“If I know I am on the pill and I get pregnant, it’s an act of God”: women’s views on fatalism, agency and pregnancy

OBJECTIVES: Fatalism is the idea that outside forces have control over events. Pregnancy and pregnancy prevention play a prominent role in many women’s lives, and we sought to understand if and how fatalism informed their thinking about these issues. STUDY DESIGN: We conducted in-depth interviews with 52 unmarried women between the ages of 18 and 30. We used NVivo to analyze the transcripts. The current analysis focuses on the ways that women discussed fatalism and pregnancy both in response to a direct question and as it came up spontaneously. RESULTS: The majority of respondents expressed a mix of fatalistic and non-fatalistic views about pregnancy. Many related that “fate,” “destiny” and/or God play a role in pregnancy, but most also asserted that pregnancy risk could be substantially reduced, most commonly by using contraception. Fatalism sometimes served a positive function, for example as a mechanism to deal with an unintended pregnancy. Having a fatalistic outlook did not preclude contraceptive use. Rather, some women using highly effective methods related that if they were to become pregnant, they would interpret it as a sign that the pregnancy was “meant to happen.” Finally some women related that there was no guarantee a woman could get pregnant when she wanted to, suggesting that some degree of fatalism may be inevitable when it comes to pregnancy. CONCLUSIONS: Fatalism and agency should not be viewed as opposing outlooks when it comes to pregnancy and pregnancy prevention; having fatalistic views about pregnancy does not preclude contraceptive use. IMPLICATIONS: Given that women do not have total control over attainment of a wanted pregnancy or even prevention of pregnancy, some amount of fatalism about fertility is a logical and pragmatic response. Both research and clinical practice need to recognize that fatalism and contraceptive use are often not in conflict.