightforward and productive.

A provider's response to a client who reveals unclear or incongruent pregnancy desires may be influenced by personal or unconscious biases. They may inadvertently push their client towards or away from contraception as a result. It is the provider’s responsibility to examine and identify their own biases, and prevent biases from influencing their behavior.

Aiken et. al. (2016), proposed a framework for preventing undesired pregnancies instead of unintended pregnancies and explains that for clients with unclear or incongruent pregnancy desires:

…providers would encourage such women to discuss the possibility of conception and would help them to take steps to prepare for a healthy pregnancy. Women who might desire to avoid pregnancy, but who view themselves as unlikely to get pregnant or perceive no good contraceptive options, would be guided to seek additional information about their fecundity or to request personalized discussions about their ideal contraceptive.

Providers should approach each client as an autonomous individual with feelings and desires that are constantly evolving and are influenced by external and internal factors. They should avoid any preconceived notions or dichotomous thinking around a client’s reproductive goals.

During the counseling session, providers should use open ended questions to help determine what information and resources can help their client achieve their reproductive goals. This might include educating a client on how to prepare for a healthy pregnancy and discussing contraception during the same visit, or sharing information on less effective forms of contraception to find an option that fits their preferences.

Providers must be comfortable navigating pregnancy ambivalence and refrain from persuading clients to make a concrete choice.

< Toolkit Homepage

The content on this page was last reviewed and updated in October 2023.