This page provides methodological information relating to the LMUP. It lists publications that relate to the original development study, to the evaluation of the LMUP in new contexts, and/or provide insights into the performance of the LMUP as a psychometric measure.

Key publications from the original LMUP development and evaluation study

Barrett G, and Wellings K. 2002 What is a “planned” pregnancy? Empirical data from a British study Social Science and Medicine 55; 545-557 Abstract Abstract and full text

Barrett G, Smith SC, Wellings K. 2004 Conceptualisation, development and evaluation of a measure of unplanned pregnancy Journal of Epidemiology and Community Health 58:426-433 Abstract Full text

See all publications from the LMUP development and evaluation study

The UK LMUP - updates

Barrett G, Nolan EM, Gürtin ZB, Stephenson J, Hall JA. 2020 London Measure of Unplanned Pregnancy and newer family forms: an update Journal of Epidemiology and Community Health Abstract Full text Further information

Publications evaluating the measurement properties of the LMUP in translation and/or new populations

Rocca CH, Krishnan S, Barrett G, and Wilson M. 2010 Measuring pregnancy planning: an assessment of the London Measure of Unplanned Pregnancy among urban, south Indian women. Demographic Research 23(11):293-334 Abstract and full pdf Further Information

Morof D, Steinauer J, Haider S, Liu S, Darney P, Barrett G. 2009 Evaluation of the reliability and validity of the London Measure of Unplanned Pregnancy in a U.S. population of women. International Journal of Gynecology and Obstetrics Vol.107 Supplement 2 p.S275 journal page Further Information

Morof D, Steinauer J, Haider S, Liu S, Darney P, Barrett G. 2012 Evaluation of the London Measure of Unplanned Pregnancy in the a United States population of women. PloS One 7(4) Article number e35381 Abstract and full pdf Further Information

Hall J, Barrett G, Mbwana N, Copas A, Malata A, Stephenson J. 2013 Understanding pregnancy planning in a low-income country setting: validation of the London measure of unplanned pregnancy in Malawi BMC Pregnancy and Childbirth 13:200 Abstract and full pdf Further Information

Roshanaei S, Shaghaghi A, Jafarabadi MA, and Kousha A. 2015 Measuring unintended pregnancies in postpartum Iranian women: validation of the London Measure of Unplanned Pregnancy Eastern Mediterranean Health Journal 21(8):572-578 Abstract and full text Further information

Borges ALV, Barrett G, dos Santos OA, Nascimento NC, Cavalhieri FB, Fujimori E. 2016 Evaluation of the psychometric properties of the London Measure of Unplanned Pregnancy in Brazilian Portuguese BMC Pregnancy and Childbirth 16:244 Abstract and full pdf Further information

Habib MA, Raynes-Greenow C, Nausheen S, Soofi SB, Sajid M, Bhutta ZA, Black K. 2017 Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan BMC Pregnancy and Childbirth 17:156 Abstract and full pdf Further information

Almaghaslah E, Rochat R, Farhat G. 2017 Validation of a pregnancy planning measure for Arabic-speaking women PloS ONE 12(10): e0185433 Abstract and full pdf Further information

Goossens J, Verhaeghe S, Van Hecke A, Barrett G, Delbaere I, Beeckman D. 2018 Psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth PloS ONE 13(4): e0194033 Abstract and full pdf   Further information

Yeatman S, Smith-Greenaway E. 2018 Birth planning and women's and men's health in Malawi Studies in Family Planning 43;3:213-235 Abstract

Lang AY, Hall JA, Harrison CL, Teede H, Moran LJ, Barrett G. 2019 Validation of the London Measure of Unplanned Pregnancy among pregnant Australian women PLoS ONE 14(8): e0220774 Abstract and full text Further information

Bukenya JN, Nalwadda CK, Neema S, Kyambadde P, Wanyenze RK, Barrett G. 2019 Pregnancy planning among female sex workers: evaluation of the psychometric properties of the London Measure of Unplanned Pregnancy African Journal of Reproductive Health 23;3:79-95 Abstract and full pdf Further information

Brima N, Samba TT, Yamba A, Barrett G, Stephenson J, Hall J. 2019 Evaluation of the Krio language version of the London Measure of Unplanned Pregnancy in Western Area, Sierra Leone African Journal of Reproductive Health 23(4):81-91 Abstract and full pdf

Ranatunga IDJC, Jayaratne K. 2020 Proportion of unplanned pregnancies, their determinants and health outcomes of women delivering at a teaching hospital in Sri Lanka BMC Pregnancy and Childbirth 20:667 Abstract and full pdf

Altiparmak S, Yilmaz AN, Derya YA. 2021 The Turkish validity and reliability study of the London Measure of Unplanned Pregnancy Journal of Obstetrics and Gynaecology Research 47;4:1362-1370 Abstract Further Information

Hall JA, Stephenson J, Barrett G, 2021 Evaluating the Chichewa version of the London Measure of Unplanned Pregnancy in Malawi: a validation update BMC Research Notes 14:231 Abstract and full pdf Further Information

Das S, Hall J, Barrett G, Osrin D, Kapadia S, Jayaraman A. 2021 Evaluation of the Hindi version of the London Measure of Unplanned Pregnancy among pregnant and postnatal women in urban India BMC Pregnancy and Childbirth 21:602 Abstract and full pdf Further Information

Muleva BR, Borges ALV, Hall JA, Barrett G. 2022 Evaluation of the Portuguese version of the London Measure of Unplanned Pregnancy in Mozambique: a psychometric measurement study African Journal of Reproductive Health 26;2:47-57 Abstract and full pdf Further Information

Olani AB, Bekelcho T, Woldemeskel A, Tefera K, Eyob D. 2022 Evaluation of the Amharic version of the London Measure of Unplanned Pregnancy in Ethiopia PloS ONE 17(6): e0269781 Abstract and full pdf Further Information

Karp C, Moreau C, Shiferaw S, Seme A, Yihdego M, Zimmerman LA. 2023 Evaluation of the London Measure of Unplanned Pregnancy (LMUP) among a nationally representative sample of pregnant and postpartum women Ethiopia Contraception X 5:100094 Abstract and full pdf

Barrett G, Borges ALV, Bukenya JN, Olani AB, Hall JA. 2023 Evaluation of the LMUP in Ethiopia: Requirements, challenges and best practice Contraception X 5:100097 Full text and pdf

For evaluations of the LMUP currently underway but as yet unpublished, please see the LMUP Versions

For evaluations of the LMUP for partners, please see Partners

Recommendations for analysis using the LMUP

Hall JA, Barrett G, Copas A, Stephenson J. 2017 London Measure of Unplanned Pregnancy: guidance for its use as an outcome measure Patient Related Outcome Measures 8:43-56 Abstract and full pdf

Comparing the LMUP with other ways of assessing pregnancy planning/intention

LMUP versus a single question

There have been various instances where the LMUP has been compared to a single question that asks about pregnancy planning:

The LMUP was compared to the single question, “Was your pregnancy planned?” among a small sample of teenagers who were surveyed as part of the Evaluation of the Teenage Pregnancy Strategy. This analysis is reported in Geraldine Barrett’s PhD:

Barrett G. 2002 Developing a measure of unplanned pregnancy. London School of Hygiene and Tropical Medicine, University of London. PhD Thesis. (PhD, see pages 280-2)

The LMUP was compared to the single question, “Did you plan on becoming pregnant now?” in an analysis by Aiken et al in 2016. Barrett et al commented on the analysis in 2017:

Aiken ARA, Westhoff CL, Trussell J, Castano PM. 2016 Comparison of a timing-based measure of unintended pregnancy and the London Measure of Unplanned Pregnancy Perspectives on Sexual and Reproductive Health 48;3:139-146 Abstract

Barrett G, Hall JA, Stephenson J. 2017 Measuring unintended pregnancy: the complexity of comparison Perspectives on Sexual and Reproductive Health 49;1:69-70 Letter Full text

The LMUP in Swedish was compared to the single question, “How planned was your current pregnancy?” in an analysis by Drevin et al in 2017. Barrett et al commented on the analysis in 2018:

Drevin J, Kristiansson P, Stern J, Rosenblad A. 2017 Measuring pregnancy planning: a psychometric evaluation comparison of two scales. Journal of Advanced Nursing 73:2765-2775 Abstract

Barrett G, Hall JA, Borges ALV, Rocca C, Almaghaslah E, Stephenson J. 2018 Commentary on Drevin et al. (2017) Measuring pregnancy planning: a psychometric evaluation comparison of two scales. JAN Interactive Commentary

LMUP and the Demographic and Health Surveys

Comparison of the LMUP with the DHS (Demographic and Health Surveys) question on pregnancy intention can be found below. The LMUP outperforms the DHS in terms of stability/reliability:

Hall JA, Stephenson J, Barrett G. 2019 On the stability of reported pregnancy intentions from pregnancy to 1 year postnatally: impact of choice of measure, timing of assessment, women's characteristics and outcome of pregnancy. Maternal and Child Health Journal 23:1177-1186 Abstract and full pdf

Hall J, Stephenson J, Barrett G. 2018 Comparing the order of the London Measure of Unplanned Pregnancy and the Demographic and Health Survey question on pregnancy intention in a single group of postnatal women in Malawi ‐ the effect of question order on assessment of pregnancy intention BMC Research Notes 11:487 Abstract and full pdf

Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. 2018 Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health Lancet 391(10132):1830-41 Abstract and full pdf

Further analyses comparing the LMUP to the DHS and NSFG questions are currently being carried out.

Stability over time in reporting pregnancy intention: LMUP data

The stability of women's reports of pregnancy over time (i.e. the further away they get from conception) has been investigated in the past with other ways of measuring pregnancy intention. The contributions of LMUP data to this question are listed here:

Markowitz MA, Lundsberg LS, Gariepy AM. 2024 A multidimensional and longitudinal exploratory study of the stability of pregnancy contexts in the United States Women's Health Reports 5;1 Abstract and full pdf

Chamberlin S, Njerenga S, Smith-Greenaway E, Yeatman S. 2022 Women's life experiences and shifting reports of pregnancy planning Maternal and Child Health Journal 26:1719-1726 Abstract
(This is an insightful qualitative paper, which selected women according to their original LMUP scores, and then interviewed them three years later, assessing how their answers had changed on selected LMUP questions, with an exploration of their life experiences since their baby.)

Hall JA, Stephenson J, Barrett G. 2019 On the stability of reported pregnancy intentions from pregnancy to 1 year postnatally: impact of choice of measure, timing of assessment, women's characteristics and outcome of pregnancy. Maternal and Child Health Journal 23:1177-1186 Abstract and full pdf

Rocca CH, Wilson MR, Jeon M, Foster DG. 2019 Stability of retrospective pregnancy intention reporting among women with unwanted pregnancies in the United States Maternal and Child Health Journal Maternal and Child Health Journal 23:1547-1555 Abstract

Ralph L, Greene Foster D, Rocca C. 2018 Comparing prospective versus retrospective pregnancy intention reporting on incident pregnancies in a longitudinal study of U.S. women Population Association of America Annual Meeting, Denver, April 2018 Abstract

Rocca C, Foster D. 2016 Changes over time in retrospective reporting of pregnancy intentions among women who sought an abortion in the United States Population Association of America Annual Meeting, Washington D.C. April 2016 Abstract

Rocca CH, Krishnan S, Barrett G, and Wilson M. 2010 Measuring pregnancy planning: an assessment of the London Measure of Unplanned Pregnancy among urban, south Indian women. Demographic Research 23(11):293-334 Abstract and full pdf
Further Information
In the sections on reliability, Rocca et al report their findings from a repeated measures design to compare LMUP scores one year apart among: a) women who were pregnant at time 1 and postnatal at time 2; and b) women who were reporting on a prior pregnancy at time 1 and reporting on the same pregnancy at time 2.

Barrett G, Smith SC, Wellings K. 2004 Conceptualisation, development and evaluation of a measure of unplanned pregnancy Journal of Epidemiology and Community Health 58:426-433 Abstract Full text Abstract and full pdf
In the “long term test-retest” section, Barrett et al report their findings of repeated measures design to compare LMUP score in pregnancy with the score after birth, with up to 10 months between LMUP completions.

Publications that provide insight into the validity of the LMUP

Insights can be gained into the validity (in particular the "construct validity") of a measure from its use in research studies. The following studies (incidentally) provide information about the performance of the LMUP in relation to the construct of pregnancy planning/intention.

Rocca CH, Kimport K, Gould H, Foster DG. 2013 Women's Emotions One Week After Receiving or Being Denied an Abortion in the United States. Perspectives on Sexual and Reproductive Health 45:122–131. Abstract
This is an extremely interesting paper. In relation to the LMUP it shows that women with higher LMUP scores who go on to have an abortion experience more negative emotions one week post-abortion. This finding makes sense. In terms of the performance of the LMUP, it suggests that LMUP scores are providing a fairly high degree of discrimination of the construct of pregnancy planning/intention, particularly in the lower/mid range.

Cameron ST, Glasier A. 2013 Identifying women in need of further discussion about the decision to have an abortion and eventual outcome Contraception 88;1:128-132. Abstract
This is also an interesting paper. It shows that, at a group level, LMUP scores are associated with the likelihood of abortion (lower scores mean abortion is more likely; higher scores mean abortion less likely) in a fairly homogeneous group (i.e. women attending a clinic for assessment for abortion). The strength of this study is the separation in time between completion of the LMUP (at clinic assessment for abortion) and the outcome (whether the woman had an abortion).

Recommendations for use of the LMUP

The LMUP is recommended as an outcome measure in relation to preconception care in the U.S. and U.K.:

Stephenson J, Vogel C, Hall J, Hutchinson J, Mann S, Duncan H, Woods-Townsend K, de Lusignan S, Poston L, Cade J, Godfrey K, Hanson M, Barrett G, Barker M, Conti G, Shannon G, Colbourn T, for the Preconception Partnership. 2019 Preconception health in England: a proposal for annual reporting with core metrics. Lancet 393(10187): 2262-2271. doi:10.1016/S0140-6736(19)30954-7 Abstract

Frayne et al. 2016 Health care system measures to advance preconception wellness: Consensus recommendations of the clinical workgroup of the National Preconception Health and Health Care Initiative Obstetrics and Gynecology 127(5):863-872 Abstract and full text

The LMUP is recommended for national surveys to allow comparisons of rates of unintended births:

ESHRE Capri Workshop Group 2014 Simultaneous prevention of unintended pregnancy and STIs: a challenging compromise Human Reproduction Update 20(6):952-963 Abstract and full text “planned”

In the UK, the All Party Parliamentary Group on Sexual and Reproductive Health recommended, in the 2020 “Women’s Lives, Women’s Rights: Strengthening Access to Contraception Beyond the Pandemic” report, routine data collection using the LMUP:

“Recommendation: To provide a better outcome indicator for all ages, the London Measure of Unplanned Pregnancy should be adopted as primary data standard, collected at front line by maternity, early pregnancy and abortion services. The data should subsequently be utilised as part of the Public Health Outcomes Framework.”

In the UK in 2022, the Faculty of Sexual and Reproductive Health published the FSRH Hatfield Vision: A Framework to Improve Women and Girls' Reproductive Health Outcomes. Action 8 of the Hatfield Vision relates to the LMUP:

Action 8: The London Measure of Unplanned Pregnancy is introduced as the standard national measure of unplanned pregnancy.

The Vision Task force was set up in 2023 in order to drive forward the goals of the The FRSH Hatfield Vision.

NHS

The LMUP is listed in the National Clinical Content Repository of the NHS (scroll down to the LMUP)

The LMUP in Clinical Care

Using the LMUP within clinical care and services is being explored or implemented in the UK and Australia:

Hall J, Stewart C, Stoneman B, Bicknell T, Duncan H, Stephenson J, Barrett G. 2024 Implementation of the London Measure of Unplanned Pregnancy in routine antenatal care: a mixed-methods evaluation in three London NHS Trusts European Journal of Midwifery 8:26 Abstract and full pdf

Black KI, Dorney E, Hall JA, Pelosi M, Khan SA, Cheney K. 2023 Using a validated instrument to assess pregnancy planning and preconception care at antenatal booking visits: a retrospective cohort study Medical Journal of Australia 219;8:366-370 Abstract and full pdf

Cheney K, Black K, Pelosi M, Dorney E. 2023 Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives' perspective BMJ Sexual and Reproductive Health 49:112-117 Abstract

Black K, Dorney E, Pelosi M, Khan S, Cheney K. 2022 Introduction of the London Measure of Unplanned Pregnancy at the booking visit Women and Birth 35;Supplement 1:7-8 Abstract

Narayanan N, Reynolds-Wright JJ, Cameron ST. 2022 Views of clinicians towards providing contraceptive advice and contraception to women following early pregnancy loss: a qualitative study BMJ Sexual and Reproductive Health 48;4:281-287 Abstract