Chapter 7 182 have different needs and experiences due to, for example, language or cultural barriers or discrimination in healthcare. This reflects the investigators’ demographics, as the study group consisted of native Dutch women proficient in Dutch and English (only). This may have caused a threshold for women from other origins or demographic groups to join the study. The outpatient clinic is an advisory clinic, which indicates that all participants voluntarily consulted on their mental health, implying at least a certain degree of mental health awareness. Although we included participants from various countries of origin, there were no participants who moved to the Netherlands as refugees, limiting the transferability of our results to a larger audience. In addition to limitations resulting from the sampling strategy, there are certain challenges with the use of interviews. There is a possibility of response bias (socially acceptable responses), but we consider this bias limited because the participants’ responses were diverse and captured a range of emotions and reactions. Several issues are related to the data collection. Diversity in the timing of the interview (weeks of gestation) might have increased recall bias. Pregnancy intentions are difficult to recollect after a pregnancy is accepted, especially as mothers’ bonding can increase during pregnancy and change recollections39. Postpartum interviews were held with only six participants. Participants who did not join might have experienced pregnancy loss, complicated pregnancies or postpartum mental health problems. The postpartum perspectives may thus be marked by those with positive pregnancy and birth experiences. Finally, as all pregnant women and partners discovered UP in the first trimester of pregnancy, there was a possibility for legal abortion. This is relevant, as the women in our study opted to pursue their pregnancies and may have felt more positive about the pregnancy than women with UPs who did not have the option to abort. Interpretation of findings The results from our study show women’s conflicting feelings toward UPs. A previous study demonstrated how incongruence between pregnancy desires and planning can cause internal or external conflicts, such as desiring a pregnancy but also experiencing financial worries17. In our sample, fear of motherhood but at the same time desire to create a family might explain the incongruence between pregnancy desires and pregnancy planning. Some women actively aimed to avoid pregnancy (through condom usage, long-acting hormonal contraceptive usage or periods of abstinence), while other women did not want to become pregnant but did not actively avoid pregnancy. Previous qualitative work has indicated that in addition to ambivalence, some women do not formulate any pregnancy intentions40. In our work, pregnancy intentions were indeed not always formulated by women prior to the UP, which may have influenced contraceptive adherence. Additionally, pregnancy
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