Moving Beyond Unintended Pregnancy: Development of a Person-Centered Conceptual Framework and Measure of Self-Assessed Pregnancy Acceptability.

Sexual and reproductive health (SRH) research, programming, policy, and services have long relied on the narrow paradigm of "pregnancy intendedness and planning," including its "unintended pregnancy" measure. This framework is limited and problematic, overlooking diverse perspectives on pregnancy, structural factors, and non-parenting outcomes such as abortion and adoption. In response, we developed the Self-Assessed Pregnancy Acceptability (SAPA) framework and measure as a person-centered alternative. The SAPA framework was developed by centering the lived experiences of pregnant people in Texas, Tennessee, Pennsylvania, and California through baseline interviews shortly after pregnancy confirmation (N = 31) and follow-up post-pregnancy interviews (N = 14). Development was also informed by a diverse Expert Panel (N = 19) including reproductive justice leaders, reproductive measurement experts, and lived experience experts. Using cognitive interviews (N = 13), we refined an 11-item measure of SAPA that is currently being validated in a nationwide sample of nearly 600 people in early pregnancy. Following validation, SAPA could be integrated into national and state-level epidemiological surveillance surveys such as the National Survey of Family Growth and the Pregnancy Risk Assessment Monitoring System. This novel framework and measure offer an alternative to unintended pregnancy and contribute to an ecosystem of person-centered, rigorously developed measures of SRH equity.