A Developmentally-Informed Model of Adolescent Decision-Making Around Pregnancy: A Qualitative Study

This study sought to formulate a model of the process through which adolescents and young adults (AYAs) progress when making decisions around pregnancy.

We recruited United States-based participants aged 18-35 years in 2020-2021 who experienced pregnancy under age 20 across 3 pregnancy outcomes (parenting, adoption, abortion). Through semi-structured phone interviews, we explored participants' emotions around pregnancy, pregnancy disclosures, and pregnancy-related decision-making. We used qualitative analysis to identify common themes in the steps of the process experienced by participants in their decision-making and associated influences and develop a model of that process.

We interviewed 50 participants aged 13-19 years at the time of 1 or more pregnancies, totaling 56 pregnancies (16 parenting, 19 abortions, 18 adoptions, and 3 miscarriages). The developed Pregnancy Decision-making and Outcome Trajectories (PDOT) model incorporates varied trajectories of intention establishment/achievement. PDOT has 4 stages: 1) initial reactions, 2) intention analysis, 3) planning, and 4) action/inaction. PDOT highlights AYA potential to experience persistent uncertainty around pregnancy but also potential to express certainty and move toward thoughtful research, support-seeking, and cost/benefit analysis. PDOT also highlights the impact of barriers and facilitators that limit AYAs from or help AYAs with achieving their desired pregnancy outcome.

Pregnant AYAs experience difficulty making and following through with decisions around pregnancy outcomes. People interfacing with pregnant AYAs can utilize this framework to give AYAs appropriate, intentional support to boost AYA agency in making decisions around pregnancy and acting on those decisions.