When pink clouds are absent: Effects of unwanted pregnancy on psychosocial health of women, men, and their children, and the protective role of partner involvement, social support, and decision ownership.

In the Netherlands, about one in five women has ever experienced an unintended pregnancy. Despite being unintended, such pregnancies can lead to a variety of different outcomes, with some of these pregnancies resulting in the birth of much wanted and loved children, others are terminated, and some will be carried to term despite being unwanted. Unintended pregnancies may induce stress in the women and men confronted with the situation, although the level of stress and the duration very much depend on the circumstances and the environment. Irrespective of pregnancy outcome, the psychosocial stress of an unintended pregnancy may have negative effects on post-pregnancy psychosocial health of women and men. Furthermore, it could affect child health as well, when the decision is made to carry the pregnancy to term. Maternal psychosocial stress in pregnancy has indeed been linked with negative outcomes for child development behavior and health, with the potential to transfer stress from one generation to the next, creating an intergenerational cycle of adversity. However, the scientific evidence on the role of pregnancy intentions is mixed. Furthermore, it is unclear what factors facilitate or protect against the recurrence and intergenerational transfer of psychosocial stress after an unintended pregnancy. In the proposed research project, we will address these knowledge gaps by examining associations between pregnancy intentions and (short- and long-term) psychosocial health outcomes for women and men living in the Netherlands, and their children (if any). We will examine the role of important risk and protective factors, as well as confounding covariates (co-occurring risks), in two longitudinal studies. The first is an existing longitudinal cohort study, the ‘Amsterdam Born Children and their Development (ABCD) Study’. In this study, psychosocial and general health outcomes of pregnant women and their children have been followed for 16+ years, which enables investigation of long-term impact of pregnancy intentions on children’s psychosocial and health outcomes. The second study is a mixed-methods longitudinal study (the ‘BluePrInt Study’), in which the variable pregnancy outcome (abortion versus carrying to term) is included, as well as important moderating factors (partner involvement, social support, decision ownership), and co-occurring risk factors (history of psychosocial problems, adverse childhood events). Furthermore, men are included in this study, and needs with regard to counseling and care around unintended pregnancies are assessed, using qualitative in-depth interviews with a subsample of women (and their male partners) with a history of psychosocial problems, who carried an unintended pregnancy to term. In this project, knowledge exchange is bidirectional. Experience experts and professionals have an important active role in this project in the advisory committee, the recruitment of participants, and the development of a communication and action plan. To secure the position of the mothers’ and fathers’ perspective in this project, female and male experience experts are involved. We will also cooperate with professional associations, midwives, and abortion clinics in different stages of the project. This direct exchange increases the potential for synergy and improvement of care. The knowledge gained from this study is vital for tailoring interventions to the needs of women and men who are faced with an unintended pregnancy and are at risk for adverse psychosocial health outcomes. By doing this, we ultimately aim to improve their future health and wellbeing, help prevent future unintended pregnancies, and give their (potential) children a good start in life. Note about language use Throughout this proposal, we will use the nouns women and men, however, also individuals who do not identify as women can get pregnant, and those who do not identify as men can impregnate others. For practical purposes, woman/women is used for (an) individual(s) who can get pregnant, and man/men for those who can impregnate. The term 'pregnancy carried to term' does not include pregnancies of which the child has been given up for adoption or foster care, as this is beyond the scope of this project. It is also important to note that we use the term 'unwanted' or 'less wanted' for those pregnancies that were not just slightly mistimed, but received with negative and conflicting emotions. The word 'unwanted' is often not preferred by individuals in the context of their pregnancy; especially when it is carried to term. Other terminology like the word ‘undesired’ may be more adequate. We acknowledge that pregnancy intentions may be fluid and multidimensional (see Strategy), and that different terms might not fit with individuals' narratives, but for reasons of clarity we will continue to use the terms unwanted and unintended or unplanned in this proposal.