Capturing pregnancy recognition trajectories: a critical reflection of new quantitative measures tested in Ethiopia, Malawi, Nigeria and Zambia.

The experiences and timings of pregnancy recognition trajectories have significant impacts on pregnancy-related care. Understanding individuals' contextually informed trajectories is crucial to their reproductive rights and service delivery needs. While many studies take pregnancy recognition as a starting point, capturing the complexities and nuances of these trajectories has received much less attention. This paper critically reflects on new approaches to capturing pregnancy recognition trajectories in two studies conducted between 2018 and 19, one in Nigeria with women aged 18 and over ( = 394), and a three-country study with adolescents aged 10-19 in Ethiopia, Malawi, and Zambia ( = 313). Pregnancy recognition trajectories were complex and involved multiple physical, material, and psychological recognition factors. Adolescents in the three-country study cited predominantly between two and four factors that led to their pregnancy recognition, with a range of one to seven factors. In the Nigerian study, 43.4% of respondents named two factors that led them to recognise they were pregnant, with a range of one to five factors. As pregnancy recognition is the starting point for many public health actions and interventions, it is imperative that future survey tools better capture this complex and poorly understood process. Our analyses suggest that questions should include response categories that capture physical, material, and psychological contributors to pregnancy recognition, including open-ended responses to capture heretofore unidentified aspects of this process. Questions on the duration of time between recognition factors would be beneficial, as well as an understanding of what factors were most important to an individual when recognising a pregnancy.