The Desire to Avoid Pregnancy Scale: clinical considerations and comparison with other questions about pregnancy preferences

ABSTRACT Background Clinicians and people of reproductive age would benefit from a reliable way to identify who is, or is not, likely to become pregnant in the next year, to direct health advice. The 14-item Desire to Avoid Pregnancy (DAP) Scale is predictive of pregnancy; this paper compares it with other ways of assessing pregnancy preferences to shortlist options for clinical implementation. Methods A cohort of 994 UK women of reproductive age completed the DAP and other questions about pregnancy preferences, including the Attitude towards Potential Pregnancy Scale (APPS), at baseline, and reported on pregnancies quarterly for a year. For each question, DAP item, and combinations of DAP items, we examined the predictive ability, sensitivity, specificity, area under the receiver operating curve (AUROC), and positive and negative predictive values. Results The AUROCs and predictive ability of the APPS and DAP single items were weaker than the full DAP, though all except one had acceptable AUROCs (>0.7). The most predictive individual DAP item was ‘It would be a good thing for me if I became pregnant in the next three months’, where women who strongly agreed had a 66.7% chance of pregnancy within 12months and the AUROC was acceptable (0.77). Conclusion We recommend exploring the acceptability to women and healthcare professionals of asking a single DAP item (‘I wouldn’t mind if I became pregnant in the next three months’), possibly in combination with additional DAP items. This will help to guide the provision of information and services to support reproductive preferences. Key messages Clinicians do not currently have a valid and reliable way of asking people about their pregnancy preferences. A single item from the Desire to Avoid Pregnancy Scale is effective at identifying who is likely to become pregnant in the next year; other questions, including the APPS, are less discriminative but may be more acceptable. The acceptability to women and health professionals of different ways of asking people about their pregnancy preferences in health care settings should be explored.