Ambivalence Toward Pregnancy as an Indicator for Contraceptive Nonuse: A Systematic Review and Meta-Analysis

Introduction This systematic review and meta-analysis examines the association between contraceptive nonuse and ambivalence toward pregnancy. Methods Following an a priori protocol, 4 databases were searched, and results were reported using the Meta-Analysis of Observational Studies in Epidemiology guidelines. Studies were appraised for quality using the Appraisal Tool for Cross-Sectional Studies, and those reporting results as frequencies or odds ratio (OR) were included in random effects meta-analytic models. Results Of 209 identified studies, 6 met criteria for systematic review and meta-analysis. Pooled data from 8360 women in 6 studies demonstrated a significant association (OR, 2.41; 95% CI, 1.4-4.15; P < .0001) between ambivalence toward pregnancy and nonuse of contraception. Pooled data from 735 men (2 studies) demonstrated no significant differences (OR, 1.96; 95% CI, 0.7-5.47; P = .20) between ambivalence toward pregnancy and male contraceptive nonuse. Discussion Women with ambivalent pregnancy attitudes are more likely to forgo contraception compared with women with anti-natal (strong desire to avoid pregnancy) attitudes, which has not been validated to date in a systematic review and meta-analysis. There was no significant association between men's pregnancy attitudes and their contraceptive nonuse, however. Although a cohesive theoretical definition of ambivalence is lacking, health care providers are advised to help guide people who have either conflicting or absent attitudes toward pregnancy to formulate a concrete opinion about their family planning goals.