February 25, 2019

Are you trying to become pregnant? For many women, the answer is, 'I'm not sure.'

Daily Briefing

    Read Advisory Board's take: How can your organization attract these 'ambivalent' mothers?

    While health care providers usually discuss pregnancies in terms of "planned or unplanned," new CDC data suggest that for some new mothers the question of whether they did or did not want a child is not so black and white—and that could change the way providers discuss pregnancy with patients, Margot Sanger-Katz and Claire Cain Miller write for the New York Times' "The Upshot."

    A significant number of women are 'uncertain' about being mothers

    In 2014, CDC updated how it surveys new mothers. Now, when new mothers respond to a survey question that asks whether or not they desired to have children right before they became pregnant, women can respond "I wasn't sure."

    That change helped identify a population of women who are uncertain about being mothers, Sanger-Katz and Cain Miller report. For example, a Guttmacher Institute analysis that combined the 2014 CDC survey results with abortion provider data found that a woman responded that she "wasn't sure" about being pregnant in 9% to 19% of pregnancies.

    Another analysis of 33 studies about fertility intentions revealed that about one-fifth to one-third of women in developed countries said they weren't sure whether they wanted to have children or have more children.

    Women who don't have set feelings tend to fall into one of two categories, according to Sanger-Katz and Cain Miller: they are younger and still determining their life plans, or older and are approaching menopause.

    Isaac Maddow-Zimet, a senior research associate at Guttmacher, citing a yet-to-be-published analysis, said women who are uncertain about pregnancy are more likely to have at least two children and to be black instead of white.

    Why women are unsure about becoming mothers

    So what makes roughly one-fifth of women unsure about having children?

    According to Sanger-Katz and Cain Miller, some women's desire for pregnancy can be influenced by "social norms," such as the pressure to meet ideal circumstances for pregnancy. In addition, they write, "Women face even more trade-offs today because they have more choices" surrounding education and career opportunities. The rising costs of housing and child care also could make women question whether they can afford children.

    As a result, there are a lot of women "who very much want a child, but don't feel they're at that ideal place in their life where it's permissible to want one," according to Maria Isabel Rodriguez, an obstetrician-gynecologist at Oregon Health and Science University.

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    For example, Kristin Jennings struggled with fertility and "decided that children weren't for her." But a year later, when she and her husband felt more financially secure they decided to stop contraception, and within weeks she was pregnant—and offered a big promotion at her job. "Had I not gotten pregnant that month specifically, I probably would have told my husband: 'I can't do this. I need to focus on my job.'"

    'The best care for an ambivalent woman'

    "In the past we thought of it as binary, you want to be pregnant or not, so you need contraception or a prenatal vitamin," Isabel Rodriguez said. "But it's more of a continuum."

    Heather Rackin, a sociologist studying fertility intentions at Louisiana State University, said, "It might not be that unintended pregnancy has all these negative consequences that we think about." In fact, "[f]or some people, it might have positive consequences," Rackin said.

    But that new insight means providers must change the way they communicate with women who express uncertainty. "If the women say they are not planning for pregnancy, doctors can offer long-acting forms of contraception that are more effective than birth control pills or condoms and that take a doctor's visit to remove," Sanger-Katz and Cain Miller write. Whereas, "[t]he best care for an ambivalent woman," might be a more reversible, short-acting form of birth control, according to Sanger-Katz and Cain Miller.

    Rodriguez said that when a patients tells her they are uncertain about being pregnant, she talks to them about prenatal care options as well as emergency contraception and abortion. Rodriguez also talks to her patients about underlying "stressors related to family planning" in an effort to get to the bottom of their uncertainty, Sanger-Katz and Cain Miller write (Sanger-Katz/Cain Miller, "The Upshot," New York Times, 2/15).

    Advisory Board's take

    Anna Yakovenko, Practice Manager, and Emily Heuser, Senior Consultant, Market Innovation Center

    Our research indicates that the strategy for attracting women who are unsure about whether or not they want to become pregnant may not be all that different than one for those that do. We recently conducted a survey of nearly 2,000 women ages 18-40 to understand how they chose gynecology and pregnancy care. A key insight: A majority (61%) of women don't choose a new provider when they become pregnant. Rather, most women (even those who don't plan to get pregnant for at least 10 years, if at all) are choosing gynecologist who they believe will be able to provide a high-quality, high-value delivery experience down the line.

    “61% of women don't choose a new provider when they become pregnant.”

    This means that for providers hoping to attract both women sure they want to get pregnant in addition to those ambivalent about pregnancy, it's important to invest in offering preliminary gynecology services. Engaging women with these preliminary services is the best way to integrate them into all of the women's services at the organization.

    Attracting women for OB/GYN services requires competing on consumer preferences. In fact, OB/GYN has the highest self-referral rate (45%) of any major service line, meaning that providers cannot rely solely on referrals to grow OB/GYN volumes.

    To market to self-referrers, providers should be sure to:

    • Ensure their website clearly shows where OB/GYNs deliver and highlights those facilities' birth quality scores, accreditations, and specialized infant services, as being affiliated with a high-quality facility was the second most important attribute in women's choice of a gynecologist; and
    • Provide a top-notch patient experience, specifically ensuring that providers take the time to explain health conditions clearly to women and help them stay healthy, which was the third most-important attribute in gynecologist choice.

    A strong performance on these two attributes should help your OB/GYN service line attract self-referrers and garner recommendations from family and friends that can help grow volumes. Plus, offering an excellent patient experience can help ensure that women stay at your practice if they do decide to become pregnant.

    To learn more about what else your OB/GYN practice can do to build loyalty, and what makes a woman decide to stay with their gynecologist throughout delivery, be sure to download our report outlining 16 key insights on How Women Chose their Pregnancy Care.

    Download Now

    Then, join us on Thursday, March 21st at 3pm to learn more about the changing landscape of women's services. We'll cover they key changes in demand for women's services, the financial outlook for these services, and how providers can stay ahead of the curve in responding to these new trends.

    Register Now

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