The Self-Assessed Pregnancy Acceptability (SAPA) measure is a retrospective epidemiological measure capturing a person's initial self-assessment upon learning they are pregnant—specifically their attitude toward and perceived feasibility of the potential pathways through the pregnancy (i.e., parenting, abortion, adoption)—in the context of their life circumstances.
SAPA Materials
- The SAPA Measure
-
The SAPA measure consists of 11 questions administered after a pregnancy has been confirmed. Seven items are used to assess pregnancy acceptability and four provide additional context about an individual's circumstances and the factors that may shape their pregnancy-related options and decisions. For each question, participants are asked to reflect on the time when they first learned they were pregnant.
Download Here
- Scoring Rubric
-
Each response in the SAPA measure is evaluated using our scoring rubric, which categorizes a pregnancy as highly acceptable, mixed acceptability, or unacceptable. The scoring rubric, along with STATA syntax for creating a SAPA variable, can be accessed using the link below.
Download Here
Our Findings
We evaluated SAPA in a longitudinal cohort of 595 pregnant individuals at three time points: before 15 weeks' gestation, approximately five months later (during the third trimester for those who remained pregnant), and approximately five months after that (post-pregnancy).
SAPA is a temporally stable, valid retrospective measure of pregnancy acceptability.
- During validation testing, 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).
Pregnancy acceptability is closely associated with a wide range of maternal, pregnancy, and infant health outcomes
Our research found that pregnancies categorized as less acceptable were associated with:
- Higher levels of anxiety and depression
- Poorer physical health
- Lower quality of life
- Greater likelihood of abortion
- Increased suicidality
- Increased substance use during pregnancy
- Greater exposure to intimate partner violence during pregnancy
- Higher risk of low birth weight
- Lower likelihood of breastfeeding
- Lower levels of maternal-child bonding
Bottom Line
SAPA is a rigorous, valid, and temporally stable retrospective measure of pregnancy acceptability. By illuminating how pregnancy experiences are linked to health and social outcomes, SAPA offers valuable insights for advancing sexual and reproductive health equity through research, policy, and practice.