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May 2016

 

For so long, we have heard that half of all pregnancies in the United States are unintended. The good news is that the statement may no longer hold true. In the most recent analyses by the Guttmacher Institute, the proportion of unintended pregnancies decreased by 18%.[1] This decrease can be seen across a broad swath of demographic groups, including the most vulnerable sub-populations of women.

In 2011, the unintended pregnancy rate was 45%, which was lower than rates reported since 1981. In 2008, just three years earlier than the most recent assessment, the rate was 51%. Teen women ages 15-19 exhibited the greatest reduction since 2008: their rate dropped 28%. In the group with the highest risk of unintended pregnancy, young adult women ages 20-24, the rate dropped 22%.

Not only does age influence the risk for having an unintended pregnancy, but so do income and education levels. Women who were poor and had lower levels of education showed the greatest drop in unintended pregnancy levels, though they continued to have the highest rates of unintended pregnancy. Compared to white women, minority women also continued to have the higher rates despite the dramatic decline between 2008 and 2011. The substantial decrease in rates among these most vulnerable women erased some of disparities generally seen when the unintended pregnancy rates of these women are compared to rates of women with higher education and income and who are non-minority.

The researchers examined abortion rates, but found that these rates had held steady. Despite there being no change in the abortion rate, unintended birth rates decrease due to the decrease in the rate of unintended pregnancies. However, disparities increased in the rates of unintended births among those less likely to afford abortion—the poor and less educated.

Why the downward shift in unintended pregnancies? Sexual behaviors appeared not to change in any way that could account for the decreases. It appears that small changes added up as more women had intended pregnancies, used contraception, and selected highly effective long-acting methods, especially IUDs. Of note, the increase in contraceptive use and the shift to greater use of more effective methods took place before the Affordable Care Act took full effect. What effect will we see once the increased ACA coverage of contraception is measured?

Still, the unintended pregnancy rate is higher than we would like to see it. About 60% of unintended pregnancies occur to women who do not use any contraceptive method.[2] Most likely not to use a contraceptive are women who think they will not get pregnant, perhaps because they believe themselves infertile or are in a phase of the menstrual cycle that they believe places them out of risk. Cohabiting women and women newer to sex are more likely to choose not to use a contraceptive than are women who are married or more sexually experienced. Fear of side effects from contraceptives were a reason for non-use for about 10% of women. Twice that percentage of women (20%) chose not to use a method because although they did not intend to get pregnant, they “did not mind getting pregnant.”

Providers can offer effective contraception, but the most at-risk women, those who use no contraceptive, could benefit from targeted counseling and education about their misconceptions regarding their fertility and risk of pregnancy, their low risk of serious contraceptive side effects, and the need to be in a state of health conducive to a healthy pregnancy should they find themselves with an unintended pregnancy. The Centers for Disease Control and Prevention recommends that all women of reproductive age adopt the following healthy behaviors:[3]

—Submitted by Deborah Kowal, MA, PA, executive editor of Contraceptive Technology


[1] Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med 2016;374:843-52.

[2] Mosher W, Jones J, Abma J. Nonuse of contraception among women at risk of unintended pregnancy in the United States.  Contraception 2015;92:170-6.

[3] Centers for Disease Control and Prevention. Unintended pregnancy prevention. Accessed May 2, 2016 at http://www.cdc.gov/reproductivehealth/unintendedpregnancy/