The CONVERGE team has developed and tested Self-Assessed Pregnancy Acceptability (SAPA), a new conceptual model and epidemiological measure of sexual and reproductive health equity.
The fields of public health, demography, health services research, and clinical practice have long relied on "unintended pregnancy" as a key metric of reproductive health and wellbeing. However, this framework is deeply flawed and often fails to capture the complexity of people's experiences, preferences, and life contexts. Self-Assessed Pregnancy Acceptability (SAPA) offers a person-centered alternative to pregnancy intendedness, one that accounts for the structural conditions shaping reproductive decision-making and possibilities.
- Stakeholder Engagement & Collaboration
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The CONVERGE team partnered with researchers at the University of California-San Francisco, the University of Texas, the University of Tennessee-Knoxville, and the University of Washington to design the SAPA measurement. The team conducted longitudinal, in-depth interviews with pregnant people and people who recently had an abortion or miscarriage. These interviews informed a preliminary conceptual framework and set of measure items, which were refined by the UPitt Youth Research Advisory Board and an expert panel of interview participants, clinicians, reproductive justice advocates, and measurement researchers. The refined measure was tested and finalized with cognitive interviews among people during early pregnancy.
- Measure Validation
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The SAPA measure consists of 11 items. 7 items are used to score pregnancy acceptability and 4 provide additional context. The scoring rubric can be accessed here. We tested SAPA in a longitudinal cohort of 595 pregnant people at <15 weeks’ gestation, 5 months after that (third trimester for those still pregnant), and 5 months after that (post-pregnancy). Participants were recruited nationally from prenatal clinics, abortion clinics, college campuses, commercial centers, and online.
SAPA demonstrated strong temporal stability: 81% of participants reported the same SAPA category during early pregnancy (Time 1) and 10 months later (Time 3). The reliability coefficient was 0.64 (p<0.001).
We conclude that SAPA is a temporally stable, valid retrospective measure of pregnancy acceptability. It has meaningful associations with health and social outcomes, and it illuminates policy recommendations for reproductive wellbeing.
Learn more about the development process of SAPA in our Studies in Family Planning article and the associated blog post.
- Our Team
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Co-Principal Investigators:
- Sonya Borrero (University of Pittsburgh)
- Galen Switzer (University of Pittsburgh)
Co-Investigators:
- Elizabeth Mosley (University of Pittsburgh)
- Christine Dehlendorf (University of California-San Francisco)
- Lisa Callegari (University of Washington)
- Nikki Zite (University of Tennessee-Knoxville)
- Megan Hamm (University of Pittsburgh)
- Funding
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This study was funded by the National Institutes of Health (R01HD103286).
We hope that SAPA will be adopted in future epidemiological surveys and research studies. If you’re interested in collaborating with us or have questions about implementing SAPA in your project, you can contact us at SAPA@pitt.edu.