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This article presents information on unintended pregnancies and the ongoing efforts of policy makers to promote long-acting reversible contraception (LARC) to reduce the numbers of such pregnancies. Also discussed is the tension between the encouragement of LARC to promote the public's interests in achieving that goal versus the need to assure that all women can decide about their bodies and reproductive needs. Our discussion includes information, primarily from the United States, on (a) risks associated with unintended pregnancies, (b) LARC devices approved in the United States (copper intrauterine devices (IUDs), hormone IUDs, and implants), (c) public and social benefits of increasing the use of LARC, (d) disadvantages and barriers to using LARC, (e) dangers of promoting LARC in unjust ways, and (f) the meaning of reproductive justice and its connection to social justice. By sharing the information with the audience of this journal, we hope that it will be integrated into clinical work and research on mental health and development. We also hope that experts in those fields will become discussants in the conversation regarding women's reproductive health and social justice that is taking place in the United States and elsewhere.

Este artículo presenta información sobre embarazos no intencionales y el continuo esfuerzo de las autoridades para promover LARC (Contracepción Reversible de Larga Actuación) con el fin de reducir el número de tales embarazos. También se discute la tensión entre el aconsejar LARC para promover los intereses públicos de alcanzar esa meta vs. la necesidad de asegurar que todas las mujeres puedan ellas mismas decidir sobre sus cuerpos y necesidades reproductivas. Nuestra discusión incluye información, primariamente de los Estados Unidos (EUA), sobre: (1) riesgos asociados con embarazos no intencionales, (2) objetos de LARC aprobados en EUA (objetos intrauterinos de cobre -IUD-, IUD de hormonas, e implantes), (3) los beneficios públicos y sociales de aumentar el uso de LARC, (4) desventajas y barreras que presenta el uso de LARC, (5) peligros de promover LARC de maneras injustas, y (6) el significado de la justicia reproductiva y su conexión con la justicia social. Al compartir la información con el público de esta revista especializada, esperamos que la misma sea integrada dentro del trabajo clínico y la investigación sobre salud y desarrollo mental. También esperamos que los expertos en esos campos de estudio participarán activamente en la conversación acerca de la salud reproductiva de las mujeres y la justicia social que se lleva a cabo en EUA y otros lugares.

Cet article porte sur les grossesses involontaires et les efforts continus que font les responsables politiques pour promouvoir la contraception à long terme et réversible LARC (en anglais Long Acting Reversible Contraception) de façon à réduire le nombre de ces grossesses. Nous discutons aussi la tension entre l'encouragement de la LARC à promouvoir les intérêts publics pour arriver ce but et le besoin qui existe de s'assurer que toutes les femmes puissent décider d'elles-mêmes ce qu'elles veulent faire avec leur propre corps et leurs besoins sexuels. Notre discussion inclut des renseignements, principalement des Etats-Unis d'Amériques, sur: (1) les risques liés aux grossesses involontaires; (2) les dispositifs de contraception à long terme réversible approuvés aux Etats-Unis d'Amérique (dispositifs intra-utérins au cuivre (DIU), hormones DIU, et implants), (3) les avantages publics et sociaux qu'il y a à augmenter l'utilisation de la LARC, (4) les désavantages et les barrières à l'utilisation de la LARC, (5) les dangers de la promotion de la LARC de manières injustes, et (6) la signification de la justice reproductive et son lien à la justice sociale. En partageant ces informations avec les lecteurs de cette revue, nous espérons qu'elles seront intégrées dans le travail clinique et les recherches sur la santé mentale et le développement. Nous espérons aussi que les experts dans ces domaines pourront ainsi intervenir dans la conversation qui concerne la santé reproductive des femmes et la justice sociale qui se tient aux Etats-Unis et ailleurs.

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Medically high-risk pregnancy (MHRP) affects 3 to 10% (diagnosis-dependent) of pregnant women in the United States (National Institute of Child Health Development, 2015), threatening maternal and fetal well-being. Although mothers' prenatal distress and mother-infant attachment after birth have been quantitatively researched, little research has examined women's lived experiences of MHRP in the United States. We examined 16 women's experiences of MHRP during hospitalization at an urban, Northeastern U.S. hospital using an interpretive phenomenological approach. Our qualitative findings provide new understanding of how women expend tremendous energy simultaneously navigating new roles of mother and patient. While negotiating these roles, they experienced dialectical struggles and uncertainty relating to emotion management, locus of control, appraisals of self/others, and relational self. Women managed these conflicts within the contexts of their emerging maternal identity, patient-provider relationships, and social relationships. Women struggled as they managed emotion, determined their level of responsibility for fetal outcomes, appraised others and themselves, and worried about how they were perceived. This amplified distress and contributed to women's emotional exhaustion, sense of being overwhelmed, and stress burden. New explication of these energy-depleting dynamic processes underlying women's experiences of MHRP and their impact on the future mother-infant relationship is considered, and strategies for psychosocial support are identified.

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Recollections of own maternal care measured by parental bonding were found to be important in the pregnant woman's construction of herself as a mother. Although these recollections were studied with regard to various variables, there is a dearth of studies associated with pregnancy and childbirth. In this cross-sectional study, 341 pregnant women were recruited. Measures included a Sociodemographics-Obstetric History Questionnaire; the Childbirth Choices Questionnaire (H. Preis, M. Gozlan, U. Dan, & Y. Benyamini, 2018); the Parental Bonding Instrument (G. Parker, H. Tupling, & L.B. Brown, 1979); a question regarding the planned presence of the woman's mother at delivery; and the Maternal-Fetal Attachment Scale (M.S. Cranley, 1981). Parental recollections of Care were associated with fewer natural birth choices (hence, a more "medicalized" delivery), lower maternal-fetal attachment, and a wish for the mother's mother to be present at the birth. Parental recollections of Encouragement of Behavioral Freedom in childhood were associated with more natural choices regarding childbirth. In addition, women with higher scores on the parental bonding Denial of Autonomy factor reported stronger maternal-fetal attachment. Thus, early recollections of experiences with caregivers as manifested in parental bonding may be a possible influence on the transition to motherhood, and working through possible difficulties associated with these recollections may improve adjustment to motherhood.

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Parents' representations of their infants consist of parents' subjective experiences of how they perceive their infants. They provide important information about the quality of the parent-infant relationship and are closely related to parenting behavior and infant attachment. Previous studies have shown that parents' representations emerge during pregnancy. However, little is known about prenatal (risk) factors that are related to parents' representations. In a prospective study, 308 mothers and 243 fathers were followed during pregnancy and postpartum. Prenatal risk factors were assessed with an adapted version of the Dunedin Family Services Indicator (T.G. Egan et al., ; R.C. Muir et al., ). At 26 weeks' gestation and 6 months' postpartum, parents' representations of their children were assessed with the Working Model of the Child Interview (C.H. Zeanah, D. Benoit, L. Hirshberg, M.L. Barton, & C. Regan). Results showed stability between pre- and postnatal representations, with fathers having more disengaged representations than did mothers. In addition, prenatal risk factors of parenting problems were associated with the quality of parents' prenatal (only in mothers) and postnatal representations. This study provides valuable information concerning parents at risk of developing nonbalanced representations of their children. In clinical practice, these families could be monitored more intensively and may be supported in developing a more optimal parent-infant relationship.

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Research has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self- reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions--wanting to comfort, wanting to turn away, and feelings of anxiety--using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63-10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09-0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.

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