Review of Religious Research

https://doi.org/10.1007/s13644-021-00444-3

RESEARCH NOTE

Does Religion Affect Perception of Pregnancy Timing

among Women Using Contraception?

Rachael Langley, et al. [full author details at the end of the article]

Received: 13 April 2020 / Accepted: 9 January 2021

© Religious Research Association, Inc. 2021

Abstract
Background  Nearly half of all pregnancies in the U.S. are unintended. Unintended
pregnancy refers to a mistimed or unwanted pregnancy. Unwanted and mistimed
pregnancies are often distinguished from each other because of the negative social
connotations and poorer health outcomes associated with unwanted pregnancies.
However, mistimed pregnancies also pose significant economic, societal, and health
burdens that necessitate enhanced risk factor identification and prevention efforts.
Purpose  Religion and religious practices are important to consider as potential risk
factors for mistimed pregnancy as over 70% of Americans identify as religious.
However, little research exists on the potential religious factors-mistimed preg-
nancy association. The purpose of this study was to evaluate this association among
women using contraception in the U.S.
Methods This analysis used National Survey of Family Growth data. Women
(n = 2841) self-reported measures of religion, religiosity and pregnancy tim-
ing. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence
intervals.
Results  After adjustment, women who reported currently being Catholic, Protestant,
or another religion had statistically significant increased odds of mistimed preg-
nancy compared to women with no current religious affiliation (Catholic OR = 2.31,
Protestant OR = 1.41, Other OR = 2.58). Women who reported that religion was
very important or somewhat important had statistically significant increased odds of
mistimed pregnancy (Very Important OR = 1.82, Somewhat Important OR = 1.60).
More frequent service attendance was associated with statistically significant
decreased odds of mistimed pregnancy. Specifically, women who reported attending
services 2–3 times a month or 1 or more times per week had nearly half the odds of
mistimed pregnancy compared to women who never attended services (OR = 0.54
and OR = 0.51).
Conclusions and Implications  This study provides insight into the interrelationship
of religion as a sociocultural risk factor for mistimed pregnancy and found that while
religiously active women had increased odds of mistimed pregnancy, frequency of
service attendance was a protective factor against mistimed pregnancy. Given that
approximately half of pregnancies in the U.S. are unintended, additional studies are

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needed to further understand cultural mechanisms that may be important risk factors
of unintended pregnancy, and to confirm this study’s findings.

Keywords  Mistimed pregnancy · Contraception · Religion · Religiosity ·

Unintended pregnancy

Introduction

Approximately 45% of the 6.1 million pregnancies that occur annually in the
United States are unintended (Finer and Zolna 2016). Unintended pregnancy
refers to a pregnancy that was either unwanted or mistimed. Unwanted and mis-
timed pregnancies are often distinguished from each other because of the negative
social connotations and poorer health outcomes associated with unwanted preg-
nancies compared to mistimed pregnancies (Wildsmith et al. 2010). While nega-
tive health outcomes correlated with unwanted pregnancy are well-established,
including low birth weight and preterm deliveries among a myriad of other poor
physical and psychological maternal and child health outcomes, research examin-
ing health outcomes associated with mistimed pregnancy is lacking, which can
partially be attributed to the difficulty in measuring pregnancy intention.
Birth intendedness is inherently difficult to measure because the majority of
research examining pregnancy intention is collected retrospectively, typically
through a series of indirect questions, and is thus subject to social desirability
bias, recall bias, or rationalization (Guzzo and Hayford 2014). Pregnancy wanted-
ness data collected retrospectively likely does not capture attitude changes among
women who would have considered a pregnancy unintended prior to the birth of
a child, due to a reluctance among respondents to admit to such changes in atti-
tude (Williams et  al. 1999). Subsequently, the number of mistimed pregnancies
is likely underreported because of the recharacterization of a birth as positive
or intended over time. The difficulty in reliably measuring pregnancy intention
proves to be particularly challenging when considering the significant economic
and societal burdens associated with mistimed pregnancy, as recharacterizations
of a birth as intended rather than mistimed likely minimizes the true economic
and social costs associated with mistimed pregnancy.
In 2010, births resulting from mistimed pregnancies cost federal and state
governments an estimated $21 billion nationwide and government expenditures
amounted to an estimated $336 per capita for women aged 15–44 (Sonfield and
Kost 2015). Mistimed pregnancies also pose a societal burden commensurate
with that of the considerable economic burden. Women with mistimed pregnan-
cies have higher risks of maternal depression, physical violence, and unhealthy
behaviors during pregnancy, and are less likely to seek early prenatal care
(D’Angelo et  al. 2004; Kost et  al. 1998). Additionally, children who were born
from mistimed pregnancies may face negative, long-term health outcomes, such
as higher risk of cognitive impairment and poor physical health later on in life

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(Logan, et  al. 2007). The significant negative effects associated with mistimed
pregnancy necessitate enhanced risk factor identification and prevention efforts.
Known risk factors for mistimed pregnancy include young maternal age at first
birth, higher parity, educational attainment level, and low socioeconomic status
(D’Angelo et al. 2004). Contraceptive use has also long been established as one of
the most significant risk factors associated with unintended pregnancy, whereby
contraception use is understood to be an umbrella term that includes nonuse, incon-
sistent use, incorrect use, and method failure (Speidel et al. 2008). However, little
emphasis has been placed on the effect of cultural or social forces as risk factors of
mistimed pregnancy.
Religion is one such cultural force that is important to consider, but has not been
thoroughly examined, as a potential risk factor for mistimed pregnancy, particu-
larly in the U.S. where religion is a significant cultural force. Americans are com-
paratively more religious than individuals in similarly industrialized countries and is
evidenced by the estimated 70.6% of Americans who identify as religious (Kramer
et al. 2007). Religion is widely accepted to be a guiding framework that influences
the beliefs, values, and attitudes among individuals with high levels of religiosity,
where religiosity is understood as the degree to which religion is an important aspect
in daily life and individuals (Regnerus and Smith 2005). An important component
of religiosity is how closely individuals conform to the teachings or doctrine held
by the church, which often influences the behavior of religious followers. Research
demonstrates that people with high levels of religiosity typically hold traditional
family values where heavy emphasis is placed on the family unit (Hayford and Mor-
gan 2008). Subsequently, attitudes and behaviors towards sexual activity can indi-
rectly be interpreted as complete avoidance of sexual impropriety of any kind that
poses significant risks, specifically for teenagers (Hayford and Morgan 2008).
Researchers have found that teenagers who come from religious backgrounds
report traditional social values to be important components in personal identity
and typically hold conservative attitudes towards non-marital sexual relations, gen-
der roles, childbearing, and contraceptive use. For example, teens from conserva-
tive, religious backgrounds report complete abstention from sexual relations until
marriage and the preservation of the traditional family unit as important personal
characteristics (Hayford and Morgan 2008). However, research indicates that 57%
of teenagers from religious backgrounds have engaged in sexual activity of some
kind and that sexually active teens who report a religious upbringing are 56% more
likely to engage in unprotected sex compared to teens who report not having reli-
gious backgrounds (Quinn and Lewin 2019).
Current studies primarily explore sexual behavior, family relations or stability,
socioeconomic disadvantages, or educational differences relative to rates of unin-
tended pregnancy. Additionally, concentrated efforts targeted towards reducing
unintended pregnancy among teenagers have resulted in a robust understanding of
the aforementioned risk factors for teens. However, minimal research has been con-
ducted to understand such associations specifically for mistimed pregnancy.
Knowledge is particularly lacking in the current literature related to the associa-
tion of religion as a risk factor for mistimed pregnancy. Religion is widely accepted
to be a guiding framework that influences individuals’ beliefs, values, and behaviors

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that may be helpful in better understanding the association between religion and
mistimed pregnancy. It is also a particularly salient area of interest as rates of mis-
timed pregnancy consistently hover around 50% despite women increasingly delay-
ing childbearing (Regnerus and Smith 2005). Therefore, the aim of this study is to
evaluate the association between religion and mistimed pregnancy among women
using contraception in the U.S.

Methods

Study Design and Population

Data from the 2013–2015 National Survey of Family Growth (NSFG) were used
to evaluate the effect of religion and religiosity on perception of pregnancy timing.
NSFG is a surveillance system that gathers data to identify trends in family life,
pregnancy, infertility, current use of contraception, and women’s and men’s health
in the U.S. (Centers for Disease Control and Prevention [CDC] 2016). The NSFG
data sample selection is based on a stratified, multistage area probability sample in
which persons from eligible households are identified proportionately to sampling
unit size. Sampling eligibility criteria were non-institutionalized men and women in
the 50 United States and District of Columbia between the ages of 15–44.
In-person interviews were conducted between September 2013 and September
2015. Interviewers were trained to conduct the NSFG survey and interviewed a
total of 10,205 people: 5699 women and 4,506 men. The response rate for female
respondents from the 2013–2015 NSFG survey was 71.2% (CDC 2016). For this
analysis, women who were not between the ages of 18 and 45 (n = 613), did not
report any form of current contraceptive use (n = 311), did not respond to the preg-
nancy timing question since they never had a live birth (n = 1927), and indicated “do
not know” or “refused” to the religious questions (n = 7) were excluded. Thus, 2841
participants remained for analysis.

Independent Variables

Women were asked questions related to religion and religiosity during the in-per-
son interview process. The independent variables examined were current religious
affiliation, frequency of service attendance, the religion in which the respondent was
raised, and self-reported importance of religion in daily life.
To assess current religious affiliation, women were asked, “What religion are
you now, if any?” Women could respond with a large number of responses cover-
ing many possible sects of religion. Given the small number of women who indi-
cated that they belonged to some of these religions, we chose to use a recoded vari-
able provided by the NSFG. This recoded variable further collapsed the responses
into None, Catholic, Protestant, and Other, with Other including all non-Catholic or
Protestant religions. This recoded variable has been used in other research related to
religion, current contraception, and unintended pregnancy (Kramer et al. 2007).

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The question regarding the frequency of service attendance was asked of all
respondents. The response options for this question were: more than once a week,
once a week, 2–3 times a month, once a month (about 12 times a year), 3–11 times a
year, once or twice a year, and never.
The question regarding the religion in which the respondent was raised was simi-
lar to the question regarding current religious affiliation. Although women were able
to choose from numerous responses covering many sects of religion, we decided to
create a variable that considered the same categories that we used for the current
religion question due to the fact that many of the categories had small sample sizes.
To assess the importance of religion, only individuals who reported a current
religious affiliation were asked “Currently, how important is religion in your daily
life?” The available responses to this question were (1) very important, (2) some-
what important, (3) not important, or (4) I don’t know. We created an additional
“not asked” category for the purposes of our analysis, and this category included the
women who were not asked the importance of religion in daily life question due to
the fact that they did not report a current religion.

Dependent Variable

The dependent variable examined in this study was mistimed pregnancy. During the
interview, participants were asked the following question about their most recent
pregnancy: “So, would you say you became pregnant too soon, at about the right
time, or later than you wanted?” Response options for this question were: right time,
too soon, and later. If a woman indicated that the pregnancy occurred “too soon,”
the pregnancy was considered to be mistimed.

Covariates

The following variables were considered to be potential confounders: educa-

tion level (some high school, high school graduate/GED, some college/associate’s
degree, bachelor’s degree, or more than a bachelor’s degree), type of contraception
currently used (sterilization, condoms, short-term, injectables, withdrawal, or other),
family income (less than $30,000 per year, $30,000–$50,000 per year, or more than
$50,000 per year), employment status (full time, part time, some of each, or miss-
ing), parity (no live births, 1–2 live births, or 3 or more live births), race/ethnicity
(Non-Hispanic black, Non-Hispanic white, Hispanic, or Non-Hispanic other/Multi-
ple races), marital status (never married, married, cohabitating or formerly married),
number of sexual partners (1, 2–3, 4–5, > 5, or missing), time since last pregnancy
(0–5 years, 6–10 years, or more than 10 years), and age (18–24 years, 25–29 years,
30–39 years, or > 40 years) (Santelli et al. 2003; Huber et al. 2013).

Statistical Analysis

Descriptive statistics, including frequencies and weighted percentages, were used

to describe the study population. Logistic regression was used to evaluate the

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association between religion and mistimed pregnancies and to confirm other risk
factors. Prior to constructing the final multivariate models, collinearity diagnostics
were used to assess whether any of the independent variables were highly corre-
lated with each other. No collinearity problems were identified. Multivariate logistic
regression was used to obtain adjusted odds ratios (ORs) and 95% confidence inter-
vals (CIs). If a potential confounding factor altered the magnitude of the exposure-
outcome association by at least 10%, it was considered to be a confounding fac-
tor (Maldonado and Greenland 1993). Lastly, we created multiplicative interaction
terms between education and current religious affiliation as well as frequency of ser-
vice attendance and current religious affiliation. Statistical significance was deter-
mined at p < 0.05 and all analyses were conducted using SAS-callable SUDAAN to
account for the complex sampling design used by NSFG.

Results

Table 1 shows the sample characteristics representing women who reported current
contraceptive use. Most of the women were between 30 and 39 years old (46.60%),
Non-Hispanic White (54.64%) and married (58.09%). Although similar percentages
of women were raised as Catholic (32.06%) and Protestant (35.09%), most women
currently identified as Protestant (50.49%). Nearly 50% of women said religion was
very important in their daily life and most women reported attending religious ser-
vices at least once per week (30.66%). About half of the women (47.30%) reported
that their most recent pregnancy was mistimed.
Women who were between 18 and 24 years had increased odds of mistimed preg-
nancy (OR = 1.74) while older women had decreased odds of mistimed pregnancy
(30–39 years OR = 0.54 and 40 and older OR = 0.56) as compared to women ages
25–29 years old, and these results were statistically significant (see Table 2). Minor-
ity women had statistically significant increased odds of mistimed pregnancy com-
pared to Non-Hispanic white women (Hispanic OR = 1.55 and Non-Hispanic Black
OR = 2.28). Furthermore, women who were cohabiting (OR = 2.62), never married
(OR = 5.27), and previously married (OR = 3.49) also had statistically significant
increased odds of having a mistimed pregnancy as compared to women who were
married. Women with higher educational attainment had decreased odds of mis-
timed pregnancy compared to women with a high school diploma or GED (bach-
elor’s degree OR = 0.48 and beyond bachelor’s degree OR = 0.25).
In the unadjusted analyses, women who reported their current religious affilia-
tion as Catholic or Other had statistically significant odds of mistimed pregnancy as
compared to women who reported not having a current religious affiliation (Catho-
lic OR = 1.89 and Other OR = 2.41). More frequent attendance at religious services
was associated with decreased odds of mistimed pregnancies compared to women
who never attended any religious services (2–3 times a month OR = 0.69). Addition-
ally, women who reported that religion was very or somewhat important in daily life
had nearly 1.5 times the odds of mistimed pregnancies (OR = 1.53 and OR = 1.57,
respectively) as compared to women who were not asked this question.

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Table 1  Social and demographic Variables n (%)

characteristics of women using
contraception, 2013–2015 Age
NSFG
18–24 380 (10.69)
25–29 572 (17.32)
30–39 1321 (46.60)
 ≥ 40 568 (25.39)
Race/ethnicity
Hispanic 744 (22.51)
Non-Hispanic White 1257 (54.64)
Non-Hispanic Black 567 (13.20)
Non-Hispanic Other/ Multiple Race 273 (9.64)
Marital Status
Married 1323 (58.09)
Cohabitating 483 (16.18)
Never married 654 (15.19)
Formerly married 381 (10.54)
Education
Some high school 451 (12.89)
High school diploma or GED 839 (26.20)
Some college/Associates degree 862 (29.02)
Bachelor’s degree 421 (19.44)
Education beyond bachelor’s degree 268 (12.45)
Income
 < $30,000 1316 (36.49)
$30,000–$59,999 695 (24.19)
60,000 830 (39.32)
Employment Status
Full time 1355 (51.56)
Part time 473 (16.11)
Some of each 296 (10.14)
Missing 717 (22.19)
Parity
0 296 (10.22)
1–2 1729 (61.16)
 ≥ 3 816 (28.62)
Number of sexual partners
1 525 (19.54)
2–3 605 (23.17)
4–5 578 (21.31)
 > 5 1104 (35.16)
Missing 29 (0.82)
Time Since Last Pregnancy
0–5 years 1361 (51.74)
6–10 years 707 (26.29)

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Table 1  (continued) Variables n (%)

More than 10 years 475 (21.96)

Types of Contraception
Sterilization 732 (27.67)
Condoms 281 (9.41)
Short term 293 (10.31)
Injectable contraception 436 (13.72)
Withdrawal 124 (4.35)
Other 979 (34.38)
Pregnancy Timing
Right time 1423 (52.70%)
Mistimed pregnancy 1418 (47.30%)
Current Religion
None 534 (18.47)
Catholic 636 (23.10)
Protestant 1453 (50.49)
Other 218 (7.94)
Religion Raised
None 295 (9.69)
Catholicism 902 (32.06)
Protestant 997 (35.09)
Other 647 (23.15)
Frequency of Service Attendance Now
Never 656 (22.49)
1–2 times a year 384 (13.98)
3–11 times a year 280 (11.17)
2–3 times a month 613 (21.26)
1 or more a week 908 (30.66)
Importance of Religion in Daily Life
Very important 1457 (49.54)
Somewhat important 738 (27.37)
Not important 112 (4.62)
Not asked 534 (18.47)

All religious independent variables-mistimed pregnancy models were ulti-

mately adjusted for race/ethnicity. After adjustment for race/ethnicity, the asso-
ciations between currently identifying as Catholic, Protestant, or Other affili-
ation and mistimed pregnancy increased in magnitude and results continued to
be statistically significant (Catholic OR = 2.31, Protestant OR = 1.41, and Other
OR = 2.58; Table 3). After adjustment for race/ethnicity, the association between
women who were raised as Catholic or Protestant and mistimed pregnancy
increased in magnitude and attained statistical significance (Catholic OR = 1.89
and Protestant OR = 1.57). Similarly, after adjustment for race/ethnicity, the

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Table 2  Unadjusted associations Variables Unadjusted OR (95% CI)

between select social and
demographic characteristics and Age
timing of pregnancy, 2013–2015
NSFG 18–24 1.74 (1.16–2.60)*
25–29 Reference
30–39 0.54 (0.39–0.73)*
 ≥ 40 0.56 (0.41–0.78)*
Race/ethnicity
Hispanic 1.55 (1.15–2.08)*
Non-Hispanic White Reference
Non-Hispanic Black 2.28 (1.70–3.06)*
Non-Hispanic Other/ Multiple Race 1.02 (0.63–1.67)
Marital Status
Married Reference
Cohabitating 2.62 (1.95–3.52)*
Never married 5.27 (4.02–6.91)*
Formerly married 3.49 (2.44–4.99)*
Education
Some high school 0.83 (0.54–1.27)
High school diploma or GED Reference
Some college/Associates degree 1.28 (0.94–1.75)
Bachelor’s degree 0.48 (0.30–0.79)*
Education beyond bachelor’s degree 0.25 (0.16–0.38)*
Income
 < $30,000 Reference
$30,000–$59,999 1.08 (0.83–1.41)
 ≥ $60,000 0.56 (0.41–0.76)*
Employment Status
Full time Reference
Part time 1.11 (0.82–1.52)
Some of each 0.89 (0.62–1.28)
Parity
0 2.96 (1.90–4.57)*
1–2 Reference
 ≥ 3 1.53 (1.15–2.05)*
Number of sexual partners
1 Reference
2–3 0.43 (0.27–0.66)*
4–5 0.35 (0.23–0.52)*
 > 5 0.16 (0.05–0.48)*
Time Since Last Pregnancy
0–5 years Reference
6–10 years 0.96 (0.73–1.25)
More than 10 years 0.64 (0.46–0.89)*

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Table 2  (continued) Variables Unadjusted OR (95% CI)

Types of Contraception
Sterilization 1.73 (1.15–2.61)*
Condoms Reference
Short term 2.08 (1.32–3.29)*
Injectable contraception 2.23 (1.46–3.41)*
Withdrawal 1.48 (0.72–3.03)
Other 1.53 (1.08–2.18)*
Current Religion
None Reference
Catholic 1.89 (1.26–2.84)*
Protestant 1.31 (1.00–1.71)
Other 2.41 (1.41–4.12)*
Religion Raised
None Reference
Catholicism 1.47 (1.00–2.16)
Protestant 1.39 (0.98–1.98)
Other 1.10 (0.75–1.62)
Frequency of Service Attendance Now
Never Reference
1–2 times a year 1.05 (0.71–1.55)
3–11 times a year 0.75 (0.53–1.05)
2–3 times a month 0.69 (0.50–0.95)*
1 or more a week 0.76 (0.57–1.01)
Importance of Religion in Daily Life
Very important 1.53 (1.12–2.10)*
Somewhat important 1.57 (1.17–2.10)*
Not important 1.36 (0.81–2.28)
Not asked Reference
*
 p < .05

association between frequency of service attendance and mistimed pregnancy

increased in magnitude for the most frequent attendance groups. Any attendance
was associated with decreased odds of mistimed pregnancy, and specially, women
who attended services 2–3 times a month or 1 or more per week had nearly 50%
decreased odds of mistimed pregnancy (OR = 0.54 and OR = 0.51, respectively).
Moreover, after adjustment for race/ethnicity, the association between the impor-
tance of religion in daily life and mistimed pregnancy increased in magnitude
for women who said religion was very important and remained unchanged for
women who said religion was somewhat important (OR = 1.82 and OR = 1.60,
respectively). Both findings remained statistically significant. The interaction
between current religious affiliation and education was not statistically signifi-
cant (p = 0.5939). However, the interaction between current religious affiliation

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Table 3  Adjusted association between religion and religiosity and timing of pregnancy, NSFG 2013–
2015
Variables Adjusted ­OR* (95% CI)

Model 1 Current Religion

None Reference
Catholic 2.31 (1.57–3.41)*
Protestant 1.41 (1.07–1.85)*
Other 2.58 (1.46–4.53)*
Model 2 Religion raised
None Reference
Catholicism 1.89 (1.27–2.82)*
Protestant 1.57 (1.11–2.24)*
Other 1.22 (0.82–1.82)
Model 3 Frequency of Service Attendance Now
Never Reference
1–2 times a year 0.73 (0.47–1.12)
3–11 times a year 0.87 (0.57–1.32)
2–3 times a month 0.54 (0.37–0.77)*
1 or more a week 0.51 (0.34–0.76)*
Model 4 Importance of Religion in Daily Life
Very important 1.82 (1.34–2.48)*
Somewhat important 1.60 (1.20–2.12)*
Not important 1.31 (0.78–2.20)
Not asked Reference

Each model was controlled for race/ethnicity

*
 p < .05

and frequency of service of attendance was statistically significant (β = − 0.1018,

p = 0.0474; data not shown in table).

Discussion

In this population-based study, women with a religious affiliation (current and/or

raised a religion) were more likely to consider a pregnancy mistimed as compared to
women with no religious affiliation. Furthermore, women who considered religion
to be very important or somewhat important had increased odds of mistimed preg-
nancy while women who reported more frequent religious service attendance had
decreased odds of mistimed pregnancy. Early systemic research surrounding religion
and pregnancy outcomes largely centered around denominational differences and/or
traditions (Perry and Schleifer 2018). However, recent research has demonstrated
that outcome variations are predicated on strength of religious commitment, sup-
planting earlier notions (Perry and Schleifer 2018). As such, we interpret religiosity

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as the salience of religion in daily life and the degree to which individuals adopt or
adhere to religious attitudes, values, or behaviors. Frequency of religious attendance
is one indicator commonly used for measuring religious behavioral patterns and the
finding in this analysis that frequent service attendance decreases the likelihood for
mistimed pregnancy suggests that service attendance level may serve as a protective
factor against mistimed pregnancy.
Protective factors are distinct constructs that can modify risk by influencing the
relationship between behaviors and risk factors (Hodge et al. 2001). Religious doc-
trine often emphasizes strengthening ones’ commitment to his or her faith and active
participation in religious activities is likely one pathway that acts as a protective
factor for mistimed pregnancy. The practice of attending religious services can cre-
ate a shared identity and a sense of community among frequent attenders in which
shared attitudes, beliefs, or religious teachings may counteract the perception that a
pregnancy occurred at the wrong time (Hodge et al. 2001). The association between
frequent religious service attendance and a decreased likelihood of mistimed preg-
nancy was statistically significant in both the adjusted and unadjusted models,
strengthening the notion that religious service attendance level is a protective factor
against mistimed pregnancy.
It is important to note that service attendance and importance of religion are
not perfectly correlated. Frequent service attendance and religiosity-level are not
mutually exclusive, and it is possible for women to consider themselves highly reli-
gious, but not engage in behaviors or practices typically associated with high levels
of religiosity (Hayford and Morgan 2008). This may explain why frequent service
attendance was protective for mistimed pregnancy while religious measures includ-
ing current religion, religion raised, and importance of religion in daily life were
associated with increased odds of mistimed pregnancy.
Research surrounding religion and pregnancy intention largely demonstrates that
religiously active women have comparatively lower proportions of unintended or
mistimed pregnancy than women for whom religion is a less important aspect of
daily life. Zhang (2008), Hayford and Morgan (2008) have reported such findings
for adult women and Quinn and Lewin (2019) reported similar findings for teen-
agers. However, one fundamental difference that may help to explain the findings
in previous research and the contrary conclusions drawn in this analysis may per-
tain to differences in eligibility criteria for the studies. The current study excluded
respondents who reported not using any form of contraception at the time of inter-
view to more accurately gauge pregnancy intention. As the outcome of interest was
mistimed pregnancy—or that a pregnancy was wanted, just not at the time of con-
ception—we included women who were sexually active and using contraception,
under the assumption that contraception use indicates an underlying desire to pre-
vent pregnancy. Previous studies have included all sexually active women regardless
of reported contraception use or non-use in their study populations. Additionally, it
is important to consider that previous studies by Zhang and Hayford and Morgan
used data from 2002 while the current study used data that were collected between
2013 and 2015.
Another essential difference that may expound the conclusions in this study
compared to those in previous research may be related to the recent decline of

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denominational importance among the American public. The Pew Research Center
reports that between 2007 and 2014, the percentage of the U.S. population identifying
as Christian declined from 78.4 to 70.6% (Cooperman et al. 2015). During the same
time period, the percentage of U.S. adults who identified as “unaffiliated” (i.e. atheist,
agnostic, or no religion in particular) increased from 16.1 to 22.8% (Cooperman et al.
2015). Furthermore, the Pew Research Center notes that generational replacement is
an important factor in the decline of Christianity and growth of “unaffiliated” individu-
als in the U.S. In particular, the millennial generation exhibits lower levels of religious
affiliation, including less connection with churches, than other generations (Cooperman
et al. 2015). Members of the millennial generation are now adults of reproductive age.
Thus, the apparent incongruent findings may also be related to shifting generation val-
ues and norms and our use of more recent data.
This study has several strengths and limitations. Information on religion, importance
of religion in daily life, frequency of service attendance, and childhood religious affili-
ation were self-reported by participants. Women may have misreported information or
provided answers about the importance of religion in their daily lives or frequency of
service attendance questions that they thought were more socially desirable responses.
Thus, misclassification of the exposure is possible. In addition, misclassification of
the outcome, mistimed pregnancy, may also have occurred. Mistimed pregnancy is an
example of an outcome of a sensitive nature. Therefore, it is possible that misclassifica-
tion of the outcome may have occurred because of a change in perspective regarding
the pregnancy following birth, despite it being mistimed.
While selection bias is possible, the 71.2% response rate of the NSFG makes it
highly unlikely. Similarly, while information bias is possible, it is unlikely since
NSFG interviewers were trained and given specific scripts. However, since this
study was limited to questions asked by the NSFG, the possibility of confounding
cannot be ruled out. Despite these limitations, the study did have strengths. One of
the key strengths of this study is the use of national-level data. The large study sam-
ple proportionately reflects the composition of the U.S., so as to be representative of
the national population. Thus, the results may be generalizable. However, given the
sparse literature on this topic, additional studies are needed to further examine the
potential association between religion and mistimed pregnancy. Specifically, a lon-
gitudinal study, would provide deeper insight into the role of religion on women’s
perspectives on pregnancy. Future studies could also identify potential exogeneous
variables that may impact the association between pregnancy intention and mis-
timed pregnancy that cannot be captured in the existing qualitative data. Addition-
ally, studies with sufficient numbers of women in the religious denominations that
could not be separated out in our study due to small numbers are needed to further
evaluate the association between religion and mistimed pregnancy.

Conclusions and Implications

This population-based study provides insight into the interrelationship of religion as

a sociocultural risk factor for mistimed pregnancy and found that while women who
reported greater religiosity had increased odds of mistimed pregnancy compared to

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 Review of Religious Research

women with low levels of religiosity, more frequent service attendance was a protec-
tive factor against mistimed pregnancy. As approximately half of all annual pregnan-
cies in the U.S. are unintended, additional studies are needed to better understand
cultural mechanisms that may be important risk factors for unintended or mistimed
pregnancy. Religion is one such cultural mechanism that is a significant cultural
force in the U.S. and the potential association between religion and mistimed preg-
nancy has not been well examined. Additional studies are needed to confirm the
findings in this study.

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Authors and Affiliations

Rachael Langley1 · Morium Bably1 · Ryan Siebens1   · Maria Diaz1 ·

Larissa Brunner Huber1

* Ryan Siebens
siebensrw@gmail.com
1
Department of Public Health Sciences, University of North Carolina at Charlotte, 9201
University City Blvd, Charlotte, NC 28223, USA

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