Reproductive realities:Understanding people's diverse trajectories through and beyond unintended pregnancy

This thesis examined various aspects of the trajectories that people navigate through and beyond an unintended pregnancy. By studying experiences related to pregnancy intentions, contraception, decision-making about abortion or continuing an unintended pregnancy, and the consequences for mental health, this thesis shed light on the realities that shape people’s reproductive lives within the Dutch context. Pregnancy intentions are rarely binary but better captured on a continuum based on several aspects. People’s pregnancy intentions were shaped not only by individual factors but also by relational and structural contexts, such as perceived social support and living conditions. People base their considerations about whether or to use contraception on more than just their desire to avoid pregnancy. They often reported dissatisfaction with available methods, sometimes underestimated the likelihood of pregnancy, were overconfident in chosen methods, and reported beliefs about subfertility. Limited communication with (sex) partners, as well as gendered norms around contraceptive responsibility, further influenced choice and use of contraceptive methods. Decisions to have an abortion or to continue an unintended pregnancy were shaped by multiple interrelated factors, including motivations, intuitions, beliefs, and emotions. In the Dutch context where abortion care is available, unintended pregnancy did not increase the risk on long-term mental health problems for womxn or lasting socioemotional problems for children. Instead, prior mental health, social support, and socioeconomic conditions were more influential. Overall, the thesis argues for shifting policy and practice toward promoting systemic reproductive autonomy through structural support, equitable access to care, and person-centered, nonjudgmental reproductive healthcare.