Recent research conducted in Germany explored the links between depression, pregnancy ambivalence, and contraceptive use among individuals who do not wish to become pregnant or conceive a child. Among women, more severe depressive symptoms were associated with less consistent contraceptive behaviors, while among men, higher pregnancy ambivalence was linked to less consistent use of contraceptives. The findings were published in Archives of Sexual Behavior.
Statistics show that one in three pregnancies in Germany is unintended. Overall, 47% of German women who have experienced pregnancy report having at least one unintended pregnancy in their lives. Unintended pregnancies are a significant focus of research because they tend to be associated with various negative outcomes for both the children born from such pregnancies and their parents. For example, studies show that children born from unwanted pregnancies often experience poorer physical and mental health. Women who become pregnant unintentionally are also at an increased risk of developing depression.
Unintended pregnancies primarily result from improper contraception. In the U.S., nonuse or inconsistent use of contraception accounts for around half of unintended pregnancies. Studies demonstrate that people suffering from depression are more likely to be inconsistent in their contraceptive use or to forgo it altogether.
Another factor that may contribute to inconsistent contraceptive use is pregnancy ambivalence. Pregnancy ambivalence refers to mixed or conflicting feelings about becoming or being pregnant, where an individual may simultaneously desire and fear pregnancy. In research studies, pregnancy ambivalence is often observed in individuals who report positive or neutral attitudes toward having a baby but are in situations unfavorable for pregnancy (e.g., being underage).
Study author Sina Kremer and her colleagues aimed to examine the link between inconsistent contraception, depression, and pregnancy ambivalence. They hypothesized that individuals with more severe depressive symptoms would tend to be less consistent in their contraceptive use over time. Their second hypothesis was that individuals with higher ambivalence scores would also be less consistent in their contraceptive use.
The researchers analyzed data from the second and third waves of the German Family Panel pairfam. The German Family Panel pairfam is an interdisciplinary study investigating partnerships and family living arrangements in Germany. It is conducted as a collaboration between the Universities of Bremen, Chemnitz, Mannheim, and the Ludwig Maximilian University of Munich. Launched in 2008-2009, the study adopts a multi-actor design, meaning it includes an anchor person and also interviews that person’s close others (partners, parents, children, etc.). It includes a Germany-wide random selection of over 12,000 anchor participants.
The data used in this study came from three groups of participants: those born between 1991 and 1993, between 1981 and 1983, and between 1971 and 1973. The study authors analyzed data from these individuals collected in 2009/2010 (wave 2) and 2010/2011 (wave 3).
From these groups, the authors selected participants who did not have children and reported not having tried to conceive or become pregnant in the previous 12 months but had been sexually active within the three months prior to data collection. They selected a group of 95 individuals with depression who met these criteria and matched them on various characteristics with a group of 95 non-depressed individuals. The average age of participants was 24 years, and 92% were unmarried. Of these participants, 117 were women.
The participants completed an assessment of depression in wave 2 (using the State-Trait Depression Scale-Trait) and responded to questions that allowed the researchers to estimate pregnancy ambivalence (e.g., “If you disregard all obstacles for once: Ideally, how many children would you like to have in total?” and “Once you think realistically about children: how many children do you think you will have?”). Participants who expressed a desire to have more or fewer children than they believed they would have were considered ambivalent.
However, the authors included only responses indicating a desire to have more children than the participant realistically expected. Those believing they would have more children than they wanted were excluded. In wave 3, participants reported on their contraceptive behavior (“Have you used contraception in the past 3 months?” and “Please think about the last 3 months: How consistently did you use contraception?”).
Results showed that participants with depression were less consistent in their contraceptive behaviors compared to non-depressed participants. They also believed they would have fewer children. Pregnancy ambivalence did not affect the association between depressive symptoms and contraceptive behavior consistency.
When men and women were analyzed separately, results showed that men with higher levels of pregnancy ambivalence were less consistent in their contraceptive use, while this was not the case for women. On the other hand, depressed women were less consistent in their contraceptive use compared to non-depressed women, a trend not observed in men. Among men, there was no association between depression and contraceptive behavior consistency.
“This study addressed a very important point by examining the relationship between depressive symptoms and consistency of contraceptive behavior. The connection between these two factors has been shown many times and could now be replicated in a German sample; however, the effect is small. The present study thus lays an important foundation for further research in transnational samples,” the study authors concluded.
The study highlights two potentially important factors in unintended pregnancies. However, it should be noted that the study was conducted on a very small and selective group of participants. Additionally, contraceptive consistency was measured using only two self-reported items, which may have left room for reporting and recall bias.
The paper, “Depression, Contraception, and Ambivalence Concerning Fertility,” was authored by Sina Kremer, Alexander L. Gerlach, and Doris Erbe.
