ESTABLISHING EVIDENCE-BASED CUT-POINTS ON THE DESIRE TO AVOID PREGNANCY MEASURE

Objectives

Scholars express an urgent need for alternative measures to “unintended pregnancy” that capture whether people attain their reproductive preferences. Capitalizing on the strengths of the Desire to Avoid Pregnancy (DAP) scale, we established evidence-based cut-points, defining standardized groupings of pre-pregnancy preferences to expand the scale’s utility.

Methods

More than 45,000 females, aged 18-44, across nine US states completed the DAP scale in the population-based Surveys of Women (2017-2023). We fit data to an item response model and generated a construct map, a visual representation of respondents’ probabilities of endorsing each response category over the 0-4 range of each DAP item. Additionally, we generated predicted probabilities of contraceptive use and incident pregnancy across DAP levels with mixed effects models. In 2024-2025, we twice convened a panel of diverse family planning experts, who identified empirically meaningful DAP groupings and labels based on these materials.

Results

Expert consensus was reached on three DAP groupings. Individuals with High DAP scores (>2.5-4) have responses demonstrating a strong preference to avoid pregnancy. Those with Mid-range scores (>1.5-≤2.5) have item responses indicating a moderate preference to avoid pregnancy (ie, uncertain or ambivalent). Individuals with Low DAP scores (0-1.5) are open to pregnancy (ie, desire or would be receptive to pregnancy). Approximately 50%, 30%, and 20% of females had High, Mid-range, and Low DAP scores, respectively.

Conclusions

DAP groupings offer researchers a necessary categorical coding option, facilitating the integration of rigorous, person-centered measures into future research and surveillance. A similar methodology could be employed for other critical measures in reproductive health research.