Lived experiences of contraceptive use prior to unexpected pregnancy: Narrative insights from the Netherlands

Unexpected pregnancies occur everywhere, also in contexts where contraceptive care is accessible. Research has found that contraceptive behavior extends beyond rational decision-making and is shaped by a range of personal, relational, and social factors. So far, little is known about peoples lived experiences with contraception prior to an unexpected pregnancy, particularly among adults and men in settings with accessible contraceptive care. This study therefore explores the lived experiences of adult womxn and mxn who recently experienced an unexpected pregnancy, focusing on their contraceptive behaviors before conception in the Netherlands. We analyzed 55 narrative interviews and integrated these findings with open-ended survey responses from the Dutch BluePrInt study (n = 364) to capture the complexity of people’s experiences. Participants reported inconsistent contraceptive use in the period preceding the unexpected pregnancy. Four key themes emerged: negative experiences with contraception, perspectives on fertility, confidence in contraception, and communication between partners. In addition, participants’ language use pointed to the presence of underlying narrative patterns concerning shame, imbalanced gendered responsibility, sexual pleasure, and decisional inertia. Results underscore the need for personalized contraceptive counseling and follow-up that centers lived experiences, embraces shared decision-making, and adapts to life course changes. • Inconsistent contraceptive use often preceded unexpected pregnancies (UP) • Negative experiences shaped inconsistent or absent contraceptive use prior UP • Pregnancy risks of contraception and fertility in general were often underestimated • Lack of partner communication contributed to failed/inconsistent contraceptive use • Shame, gender norms, sexual pleasure and decision inertia were underlying patterns