IMPROVING THE PREVENTION, RECOGNITION AND SUPPORT OF VULNERABLE UNINTENDED PREGNANCIES BY USING A MULTIMETHODOLOGICAL LIFE COURSE APPROACH

In the Netherlands, midwives working in urban areas indicate that almost half of the pregnancies are unintended (UP). UPs can be associated with serious consequences for women and their families, for example by increasing the risk of adverse pregnancy and birth outcomes, stressful parenting and behavioral problems during childhood. On the other hand, not all UPs are unwanted and even ambiguity towards pregnancy and parenthood can exist and affect the route towards potential vulnerability. It is essential to further conceptualize vulnerable UPs and assess its prevalence. Next it is important to identify risk and resilience factors during the life course to be able to support the recognition of potential vulnerable UPs and to implement targeted interventions for the prevention and support of this risk group. In the present project we will conduct an extensive mixed methods study to conceptualize vulnerable UPs in routine healthcare and assess the prevalence, risk and resilience factors of vulnerable UPs, and to gain insight into lifecourse pathways and needs associated with vulnerable UPs in the city of The Hague, The Netherlands. The city of The Hagueh is of particular interest given the large socioeconomic inequalities in maternal and childhood outcomes as well as the high prevalence of teenage pregnancies and perinatal morbidity and mortality relative to the rest of The Netherlands. The project consists of three work packages. WP1 will map the population of pregnant women as well as their partners in the region of The Hague by setting up a prospective population-based cohort integrated with the regional data infrastructure (DIAPER) established for the Solid Start Program (Kansrijke Start) at the LUMC Campus The Hague in collaboration with the National Public Health Institute (RIVM). By uniquely combining medical and social care data with original data collection on the basis of the London Measure of Unplanned Pregnancy and the Time-based measure of Unintended pregnancy, relevant subgroups will be associated with medical and social care utilization postpartum to identify potential vulnerability. On the basis of the different UP subgroups recruitment will be performed for WP2. In this WP, we will conduct multiple lifecourse interviews with women and their partners (including the biological fathers not involved in the pregnancy) experiencing an UP to explore how routes to vulnerability can occur during the lifecourse. For this the Transition Framework of Schlosserberg will be used to understand the life course and contextual factors associated with the transition to pregnancy and parenthood. The use of a qualitative longitudinal case study approach will enable the exploration of change over time. At last (WP3), we will conduct a realistic review of existing interventions for the prevention and support of couples experiencing vulnerable pregnancies and how these can be adapted and implemented according to the needs identified in WP2. As part of WP3, we will develop a comprehensive strategy for knowledge utilization (i.e. e-learning module and a conversation-aid) that can be used to align existing interventions to the needs of vulnerable UPs in The Netherlands and evaluate this in a feasibility study. For this we will work closely with the professionals and experience experts in The Hague by utilizing our existing network from The Hague Consortium ‘Solid Start/Kansrijke Start’ and the ZoNMW consortium ‘Improving local practice of Unintended pregnancy/parenthood’. The proposed study has an excellent fit with the priorities of the Knowledge Synthesis and the ZonMw call as it will lead to new insights into the characteristics of women and men dealing with UP as well as in the risk and protective factors associated with vulnerable UP through the in-depth quantitative and qualitative study design. In addition, the development of intervention strategies, interactive learning possibilities and the conversation aid on the basis of our findings will support professionals in tailoring interventions to these vulnerable pregnancies. This will help in closing potential gaps of care for families dealing with UPs and reducing the health and social care burden associated with it.