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People want to feel heard in the care around contraception and unintended pregnancy. This is according to new research by Utrecht ľ�ϸ���Ӱ��, Amsterdam UMC, Rutgers, Fiom and UMC Groningen, commissioned by ZonMw on behalf of the Ministry of Health, Welfare and Sport (VWS). The study looked at the factors that contribute to unintended pregnancy and experiences with care and support during an unintended pregnancy. The results are in the report “It starts with listening”, which will be presented this week to state secretary Judith Tielen (Youth, Prevention and Sport).

ZonMw commissioned this research to gain deeper insight into circumstances that contribute to unintended pregnancy, as well as perceptions of care. This study provides deeper insight, with all the nuances that go with it.

These are mostly people who are a bit older, and already have a partner and children

It can happen to anyone

The report is a follow-up to the previously published report “This is my story”, which focused on the decision-making process in unintended pregnancy. Jenneke van Ditzhuijzen, lead researcher on the project and working at Utrecht ľ�ϸ���Ӱ�� and Amsterdam UMC, explains: "It is often thought that unintended pregnancy mainly affects young girls in vulnerable circumstances. But this is not true. It mostly concerns people who are a bit older, and already have a partner and children. It can actually happen to anyone."

Contraceptive doubts and negative experiences

"Women often stop using hormonal contraception because of their own negative experiences. What people hear or read around them about hormones confirms what they experience themselves," van Ditzhuijzen said. But in the consulting room, they are told that there is a lot of misinformation about hormones. And that, according to the researchers, is not a convenient first approach to the conversation. "People then do not always feel taken seriously by healthcare providers, and then they may look for themselves, or postpone the choice of another method." During a period of contraceptive doubt, partners don't always talk to each other about it either. Van Ditzhuijzen: "The fact that people sometimes underestimate the chances of pregnancy is typically human. People are bad at assessing risks in all sorts of ways. So just giving information about risks is not enough; healthcare providers must listen to experiences, so that people can make an appropriate choice about contraception themselves."

People especially need an open, judgement-free attitude from healthcare providers

"I've been so stupid"

There is still a lot of shame surrounding unintended pregnancy. Wieke Beumer, co-researcher at Amsterdam UMC: "People often feel stupid when they get pregnant unintentionally. They feel they have done something wrong. This makes it difficult to talk about it openly." The study shows that people especially need an open, judgement-free attitude from healthcare providers. Participants in the study who experienced this attitude from healthcare providers most often look back positively on the care surrounding their unintended pregnancy. Societal perceptions also play a role. "We call for actively countering stigmatisation of unintended pregnancy by projecting a more realistic image and making it less problematic," Beumer said.

Space for men

Men and women experience care around unintended pregnancy largely the same, yet care is still very much focused on the pregnant woman. Beumer: "It is important to pay more attention to the role of partners. Men should not only be part of the conversation with the woman; you can talk to them separately about shared responsibility and the prevention of unintended pregnancy."

It starts with listening

With this report, the researchers argue for broader accessible contraceptive care around unintended pregnancy, where different healthcare professionals such as GPs, abortion doctors, midwives, GGD doctors and gynaecologists can provide the same good care. They also argue for easy-to-find care and support when someone has become unintentionally pregnant. Van Ditzhuijzen stresses: "There must be room for personal preferences and own perspectives when making appropriate choices in the event of an unintended pregnancy, for both women and men. This applies equally to contraception. And that starts with listening."