ABSTRACT
Objectives
Understanding the timing of pregnancy suspicion and confirmation, including the role
of home pregnancy tests, can facilitate earlier entry into pregnancy-related care
and identify individuals likely to be impacted by gestation-based abortion restrictions.
Study design
We use data from 259 pregnant individuals participating in a cross-sectional survey
at 8 primary and reproductive health care clinics in 6 U.S. states (2016-2017). We
use regression models to identify differences in utilization of HPTs, barriers to
use, and to compare gestational duration at pregnancy confirmation.
Results
Three-quarters (74%) of respondents took a home pregnancy test as the first step in
confirming pregnancy; this figure was lower among adolescents versus young adults
(65 vs 81%, p = 0.01). Two-thirds (64%) reported delays in home testing, higher among adolescents
(85%). People taking a test at home confirmed pregnancy 10 days earlier than those
first testing at a clinic (41.3 vs 51.8 days gestation, p = 0.02). Those that did not test at home cited concerns about test accuracy (42%) and
difficulties accessing one (26%). While overall 21% confirmed pregnancy at ≥7 weeks
gestation, and 35% at ≥6 weeks, confirmation at ≥7 weeks was higher among adolescents
versus young adults (47 vs 13%, p = 0.001), Latina versus white women (28 vs 11%, p = 0.02), food insecure versus secure women (28 vs 17%, p = 0.06), and people with unplanned versus planned/mistimed pregnancies (25 vs 13%,
p = 0.07).
Conclusions
Home pregnancy testing is common and associated with earlier pregnancy confirmation.
Still, barriers to at-home testing are evident, particularly among adolescents. Efforts
to expand access to home pregnancy tests and increase knowledge about their accuracy
may be impactful in increasing utilization.
Implications
While at home pregnancy testing is common and facilitates earlier confirmation of
pregnancy, one in 5 confirm pregnancy at 7 weeks gestation or later (and one in 3
do so at 6 weeks or later). Gestational bans in the first trimester will disproportionately
prevent young people, people of color, and those living with food insecurity from
being able to access abortion.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Late recognition of pregnancy as a predictor of adverse birth outcomes.Am J Obstet Gynecol. 2009; 201: 156.e1-156.e6https://doi.org/10.1016/j.ajog.2009.05.011
- First trimester medication abortion practice in the United States and Canada.PLoS One. 2017; e0186487: 1-10https://doi.org/10.1371/journal.pone.0186487
- Social Science Oral Abstracts: trends in self-pay costs and insurance acceptance for abortion across the United States, 2017 to 2020.Contraception. 2021; 103: 375https://doi.org/10.1016/j.contraception.2021.03.011
- Incidence of emergency department visits and complications after abortion.Obstet Gynecol. 2015; 125: 175-183https://doi.org/10.1097/AOG.0000000000000603
A Surge in Bans on Abortion as Early as Six Weeks, Before most people know they are pregnant. Guttmacher Institute 2019. https://www.guttmacher.org/article/2019/03/surge-bans-abortion-early-six-weeks-most-people-know-they-are-pregnant (Accessed June 14, 2021).
- Trends in timing of pregnancy awareness among US women.Matern Child Health J. 2017; 21: 715-726https://doi.org/10.1007/s10995-016-2155-1
- Timing of steps and reasons for delays in obtaining abortions in the United States.Contraception. 2006; 74: 334-344https://doi.org/10.1016/j.contraception.2006.04.010
- Predictors of timing of pregnancy discovery.Contraception. 2018; 97: 303-308https://doi.org/10.1016/j.contraception.2017.12.001
- Risk factors associated with presenting for abortion in the second trimester.Obstet Gynecol. 2006; 107: 128-135https://doi.org/10.1097/01.AOG.0000189095.32382.d0
- “A Private Little Revolution”: the home pregnancy test in American culture.Bull History Med. 2006; 80: 317-345
- Delayed pregnancy testing and second-trimester abortion: can public health interventions assist with earlier detection of unintended pregnancy?.Contraception. 2014; 89: 400-406https://doi.org/10.1016/j.contraception.2013.12.008
- Adolescents with negative pregnancy test results. An accessible at-risk group.JAMA. 1996; 275: 113-117
- Prevalence of home pregnancy testing among adolescents.Am J Public Health. 2000; 90: 974-976https://doi.org/10.2105/ajph.90.6.974
- Self pregnancy testing in an urban family planning clinic: promising results for a new approach to contraceptive follow-up.Contraception. 2008; 77: 40-43https://doi.org/10.1016/j.contraception.2007.09.005
- Psychometric evaluation of an instrument to measure prospective pregnancy preferences: the desire to avoid pregnancy scale.Med Care. 2019; 57: 152-158https://doi.org/10.1097/MLR.0000000000001048
- Certainty and intention in pregnancy decision-making: an exploratory study.Contraception. 2021; 103: 80-85https://doi.org/10.1016/j.contraception.2020.11.003
- Diagnostic accuracy of two food insecurity screeners recommended for use in health care settings.Am J Public Health. 2017; 107: 1812-1817https://doi.org/10.2105/AJPH.2017.304033
- Conceptualisation, development, and evaluation of a measure of unplanned pregnancy.J Epidemiol Community Health. 2004; 58: 426-433https://doi.org/10.1136/jech.2003.014787
Texas Abortion Law: Questions and Answers - The New York Times n.d. https://www.nytimes.com/2021/09/01/health/texas-abortion-law-facts.html (Accessed September 28, 2021).
- Natural limits of pregnancy testing in relation to the expected menstrual period.JAMA. 2001; 286: 1759-1761https://doi.org/10.1001/jama.286.14.1759
- Could routine pregnancy self-testing facilitate earlier recognition of unintended pregnancy? A feasibility study among South African women.BMJ Sex Reprod Health. 2021; : 1-7https://doi.org/10.1136/bmjsrh-2020-201017
- Effect of a home pregnancy test intervention on cohort retention and pregnancy detection: a randomized trial.Am J Epidemiol. 2020; 189: 773-778https://doi.org/10.1093/aje/kwaa027
- Adolescents’ and young adults’ reports of barriers to confidential health care and receipt of contraceptive services.J Adolesc Health. 2018; 62: 36-43https://doi.org/10.1016/j.jadohealth.2017.10.011
- School-based health centers to advance health equity.Am J Prev Med. 2016; 51: 114-126https://doi.org/10.1016/j.amepre.2016.01.009
- Comparison of volunteers’ experience of using, and accuracy of reading, different types of home pregnancy test formats.Expert Opin Med Diagn. 2013; 7: 435-441https://doi.org/10.1517/17530059.2013.830103
- False negative point-of-care urine pregnancy tests in an urban academic emergency department: a retrospective cohort study.J Am Coll Emerg Phys Open. 2021; 2: e12427https://doi.org/10.1002/emp2.12427
- Making sense of home pregnancy test instructions.J Womens Health (Larchmt). 2009; 18: 363-368https://doi.org/10.1089/jwh.2008.0985
Article info
Publication history
Published online: November 05, 2021
Accepted:
October 20,
2021
Received in revised form:
October 13,
2021
Received:
August 3,
2021
Footnotes
Declaration of Competing Interest: The authors declare no conflict of interest.
Funding: This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Office of Research on Women's Health, Building Interdisciplinary Research Careers in Women's Health grant #2K12HD053163 and funding from an anonymous foundation. The funders had no role in the conceptualization, design, data collection, analysis, decision to publish or preparation of the manuscript.
Identification
Copyright
© 2021 Published by Elsevier Inc.
