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. 2024 Jun 3:8.
doi: 10.18332/ejm/188118. eCollection 2024.

Implementation of the London Measure of Unplanned Pregnancy in routine antenatal care: A mixed-methods evaluation in three London NHS Trusts

Jennifer A Hall  1 , Catherine Stewart  1 , Bryony Stoneman  2 , Tamsin Bicknell  3 , Holly Lovell  4   5 , Helen Duncan  6 , Judith Stephenson  1 , Geraldine Barrett  1
Affiliations

Implementation of the London Measure of Unplanned Pregnancy in routine antenatal care: A mixed-methods evaluation in three London NHS Trusts

Jennifer A Hall et al. Eur J Midwifery. .

Abstract

Introduction: Unplanned pregnancies are associated with increased risks. Despite this, they are currently not routinely detected during antenatal care. This study evaluates the implementation of the London Measure of Unplanned Pregnancy (LMUP) - a validated measure of pregnancy planning - into antenatal care at University College London Hospital, Homerton Hospital, and St Thomas' Hospital, England, 2019-2023.

Methods: We conducted a mixed methods evaluation of the pilot. Uptake and acceptability were measured using anonymized data with non-completion of the LMUP as a proxy measure of acceptability overall. We conducted focus groups with midwives, and one-to-one interviews with women, to explore their thoughts of asking, or being asked the LMUP, which we analyzed with a Framework Analysis.

Results: Asking the LMUP at antenatal appointments is feasible and acceptable to women and midwives, and the LMUP performed as expected. Advantages of asking the LMUP, highlighted by participants, include providing additional support and personalizing care. Midwives' concerns about judgment were unsubstantiated; women with unplanned pregnancies valued such discussions.

Conclusions: These findings support the implementation of the LMUP in routine antenatal care and show how it can provide valuable insights into the circumstances of women's pregnancies. This can be used to help midwives personalize care, and potentially reduce adverse outcomes and subsequent unplanned pregnancy. Integration of the LMUP into the Maternity Services Data Set will establish national data collection of a validated measure of unplanned pregnancy and enable analysis of the prevalence, factors, and implications of unplanned pregnancies across subpopulations and over time to inform implementation.

Keywords: London Measure of Unplanned Pregnancy; evaluation; implementation; surveillance; unplanned pregnancy.

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Conflict of interest statement

The authors have each completed and submitted an ICMJE form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. J. Hall and C. Stewart report that Dama Health made payments to their institution for research consultancy relating to contraception research. H. Duncan reports that she has a leadership/fiduciary role in the coalition of academic experts and public health professionals of the UK Preconception Partnership and in the Ministerial taskforce for supporting with evidence and data from a civil service perspective of the Maternity Disparities Taskforce. She also reports substantive employment in The Office for Health Improvement and Disparities at the Department of Health and Social Care. J. Hall reports that travel and accommodation costs to attend an Annual Scientific Meeting in June 2023, were covered by the Faculty of Sexual and Reproductive Health; the NIHR Advanced Fellowship funds her salary and this research; she participates in the Data Safety Monitoring Board of ALERT; and she is a member without payment of the NHS England Maternity Transformation Programme, Public Health and Prevention Advisory Group and the Faculty of Sexual and Reproductive Health Research Group. H. Lovell reports that she has received a personal research development award from the NIHR Doctoral Clinical Academic Research Fellowship (Grant number 302860).

Figures

Figure 1
Figure 1
Themes and sub-themes identified within the overall framework of individual, organizational and external factors, from pregnant women and midwives interviewed in 2022 at University College London Hospital and Homerton Hospital, and in 2023 in St Thomas’ Hospital
See this image and copyright information in PMC

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