Half Of U.S. Pregnancies Unintended
Nearly half of all pregnancies in the United States are unintended, compared to 33 percent in France and 28 percent in Scotland.
In 2001, the last year for which data is available, there were over 3 million unintended pregnancies in the US. In addition, the percentage of births occurring within 24 months of a previous birth (the shorter the interval between births the greater the health risks for mothers and babies) increased from 11 percent in 1995 to 21 percent in 2002, despite the Healthy People 2010 target of 6 percent.
Why such a high rate of unintended pregnancy? What can be done to reverse the trend?
Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), researchers from the Centers for Disease Control and Prevention (CDC) assessed contraceptive use among postpartum women in 12 states and New York City.
Launched in 1987, PRAMS is an ongoing, state- and population-based surveillance system designed to monitor maternal behaviors and experiences that occur before, during, and after pregnancy. PRAMS is currently active in 39 reporting areas (cities and states). Up to three self-administered questionnaires are mailed monthly to a sample of mothers randomly selected from birth certificates 2 to 4 months after giving birth. Mothers who fail to respond receive follow-up telephone interviews. Questionnaires include core questions, optional standard questions, and questions unique to each state. To determine contraceptive use, each respondent was asked the following:
1) “Are you or your husband or partner doing anything now to keep from getting pregnant?”
2) “What kind of birth control are you or your husband or partner using now to keep from getting pregnant?”
Only data from those reporting areas (13) that had an overall response rate of 70 percent or higher were included. (Arkansas, Florida, Louisiana, Michigan, Mississippi, North Carolina, Nebraska, New York, New York City, Oregon, Rhode Island, South Carolina, and West Virginia.)
Women who were currently pregnant (362) or not sexually active (3615) were excluded. Also excluded were those who responded yes to the first question and either did not respond to the second question(267) or responded “other” (310). Among the remaining 43,887 women, 88 percent reported current use of at least one method of contraception during 2004 through 200. Only 61 percent of respondents reported using highly effective methods of birth control, 20 percent moderately effective methods, 6 percent less effective methods, and 12 percent no method. Women reporting the lowest use of one or more methods of birth control included those who had had no prenatal care, women who had hoped to get pregnant sooner with their most recent pregnancy, Asian/Pacific Islanders, and women 35 years and older. Only 13 percent of the women reported using condoms for protection against sexually transmitted diseases.
Study limitations
1) Data were self-reported, increasing the risk of over-reporting of desirable behavior and under-reporting of undesirable behavior.
2) Only 13 reporting areas were represented.
3) Use of spermicides, emergency contraception, and lactational amenorrhea were not listed among the methods of contraception.
4) Women who reported not doing anything to keep from getting pregnant were not asked about tubal ligation or vasectomy, increasing the risk that use of highly effective contraceptive methods was underreported.
Policy and prudence collide
Strategies for reducing unintended pregnancies was the subject of an editorial published in 2008 in the journal Contraception. Authors, James Trussell and L.L. Wynn identify three key strategies: 1) increasing the use of highly effective methods of contraception, 2) increasing the number of people who rely on highly effective methods that do not require adherence such as intrauterine devices (IUDs) and implants, and 3) increasing the simultaneous use of condoms and a highly effective method among those at risk for sexually transmitted diseases, but emphasizes the need for policy change along with technological advances.
“Although advances in technology in the form of long-acting reversible methods not requiring adherence may be helpful, as might be the development of hormonal contraceptive methods for men, technology alone is not sufficient. Many policies (such as inconsistent contraceptive coverage by insurers) discourage consistent, effective contraceptive use and deserve to be reconsidered,” said Trussell and Wynn.
Unintended pregnancies continue to serve as a reminder of how little control many women have over their reproductive lives.
What breaks my heart is that this makes it sound like unintended pregnancies are like a disease: a horrible thing to have.
As an adopted child, I am so grateful that I WAS an unintended pregnancy. It gave my (adoptive) parents the chance to have children.
As a sidenote — as a parent who adheres to Natural Family Planning and eschews the thought of using anything artificial (especially hormones!), I have exceptional control over my reproductive life. I am glad that NFP was included as an option to the forms of contraception that were available.
Please know that unintended pregnancy is a target of the Healthy People 2010, not because it is a disease, but because of the unanticipated consequences that often accompany unintended pregnancies.
In a report published by the state of Michigan (http://www.michigan.gov/documents/REDUCING_UNINTENDED_PREGNANCIES_132 688_7.pdf), data show that women experiencing unintended pregnancies are less likely to obtain prenatal care in the first trimester and to continue to use tobacco and alcohol. Children are at greater risk of weighing less than 2,500 grams at birth, of dying in the first year of life, and of being abused. The list goes on and on with an increased risk for abortion among the many consequences. According to the Michigan Department of Community Health, if all pregnancies were intended, there would be a 79 percent reduction in teen pregnancies. In 2001, 13,438 Michigan teens ages 10 to 19 years gave birth.
You are a wonderful example of what can happen when a mother with an unintended pregnancy gets the support she needs. Unfortunately, that level of support is not available to all mothers.
As a sidenote – Natural Family Planning like all methods of child spacing can be extremely effective when used properly. I was disappointed to find that the Lactational Amenorrhea Method (LAM) was not included as an option as it is considered the most effective form of healthy child spacing worldwide.
I am disappointed that CDC report (MMWR) of the PRAMS data doesn’t parse out mistimed vs. unwanted pregnancies. I recall from my days in the research department of a women’s health care organization that the former (mistimed pregnancies) greatly outweighs the latter (unwanted pregnancies), and the health consequences for “mistimed” pregnancies are much less. The analysis that jumps to my mind is this one from the Guttmacher Institute: http://www.guttmacher.org/pubs/journals/3420602.html.