Why do some women fear becoming pregnant? Tokophobia explained

Woman worried holding a pregnancy test with man's hand on her shoulder.
Tokophobia is an intense fear of pregnancy and childbirth. (Getty Images)

Social media is already flooded with comments from women who say they're scared of getting pregnant now that the Supreme Court overturned Roe v. Wade, the landmark legislation that guaranteed women the right to an abortion on a federal level. But while some have expressed fears about an unintended pregnancy or what they would do if they happened to have a complicated pregnancy, there is an actual phobia people can experience around pregnancy. It's called tokophobia and, while it's rare, it can be scary to experience.

Tokophobia is an intense fear of pregnancy — more specifically, it's an overwhelming, debilitating phobia of childbirth, according to the BMJ. Researchers estimate that about 0.032% of the population experiences this.

This pathological fear of pregnancy can lead to someone going to sometimes extreme measures to avoid becoming pregnant. People with tokophobia may have never experienced pregnancy or may have had a traumatic event during a previous pregnancy that led to the phobia.

According to the Cleveland Clinic, symptoms of tokophobia can include:

  • Avoiding sexual intercourse

  • Not feeling emotionally connected to your unborn child

  • Not feeling excited about pregnancy

  • Trying to hide the fact that you’re pregnant

  • Feeling disconnected from your partner or loved ones

People with tokophobia are also more likely to choose a cesarean section if they become pregnant, seek an abortion if they become pregnant or put their baby up for adoption, according to the Cleveland Clinic.

While it's normal to have some concerns about pregnancy, people with tokophobia "present with severe distress and avoidant thoughts and behaviors, to an extent that extends beyond what can be considered a normal reaction," Dr. Misty Richards, a psychiatrist who specializes in perinatal mental health at UCLA Health, tells Yahoo Life.

If you're feeling nervous about pregnancy right now, it's understandable to have questions about tokophobia and whether your fears may be classified as an actual phobia. Here's what you need to know.

Where does the fear of pregnancy come from?

Two main precursors lead to the development of an extreme fear of pregnancy, Sandy Capaldi, an assistant professor of clinical psychiatry and director of implementation at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania, tells Yahoo Life. "The first is the presence of other fears or phobias that are functionally related to pregnancy or childbirth, such as extreme fear of gaining weight or extreme fear of needles," she says. "In these cases, one might be afraid of becoming pregnant because it could lead to these other fears. Pregnant women often gain weight or need to have blood drawn, so a fear of becoming pregnant may develop if a person has another existing related fear." A history of sexual abuse or rape could also feed into this fear, Capaldi says.

The second major cause is related to traumatic experiences someone may have had during pregnancy or childbirth. "This type of fear of pregnancy is usually just one of many reactions to pregnancy- or childbirth-related traumas, which can include posttraumatic stress disorder and mood disorders," Capaldi says. For these people, "being back in the same environment can be very triggering," Dr. Tamar Gur, a women's health expert and reproductive psychiatrist at the Ohio State University Wexner Medical Center, tells Yahoo Life. And she adds, "It's not uncommon to see fear of pregnancy in those situations."

Are certain people more likely to develop tokophobia?

People who have "high levels of anxiety" are more likely to develop tokophobia, Thea Gallagher, a clinical assistant professor at NYU Langone Health and co-host of the Mind in View podcast, tells Yahoo Life. "Anxiety can lily-pad and jump from one thing to the next," she explains.

Cleveland Clinic says people with the following phobias may also be more likely to develop tokophobia:

  • Algophobia: fear of pain

  • Haphephobia: fear of being touched

  • Iatrophobia: fear of doctors

  • Nosocomephobia: fear of hospitals

  • Obesophobia: fear of gaining weight

  • Pedophobia: fear of children

  • Thanatophobia: fear of dying

  • Trypanophobia: fear of needles

"I would be surprised if someone had a pregnancy phobia isolated from other anxieties, unless they had seen something traumatic as a child," Gallagher says.

How to tell if you have tokophobia

Again, tokophobia is different from being nervous about being pregnant or giving birth. Still, "it can be very difficult" to draw the line between tokophobia and normal fears because "there's not a great textbook definition" for it, Gur says. "If you know that one of your pregnancies ended in miscarriage, it's understandable to have anxiety when you're spotting," she says. "But if you're finding that it changes the management of your life — you don't want to become pregnant despite wanting a child or you're ceasing all activity beyond what your obstetrician recommends over fears, you could have this phobia."

Capaldi agrees. "It’s important to remember that almost everyone who can become pregnant feels some anxiety or fear around pregnancy and childbirth," she says. "It becomes a phobia, however, when it begins to disrupt and interfere with your daily activities of living, often causing sufferers to avoid pregnancy or potential pregnancy at all costs."

But "not wanting to carry a pregnancy is more of a thought or feeling that may not lead to a significant level of distress that prevents a person from engaging in the normal activities of their life," Richards says.

If you're having fears about pregnancy or childbirth that feel overwhelming and you're changing your behaviors as a result, Capaldi says it might be time to talk to a professional about your worries.

How is tokophobia typically treated?

Tokophobia is often treated with cognitive behavioral therapy (CBT), Capaldi says. "CBT includes identifying the thoughts and feelings that are underlying the fears of childbirth and working to evaluate them in a way that will help the person gain a new perspective," she says. That can include exposure techniques, "where situations that are avoided due to the extreme fear are gradually approached," Capaldi says. The exact exposures can vary depending on what the patient is specifically afraid of but may include things like watching a video of a childbirth, going to pregnancy classes or reading about the procedure of episiotomies, Capaldi explains.

While pregnancy, childbirth and parenting aren't for everyone, Gallagher stresses the importance of getting help if you feel like you're dealing with an actual phobia around pregnancy. "You don't want to let anxiety dictate your decision making in life," she says.

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