A year of magical thinking leads to… unintended pregnancy

Qualitative Study Explores Women's Perceptions of Pregnancy Risk

In-depth interviews with 49 women obtaining abortions in the United States found that most of the study participants perceived themselves to be at low risk of becoming pregnant at the time that it happened. According to "Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions," by Lori Frohwirth of the Guttmacher Institute et al., the most common reasons women gave for thinking they were at low risk of pregnancy included a perception of invulnerability, a belief that they were infertile, self-described inattention to the possibility of pregnancy and a belief that they were protected by their (often incorrect) use of a contraceptive method. Most participants gave more than one response.
The most common reason women gave for their perceived low risk of pregnancy was perceived invulnerability to pregnancy. Study participants understood that pregnancy could happen, but for reasons they couldn't explain, thought they were immune or safe from pregnancy at the time they engaged in unprotected sex. One reported that she "always had good luck," while another said, "…It's like you believe something so much, like 'I just really don't want children,' [and] for some reason, I thought that would prevent me from getting pregnant." This type of magical thinking—that pregnancy somehow would not happen despite acknowledged exposure—suggests a disconnect between the actual risk of pregnancy incurred by an average couple who does not use contraceptives (85% risk of pregnancy over the course of a year) and a woman's efforts to protect herself from unintended pregnancy.
Equal proportions (one-third) of respondents thought they or their partners were sterile, said the possibility of pregnancy "never crossed my mind" and reported that (often incorrect) contraceptive use was the reason they thought they were at low risk. Perceptions of infertility were not based on medical advice, but rather on past experiences (e.g., the respondent had unprotected sex and didn't get pregnant) or family history. Among those who thought they were protected by their contraceptive method, most women reported inconsistent or incorrect method use. For example, one woman felt a few missed pills did not put her at risk: "I just thought…they were like magic. If I missed it one day, it wouldn't really matter."

Guttmacher Institute.

Court-Ordered Care — A Complication of Pregnancy to Avoid

But why should pregnancy diminish a competent adult woman's right to refuse care? Citizens have no legal duty to use their bodies to save one another; even parents have no such legal duty to their children. It follows, then, that “a fetus cannot have rights in this respect superior to those of a person who has already been born” (In re A.C.).

Moreover, the due-process considerations are profound. Because these cases are usually heard on an emergency basis, judicial decisions are made without full briefing on relevant law, medicine, and policy. Unlike alleged criminals, patients have no Sixth Amendment right to counsel, and they cannot instantaneously find expert witnesses to testify on their behalf. And hospital lawyers acting as state attorneys have a clear conflict of interest: as even the Supreme Court of Florida has noted, it is inappropriate for a hospital “to argue zealously against the wishes of its own patient,” and “it cannot act on behalf of the State to assert the state interests” when a competent adult refuses care (Matter of Dubreuil).

NEJM, june 14, 2012.