Pregnancy care-seeking stress in the USA: a prospective cohort study.

Abstract

To prospectively assess pregnancy-related care sought and obstacles and stress experienced by newly pregnant people. The ADAPT Study, a longitudinal cohort study, followed 2015 non-pregnant participants aged 15-34 years for a year. Those with confirmed incident pregnancies were followed through their pregnancies and for 3 years. We recruited participants from 23 reproductive and primary care facilities located in five southwestern states with different sociopolitical reproductive health contexts (restrictive, Arizona and West Texas; protective, southeastern California, Nevada and New Mexico). 334 people reported a new pregnancy within 1 year of enrolment; 324 with outcome data are included in this analysis. Types of pregnancy care sought ('Have you looked into where or how you could get (prenatal care, abortion care or adoption services)?') and care-seeking stress ('How stressful was it to find (prenatal, abortion or adoption) care for this pregnancy?'). Most participants (83%, 270/324) sought prenatal care; 43% (138/324) sought abortion care; and 5% (17/324) sought adoption services. Overall, 17%, 29% and 23%, respectively, reported that care-seeking was extremely/quite a bit stressful. Abortion care-seeking was associated with significantly more stress than seeking prenatal care in the ordinal (adjusted odds ratio (aOR 1.70, 95% CI 1.10 to 2.62) but not logistic (aOR 1.33, 95% CI 0.74 to 2.38) model. Adoption care-seeking stress did not differ from prenatal care-seeking stress in either model. Participants who experienced any type of abortion care-seeking obstacle and those recruited in a state with a restrictive policy environment (aOR 2.72, 95% CI 1.09 to 6.80) reported more care-seeking stress than their counterparts. People who seek pregnancy care often experience some care-seeking stress, regardless of the type of care they seek. Findings point to the need to reduce the burden of the pregnancy care-seeking process across all types of pregnancy care. NCT03888404.