In 2020, the birth rate for adolescents ages 15-19 in the United States (US) was 15.4 per 1000 females,1 and 3 out of 4 of these pregnancies were categorized as unintended.2 The Centers for Disease Control defines unintended pregnancy as “a pregnancy that is either unwanted, such as the pregnancy occurred when no children or no more children were desired” or “mistimed, such as the pregnancy occurred earlier than desired”.3 Assessing parenting attitudes and reproductive desires is complex because pregnancy intentions are often not binary and attitudes towards pregnancy do not always match behaviors or intentions.4,5 Research in adolescents has found that unplanned pregnancies may be acceptable sometimes.6 However, unintended pregnancies are associated with numerous health risks, including lower preconception folic acid supplementation, increased prenatal tobacco exposure, increased risk for maternal postpartum depression, shorter duration of breastfeeding and later initiation of prenatal care.7,8

Reproductive desires are well studied in adult women, however there is a gap in knowledge regarding adolescents.6,9., 10., 11., 12 Sipsma et al. found that female adolescent pregnancy desire was associated with older age, relationship duration of <6 months, and greater perceived stress.13 Additionally, little is known about male adolescents’ reproductive desires.14

The Parenthood/Pregnancy Attitude, Timing and How important is pregnancy prevention (PATH) questions are a tool to assess parenting attitudes and reproductive desires and facilitate shared decision-making in a clinical setting. These are questions that are recommended by experts in the field to use in clinical practice; they are not a validated research framework.15., 16., 17., 18 Research on the PATH tool in women ages 18 to 45 demonstrated that women who indicated they never wanted to become pregnant, were ambivalent about pregnancy, or those who wanted to wait five or more years before pregnancy were more likely to choose long-acting reversible contraceptive (LARC) methods.19 That study also found that happiness about a hypothetical pregnancy was negatively associated with selection of LARC.19 While the PATH questions have been examined in adults, there are no published reports of using the PATH tool to assess adolescent parenting attitudes and reproductive desires. In the clinical setting, using a tool to assess parenting attitudes and reproductive desires among female and male adolescent and young adult (AYA) patients can facilitate shared decision-making during reproductive counseling. The primary aim of this project was to use a modified PATH questionnaire to evaluate parenting attitudes and reproductive desires in AYAs in our outpatient Adolescent Medicine clinic. Our secondary aim was to explore the relationships between the importance of preventing pregnancy and patient-level factors, including sexual activity and contraception use.