Our previous work has shown that the Desire to Avoid Pregnancy (DAP) Scale is suitable for use in the UK (published in July 2022, read more about it here), and has shown that it is highly predictive of pregnancy (published in October 2022, read more about it here). We have now gone on to consider the clinical use of the DAP scale, comparing it with other ways of asking people about their pregnancy preferences.

Discussions about pregnancy preferences are important, regardless of whether the woman wants to become pregnant in the future or not; ensuring that those who do not wish to become pregnant have the right support to avoid pregnancy is just as important as identifying those who might benefit from pre-pregnancy health advice or those who may benefit from both. Therefore, clinicians and people of reproductive age would benefit from a reliable way to identify who is, or is not, likely to become pregnant in the next year, to direct health advice.

While the DAP Scale is a valid and reliable measure of women’s desire to avoid pregnancy, it is made up of 14 questions, which means that it is likely to be impractical in many clinical consultations. Therefore, we have compared the full DAP Scale with other methods of assessing pregnancy preferences, as well as the performance of individual and combinations of DAP questions, with the aim of identifying a brief and viable alternative to the full DAP Scale (that can still sufficiently distinguish between who will and who will not become pregnant) for clinical use.

Our group of 994 non-pregnant women in the UK all completed the P3 survey at the start (October 2018) and again every three months for a year. The survey was made up of a range of pregnancy preference questions including the DAP Scale, the Attitude towards Potential Pregnancy Scale (APPS) and ‘feeling’, ‘trying’ and ‘thinking’ questions. At every follow-up all participants were asked whether they were currently pregnant or had been since the last survey. We used this information to examine how well each of the questions (including individual and combinations of DAP questions) predicted the probability of pregnancy in the next year, comparing them to the full DAP scale.

Our analysis showed that the DAP Scale performed better than all the other methods of assessing pregnancy preferences (APPS, ‘feeling’, ‘trying’ and ‘thinking’ questions); although all except the ‘trying’ question were classed as ‘acceptable’. When looking at individual DAP questions, the best performing question was ‘It would be a good thing for me if I became pregnant in the next 3 months’, where there was a 66.7% chance of pregnancy within 12months among women who strongly agreed. While an individual DAP question is weaker than the full DAP scale, it is significantly shorter and would therefore be less burdensome for clinical use.

Overall, based on our findings and the need for a short (and accurate) tool to assess people’s pregnancy preferences, we recommend using either a single question from the DAP – ‘It would be a good thing for me if I became pregnant in the next 3 months’ – or a combination of this with additional DAP questions. Further work to explore the acceptability of this question (or combination of questions) to women and health care professionals is needed before clinical implementation. For more information, read the full paper here.