Pregnancy Intendedness by Presence and Extent of Disability in the USA, 2019-2020.

Context: Over 40% of pregnancies in the United States are unintended. Women with unintended pregnancies may be less likely to receive timely prenatal care and engage in healthy behaviors immediately before and during pregnancy. Limited research suggests that women with disabilities are more likely to have an unintended pregnancy, but to date no studies have assessed whether intendedness varies by extent of disability.

Methods: We analyzed 2019-2020 PRAMS data from 22 sites that included the Washington Group Short Set of Questions on Disability (n = 37,832). We examined associations of extent of disability (none, some difficulty, or a lot of difficulty) with pregnancy intendedness (classified as intended, mistimed, unwanted, or unsure). We used multinomial logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) while controlling for sociodemographic characteristics.

Results: Overall, 60.1% of pregnancies were intended, 18.2% mistimed, 6.4% unwanted, and 15.3% unsure. Compared to respondents with no difficulty, respondents with some difficulty or a lot of difficulty were more likely to report a mistimed pregnancy (aOR = 1.55, 95%CI 1.40,1.71; aOR = 1.62, 95%CI 1.34,1.95), an unwanted pregnancy (aOR = 1.92, 95%CI 1.66,2.24; aOR = 2.20; 95%CI 1.72,2.82), and unsure intendedness (aOR = 1.61, 95%CI 1.45,1.79; aOR = 1.75, 95%CI 1.45,2.11), respectively.

Conclusions: People with disabilities who give birth, regardless of extent of disability, had elevated odds of mistimed and unwanted pregnancy and of being unsure of their pregnancy intendedness. Our findings support the use of more inclusive measures of disability and emphasize the need for equitable reproductive healthcare that respects the childbearing potential and choices of individuals with disabilities.