Unintended pregnancy

Unintended pregnancies are pregnancies that are mistimed or unwanted at the time of conception, ^[1] also known as unplanned pregnancies. ^{[2] [3]}

Sexual activity without the use of effective contraception through choice or coercion is the predominant cause of unintended pregnancy. Worldwide, the unintended pregnancy rate is approximately 45% of all pregnancies (for a total of 120 million unintended pregnancies annually), but rates vary in different geographic areas and among different sociodemographic groups. ^{[4] [5]} Unintended pregnancies may be unwanted pregnancies or mistimed pregnancies. ^[6] While unintended pregnancies are the main reason for induced abortions, ^[6] unintended pregnancies may also result in other outcomes, such as live births or miscarriages.

Unintended pregnancy has been linked to numerous poor maternal and child health outcomes, regardless of the outcome of the pregnancy. ^[6] Efforts to decrease rates of unintended pregnancy have focused on improving access to effective contraception through improved counseling and removing barriers to contraception access.

Definitions

Research on unintended pregnancy rates is challenging, as categorizing a pregnancy as "intended" or "unintended" does not capture the many complex considerations that go into a person's or couple's feelings towards the pregnancy itself or their reproductive plans in general. ^[7] However, for data collection purposes, an "unintended pregnancy" is defined as a pregnancy that occurs either when a woman wanted to become pregnant in the future but not at the time she became pregnant, or one that occurred when she did not want to become pregnant then or at any time in the future. ^[7]

Conversely, an "intended pregnancy" is one that is consciously desired at the time of conception or sooner. ^{[6] [7]} For research purposes, all pregnancies not explicitly categorized as "unintended" are combined, including those pregnancies where the pregnant woman feels ambivalent or unsure about the pregnancy. ^[7] Most sources consider only the intentions of the woman when defining whether a pregnancy is unintended, but some sources also consider the intentions of the male partner. ^{[6] [7]}

Terming a pregnancy "unintended" does not indicate whether or not a pregnancy is welcomed, or what the outcome of the pregnancy is; unintended pregnancies may end in abortion, miscarriage, or birth. ^[7]

Epidemiology

Global incidence

The global rate of unintended pregnancy was estimated at 44% of all pregnancies between 2010 and 2014, corresponding to approximately 62 unintended pregnancies per 1000 women between the ages of 15–44 years old. ^[4] While unintended pregnancy rates have been slowly declining in most areas of the world, ^[4] different geographic regions have different estimated unintended pregnancy rates. ^{[4] [8]} Rates tend to be higher in low-income regions in Latin America and Africa, estimated at 96 and 89 unintended pregnancies per 1000 women, respectively, and lower in higher-income regions such as North America and Europe, estimated at 47 and 41 unintended pregnancies per 1000 women, respectively. ^[4] Unwanted pregnancies continues to be a major public health issue worldwide, especially in low- and middle-income countries. The annual number of unwanted pregnancies in Asia is estimated to be 53.8 million. It is estimated that between 2010 and 2014, around 5.4% of Asian women ages 15 to 44 had unintended pregnancies. ^[9]

The United Nations Population Fund, the United Nations sexual and reproductive health agency, explains that nearly half of all pregnancies, totalling 121 million each year throughout the world, are unintended. ^[5]

Incidence by country/region

Europe

From 1990–1994 to 2010–2014, European rates of unintended pregnancy decreased from approximately 66 such pregnancies per 1000 women ages 15–44 years old to 41. ^[4] These rates vary between different European countries.

Britain

According to a 2013 study approximately 16% of British pregnancies are unplanned, 29% are ambivalent, and 55% are planned. ^[10]

France

In France, 33% of pregnancies are unintended. Of women at risk for unintended pregnancy, only 3% do not use contraception, and 20% use intrauterine devices (IUDs). ^[11]

Sweden

One study from Sweden (2008–2010) showed that the prevalence of unintended pregnancies was 23.2%. ^[12] One study conducted in Uppsala (2012–2013) found that 12% of pregnancies were fairly or very unplanned. ^[13]

Russia

See also: Demographics of Russia

According to a 2004 study, current pregnancies were termed "desired and timely" by 58% of respondents, while 23% described them as "desired, but untimely", and 19% said they were "undesired". ^[14]

Asia

From 2010–2014, approximately 5.4% of women aged 15–44 years old got pregnant unintentionally, and the number of unintended pregnancies is 53.8 million each year in Asia. ^[9]

India

India, the number of unintended pregnancies has not changed much or been measured in a specific way in the last ten years.^{[ as of? ] [9]} In each of the three rounds of the National Family Health Surveys (NFHS), about a quarter of the women in India had unintended pregnancies. ^[9] Every year, there are about 121 million or 12.1 crore unintended pregnancies around the world. One of every seven of these happens in India, according to a report from the United Nations Population Fund. ^[15] India's most populous state, Uttar Pradesh, with a population of about 200 million, has twice as many unwanted births as India as a whole (1.65 vs. 0.80). ^[16] The level of unmet need for contraception among women in India is consistent with the incidence of unintended pregnancies and the incidence of abortions. These facts highlight the necessity for additional investment to meet the contraceptive needs of women and couples and to ensure access to safe abortion services. ^[17]

Africa

A quarter of unintended pregnancy happens in Africa and the average unintended pregnancy rate in Sub-Saharan Africa is 33.9%. ^[18]

North America

From 1990–1994 to 2010–2014, North American rates of unintended pregnancy decreased from approximately 50 such pregnancies per 1000 women ages 15–44 years old to 47. ^[4]

United States

According to the Guttmacher Institute, 45% of U.S. pregnancies in 2011 were unintended, approximately 2.8 million pregnancies per year. ^[7] In 2006, most states' rates were between 40 and 65 unintended pregnancies per 1,000 women. The state with the highest rate of unintended pregnancies was Mississippi, with 69 per 1,000 women, followed by California, Delaware, the District of Columbia, Hawaii and Nevada (66 to 67 per 1,000). New Hampshire had the lowest rate, 36 per 1,000 women, followed by Maine, North Dakota, Vermont and West Virginia (37 to 39 per 1,000 women). ^{[19] [20]}

Over 92% of abortions are the result of unintended pregnancy, ^[21] and unintended pregnancies result in about 1.3 million abortions per year. ^[22] In 2001, 44% of unintended pregnancies resulted in births, 42% resulted in induced abortion, and the rest in miscarriage. ^[23] It is estimated that more than half of US women have had an unintended pregnancy by age 45. ^[24] One 2012 study found over one-third of living people in the US under 31 years of age (born since 1982) were the result of unintended pregnancies, a rate virtually unchanged from 2002. ^{[25] [26]}

Unintended pregnancies and births in the United States ^[27]
Rate per 1000 women.

Year	Unintended pregnancies	Unintended births
1981	54.2 [27]	25 [27]
1987	53.5 [27]	27 [27]
1994	44.7 [27]	21 [27]
2001	48 [28]	23
2008	51 [28]	27

Factors associated with unintended pregnancy

Unintended pregnancy typically occurs after sexual activity without the use of contraception, or not using it correctly. Such pregnancies may still occur despite using contraception correctly, but are uncommon. For example, in the United States, of all the unintended pregnancies that occurred in 2008, women who used modern contraception consistently accounted for only 5% of the unintended pregnancies, while women who use contraception inconsistently or not at all accounted for 41% and 54% of all unintended pregnancies, respectively. ^[29]

There are many factors that may influence a person or couple's consistent use of contraception; a woman may not understand her risk of unintended pregnancy, and/or may not be able to access effective birth control to prevent pregnancy. Similarly, she may also not be able to control when/how she engages in sexual activity. Thus, many factors have been associated with higher likelihood of having an unintended pregnancy, as follows.

Younger age

See also: Teenage pregnancy and Adolescent sexuality

Studies across the globe consistently find that younger age (adolescence or young adulthood) increases the likelihood of a pregnancy being unintended or unplanned. ^{[30] [31] [10] [18] [32] [12]}

In the US, younger women who are sexually active are less likely to use contraception than other age groups, and thus are more likely to have unintended pregnancies. Approximately 18% of young women aged 15–19 years old at risk of unintended pregnancy do not use contraception, compared with 13% of women aged 20–24 and 10% of women aged 25–44. ^[33]

Of the estimated 574,000 teen pregnancies (to young women aged 15–19) in the US in 2011, 75% were unintended. ^[34] In 2011, the unintended pregnancy rate was 41 per 1,000 women aged 15–19. ^[34] Because many teens are not sexually active, these estimates understate the risk of unintended pregnancy among teens who are having sex. Calculations that account for sexual activity find that unintended pregnancy rates are highest among sexually active women aged 15–19 years old compared to other age groups. ^[35] About one-third of unintended teen pregnancies end in abortion. ^[34]

The unintended pregnancy rate among teens has been declining in the US. Between 2008 and 2011, the unintended pregnancy rate declined 44% among women aged 15–17 years old and 20% among women aged 18–19 years old. ^[34] This decline is attributed to improved contraceptive use among sexually active teens, rather than changes in sexual activity. ^[36]

Relationship status

Relationship status has a strong correlation with unintended pregnancy, but measures for relationship status vary by study. Some studies find that being single increases the likelihood of experiencing an unintended pregnancy, ^{[18] [37] [38]} some find that not living with a partner increases the likelihood, ^{[12] [37]} and others find cohabitation with a partner to increase the risk of unintended pregnancy. ^[39]

In the US, women who are unmarried but live with their partners (cohabiting) have a higher rate of unintended pregnancy compared with both unmarried noncohabiting women (141 vs. 36–54 per 1,000) and married women (29 per 1,000). ^[7]

Lower income

Poverty, lower income, and/or economic hardship increases a woman's risk of unintended pregnancy across the globe. ^{[31] [18] [32] [12]}

Poverty and lower income increases a woman's risk of unintended pregnancy. Unintended pregnancy rates among women with incomes less than 100% of the poverty line was 112 per 1,000 in 2011, more than five times higher than the rate among women with incomes of at least or greater than 200% of poverty (20 per 1,000 women). ^[7]

Minority racial background/ethnicity

Women living in countries where they belong to a racial or ethnic minority group frequently have higher unintended pregnancy rates compared to women of the regional majority. ^{[30] [31] [12]}

In the US, women who identify as racial minorities are at increased risk of unintended pregnancy. In 2011, the unintended pregnancy rate for non-Hispanic black women was more than double that of non-Hispanic white women (79 versus 33 per 1,000). ^[7]

Lower education level

Studies across the globe consistently find that women with relatively lower educational attainment are far more likely to experience an unplanned pregnancy than women who are more educated; the level of education education that makes the difference is relative, varying by region and country, as demonstrated by multiple studies. ^{[31] [10] [18] [32] [12] [37] [39] [40]}

Women without a high school degree had the highest unintended pregnancy rate among any educational level in 2011, at 73 per 1,000, accounting for 45% of all pregnancies in this group. Unintended pregnancy rates decreased with each level of educational attainment. ^{[7] [34]}

Lifetime abuse, Current domestic abuse, and Non-consensual intercourse

Sexual coercion, rape, or even forced pregnancy may be associated with unintended pregnancy, all of which sometimes happens in the context of domestic violence. Studies in various countries have linked intimate partner violence or current abuse, ^{[12] [37] [38] [41]} as well as prior abuse ^[12] (incl. during childhood), ^[42] to a higher risk of experiencing unintended pregnancy.

A longitudinal study in 1996 of over 4000 women in the United States followed for three years found that the rape-related pregnancy rate was 5.0% among survivors aged 12–45 years. Applying that rate to rapes committed in the United States would indicate that there are over 32,000 pregnancies in the United States as a result of rape each year. ^[43]

Birth control sabotage is abuse in the form of tampering with contraception or interfering with the use of contraception in order to undermine efforts to prevent pregnancy. ^[44]

Multiparity / Already having children

See also: Gravidity and parity

Women who already have children are more likely to report a pregnancy as unintended. The number of children that makes the difference is relative, varying by region and country, as demonstrated by different studies. ^{[31] [18] [32] [37]}

Public health implications

In the United States in 2011, 42% of all unintended pregnancies ended in abortion, and 58% ended in birth (not including miscarriages). ^[7] Regardless of the outcome of the pregnancy, unintended pregnancies have significant negative impacts on individual and public health.

Unintended births

Pregnancy, whether intended or unintended, has risks and potential complications. On average, unintended pregnancies that are carried to term result in poorer outcomes for the pregnant woman and for the child than do intended pregnancies.

Missed opportunities for preconception care

Unintended pregnancy usually precludes pre-conception counseling and pre-conception care. ^[45] Patients with unintended pregnancies with preexisting medical comorbidities such as diabetes or autoimmune disease may not be able to optimize control of these conditions before becoming pregnant, which is often associated with poorer outcomes during the resulting pregnancy. Patients taking known teratogenic drugs, such as some of those used for epilepsy or hypertension, may not have the opportunity to change to a non-teratogenic drug regimen before an unintended conception. Unintended pregnancies preclude chance to resolve sexually transmitted infections (STIs) before pregnancy; untreated STIs may be associated with premature delivery or later infection of the newborn. ^[6]

Late initiation of prenatal care

Patients with unintended pregnancies enter prenatal care later. ^{[46] [6]} Unwanted pregnancies have more delay than mistimed. ^[6] Patients who present late to prenatal care may also miss the opportunities for genetic testing of the fetus in the second trimester, which can identify abnormal fetuses and may be used in the decision to continue or terminate the pregnancy.

Maternal mental health

Women with an unintended pregnancy are more likely to develop depression during or after pregnancy. ^{[47] [48] [49]}

Relationship stress

Women with unintended pregnancy are at increased risk of physical violence during pregnancy ^{[47] [49]} and report feeling greater relationship instability. ^[50]

Substance use during pregnancy

A label on alcoholic drinks promoting zero alcohol during pregnancy

Women with unintended pregnancies are more likely to smoke tobacco, ^[45] drink alcohol during pregnancy, ^[6] , ^[51] and binge drink during pregnancy, ^[45] which results in poorer health outcomes. ^[6] (See also: fetal alcohol spectrum disorder)

Increased rates of preterm birth and low birth weight

Unintended pregnancies are more likely to delivery prematurely, ^{[6] [45] [49]} and have a greater likelihood of low birth weight, ^{[49] [52]} particularly for unwanted pregnancies. ^{[6] [51]}

Decreased bonding with infant

Unintended pregnancies have been associated with lower mother–child relationship quality. ^{[47] [50]} (See also maternal bond.)

Decreased breastfeeding

Women who deliver unintended pregnancies are less likely to breastfeed, ^{[47] [51]} which in itself has been associated with a number of improved health outcomes for both mothers and infants.

Increased rates of child neglect and abuse

Children born of unintended pregnancies have higher risk of child abuse and neglect. ^{[6] [53]}

Poorer long-term developmental outcomes

Children born of unintended pregnancies are less likely to succeed in school, ^[21] with significantly lower test scores, ^[50] more likely to live in poverty and need public assistance, ^[21] and more likely to have delinquent and criminal behavior. ^[21]

Adoption

Main article: Adoption

Unintended pregnancies may result in an adoption of the infant, where the biological parents (or birth parents) transfer their privileges and responsibilities to the adoptive parents. Birth parents choose adoption when they do not wish to parent the current pregnancy and they prefer to carry the pregnancy to term rather than ending the pregnancy through an abortion. ^[54] In the United States alone, 135,000 children are adopted each year ^[55] which represents about 3% of all live births. According to the 2010 census, there were 1,527,020 adopted children in the United States, representing 2.5 percent of all U.S. children. ^[56] There are two forms of adoption: open adoptions and closed adoptions. Open adoption allows birth parents to know and have contact with the adoptive parents and the adopted child. ^[57] In a closed adoption, there is no contact between the birth parents and adoptive parents, and information identifying the adoptive parents and the birth parents is not shared. However, non-identifying information (i.e. background and medical information) about the birth parents will be shared with the adoptive parents. ^[57]

Induced abortions

Main article: Abortion

Abortion, the voluntary termination of pregnancy, is one of the primary consequences of unintended pregnancy. ^[6] A large proportion of induced abortions worldwide are due to unwanted or mistimed pregnancies. ^{[58] [59]} Unintended pregnancies result in about 42 million induced abortions per year worldwide. ^[22] In the United States, approximately 42% of all unintended pregnancies ended in abortion. ^[7] Over 92% of abortions are the result of unintended pregnancy. ^[21] The U.S. states with the highest levels of abortions performed were Delaware, New York and New Jersey, with rates of 40, 38 and 31 per 1,000 women, respectively. High rates were also seen in the states of Maryland, California, Florida, Nevada and Connecticut with rates of 25 to 29 per 1,000 women. The state with the lowest abortion rate was Wyoming, which had less than 1 per 1,000 women, followed by Mississippi, Kentucky, South Dakota, Idaho and Missouri with rates of 5 to 6 abortions per 1,000 women. ^{[60] [61]}

Abortion carries few health risks when performed in accordance with modern medical techniques. ^{[6] [62] [63]} In higher resource areas where abortion is legal, it has lower morbidity and mortality for the pregnant woman than childbirth. ^{[6] [64] [65]} However, where safe abortions are not available, abortion can contribute significantly to maternal mortality ^[66] and morbidity. ^[62] While decisions about abortion may cause some individuals psychological distress, ^[67] some find a reduction in distress after abortion. ^{[6] [68]} There is no evidence of widespread psychological harm from abortion. ^{[6] [69] [70]}

Maternal deaths

Main article: Maternal death

Over the six years between 1995 and 2000 there were an estimated 338 million pregnancies that were unintended and unwanted worldwide (28% of the total 1.2 billion pregnancies during that period). ^[71] These unwanted pregnancies resulted in nearly 700,000 maternal deaths (approximately one-fifth of maternal deaths during that period). More than one-third of the deaths were from problems associated with pregnancy or childbirth, but the majority (64%) were from complications from unsafe or unsanitary abortion. ^[71] Most of the deaths occurred in low resource regions of the world, where family planning and reproductive health services were less available. ^[71] In certain countries with extreme prohibitions on abortions like El Salvador, Honduras, Nicaragua, Haiti, the Dominican Republic, Jamaica, Suriname, Egypt, Madagascar, Mauritania, Senegal, Sierra Leone, the Republic of Congo, Laos, the Philippines, Iraq forced women which have unintended pregnancies to commit suicide and its also contributed to maternal deaths. ^[72]

Costs and potential savings

The public cost of unintended pregnancy is estimated to be about 11 billion dollars per year in short-term medical costs. ^[21] This includes costs of births, one year of infant medical care and costs of fetal loss. ^[21] Preventing unintended pregnancy would save the public over 5 billion dollars per year in short-term medical costs. ^[21] Savings in long-term costs and in other areas would be much larger. ^[21] By another estimate, the direct medical costs of unintended pregnancies, not including infant medical care, was $5 billion in 2002. ^[73] The Brookings Institution conducted research and their results show that taxpayers spend more than $12 billion each year on unintended pregnancies. They also find that, if all unintended pregnancies were prevented, the resulting savings on medical spending alone would equal more than three-quarters of the federal FY 2010 appropriation for the Head Start and Early Head Start programs and would be roughly equivalent to the amount that the federal government spends each year on the Child Care and Development Fund (CCDF). ^[74] Contraceptive use saved an estimated $19 billion in direct medical costs from unintended pregnancies in 2002. ^[73]

Prevention

Main article: Family planning

Most unintended pregnancies result from not using contraception, or from using contraceptives inconsistently or incorrectly. ^[7] Accordingly, prevention includes comprehensive sexual education, availability of family planning services, and increased access to a range of effective birth control methods.

Use of effective contraception

In the US it is estimated that 52% of unintended pregnancies result from couples not using contraception in the month the woman got pregnant, and 43% result from inconsistent or incorrect contraceptive use; only 5% result from contraceptive failure, according to a report from the Guttmacher Institute. ^[22]

Increasing the use of long-acting reversible contraceptives (LARCs) (such as IUD and contraceptive implants) decreases the chance of unintended pregnancy by decreasing the chance of incorrect use. ^[75] Method failure is relatively rare with modern, highly effective contraceptives, and is much more of an issue when such methods are unavailable or not used. In the period from 2001 to 2008, there were notable increases in the use of long-acting methods among younger women. ^[28] (See comparison of contraceptive methods). Available contraception methods include use of birth control pills, a condom, intrauterine device (IUD, IUC, IUS), contraceptive implant (Implanon or Nexplanon), hormonal patch, hormonal ring, cervical caps, diaphragms, spermicides, or sterilization. ^[76] People choose to use a contraceptive method based on method efficacy, medical considerations, side effects, convenience, availability, friends' or family members' experience, religious views, and many other factors. ^[77] Some cultures limit or discourage access to birth control because they consider it to be morally or politically undesirable. ^[78]

While not yet available commercially, the future introduction of effective LARCs for men could have a positive effect on unintended pregnancies. ^[79]

The CDC encourages men and women to formulate a reproductive life plan to help them avoid unintended pregnancies, improve the health of women, and reduce adverse pregnancy outcomes. ^[80]

Improving access to effective contraception

Providing contraceptives and family planning services at low or no cost to the user helps prevent unintended pregnancies. Many of those at risk of unintended pregnancy have little income, so even though contraceptives are highly cost-effective, ^[81] up-front cost can be a barrier. Subsidized family planning services improve the health of the population and saves money for governments and health insurers by reducing medical, ^[47] education, and other costs to society.

In 2006, publicly funded family planning services (Title X, Medicaid, and state funds) helped women avoid 1.94 million unintended pregnancies, thus preventing about 860,000 unintended births and 810,000 abortions. ^[82] Without publicly funded family planning services, the number of unintended pregnancies and abortions in the United States would be nearly two-thirds higher among women overall and among teens, and the number of unintended pregnancies among lower-class women would nearly double. ^[82] The services provided at publicly funded clinics saved the federal and state governments an estimated $5.1 billion in 2008 in short term medical costs. ^[82] Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed. ^[82]

In the United States, women who have an unintended pregnancy are more likely to have subsequent unplanned pregnancies. ^[48] Providing family planning and contraceptive services as part of prenatal, postpartum and post abortion care can help reduce recurrence of unintended pregnancy.

Outside of the United States, providing modern contraceptives to the 201 million women at risk of unintended pregnancy in low income countries who do not have access to effective contraception would cost an estimated US$3.9 billion per year. ^[83] This expenditure would prevent an estimated 52 million unintended pregnancies annually, preventing 1.5 million maternal and child deaths annually, and reduce induced abortions by 64% (25 million per year). ^[83] Reduced illness related to pregnancy would preserve 27 million healthy life years, at a cost of $144 per year of healthy life. ^[83]

History

See also: History of abortion, History of condoms, and Timeline of reproductive rights legislation

Early ways of preventing unintended pregnancy included withdrawal and various alternatives to intercourse; they are difficult to use correctly and, while better than no method, have high failure rates compared to modern methods. ^{[84] [85]} Various devices and medications thought to have spermicidal, contraceptive, abortifacient or similar properties were also used.

Abortions have been induced to prevent unwanted births since antiquity, ^[6] and abortion methods are described in some of the earliest medical texts. ^[85] The degree of safety of early methods relative to the risks of childbirth is unclear. ^[85]

Where modern contraceptives are not available, abortion has sometimes been used as a major way of preventing birth. For instance, in much of Eastern Europe and the former Soviet republics in the 1980s, desired family size was small, but modern contraceptive methods were not readily available, so many couples relied on abortion, which was legal, safe, and readily accessible, to regulate births. ^[84] In many cases, as contraceptives became more available, the rate of unintended pregnancy and abortion dropped rapidly during the 1990s. ^[84]

Infanticide ('customary neonaticide') or abandonment (sometimes in the form of exposure) are other traditional ways of dealing with infants that were not wanted or that a family could not support. ^[85] Opinions on the morality or desirability of these practices have changed throughout history.

In the 19th and 20th centuries, the desired number of pregnancies declined as reductions in infant and childhood mortality rates increased the probability that children would reach adulthood. Other factors, such as the level of education and economic opportunities for women, have also led to reductions in the desired number of children. ^[84] As the desired number of children decreases, couples spend more of their reproductive lives trying to avoid unintended pregnancies. ^[84]

US history

US birth rates declined in the 1970s. Factors that are likely to have led to this decline include: The introduction of the birth control pill in 1960, and its subsequent rapid increase in popularity; the completion of legalization of contraceptives in the 1960s and early 1970s; the introduction of federal funding for family planning in the 1960s and Title X in 1970; increased career and educational gains for women and its consequence of increased opportunity costs; and the legalization of abortion in 1973. The decline in the birth rate was associated with reductions in the number of children put up for adoption and a reduction in the rate of neonaticide.

• It is unclear to what extent legalization of abortion increased the availability of the procedure. ^[6] It is estimated that before legalization about one million abortions were performed annually. ^[6] Before legalization, abortion was probably one of the most common criminal activities. ^[6] Before legalization, an estimated 1,000 to 10,000 women died each year from complications of poorly performed abortions. ^[6] Legalization was followed by a decrease in pregnancy-related deaths in young women, as well as decrease in hospital admissions for incomplete or septic abortions that could be caused by an induced abortion performed by inexperienced practitioners. ^[6]
• The infanticide rate during the first hour of life dropped from 1.41 per 100,000 from 1963 to 1972 to 0.44 per 100,000 from 1974 to 1983; the rate during the first month of life also declined, whereas the rate for older infants rose during this time. ^[86]

The rate of unintended pregnancy declined significantly from 1987 until 1994, due to increased contraceptive use. ^{[27] [87]} Since then, the rate has remained relatively unchanged, as described above. ^[87]

See also

• Contraceptive mandate
• Demographic dividend
• Prevalence of teenage pregnancy
• Feminization of poverty
• Healthy People program
• International Conference on Population and Development
• Legalized abortion and crime effect
  • The Impact of Legalized Abortion on Crime
• Millennium Development Goals
• Miscarriage
• Nutrition and pregnancy
• Religious views on birth control
• Take Charge

References

1. "Unintended Pregnancy". Centers for Disease Control and Prevention. Retrieved November 13, 2013.
2. "Making decisions about unplanned pregnancies". Healthdirect Australia. 2023-10-17. Retrieved 2024-04-29.
3. "Health matters: reproductive health and pregnancy planning". GOV.UK. Retrieved 2024-04-29.
4. Bearak J, Popinchalk A, Alkema L, Sedgh G (April 2018). "Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model". The Lancet. Global Health. 6 (4): e380–e389. doi:10.1016/S2214-109X(18)30029-9. PMC   6055480 . PMID   29519649.
5. "Nearly half of all pregnancies are unintended—a global crisis, says new UNFPA report". United Nations Population Fund . 30 March 2022. Retrieved 20 March 2023. Five Key Facts from the 2022 SoWP: 1. Every year, almost half of all pregnancies are unintended. Between 2015 and 2019, there were roughly 121 million unintended pregnancies globally each year.
6. Eisenberg L, Brown SH (1995). The best intentions: unintended pregnancy and the well-being of children and families . Washington, D.C.: National Academy Press. p. 72. ISBN   978-0-309-05230-6 . Retrieved 2011-09-03.
7. "Unintended Pregnancy in the United States". Guttmacher Institute. January 2019. Retrieved 20 August 2019.
8. "Changes in Unintended Pregnancy Rates by World Region". Guttmacher Institute. 3 May 2018. Retrieved 22 August 2019.
9. Sarder A, Islam SM, Talukder A, Ahammed B (2021-02-01). Darteh EK (ed.). "Prevalence of unintended pregnancy and its associated factors: Evidence from six south Asian countries". PLOS ONE. 16 (2): e0245923. Bibcode:2021PLoSO..1645923S. doi: 10.1371/journal.pone.0245923 . PMC   7850499 . PMID   33524018.
10. Wellings K, Jones KG, Mercer CH, Tanton C, Clifton S, Datta J, et al. (November 2013). "The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)". Lancet. 382 (9907): 1807–1816. doi:10.1016/S0140-6736(13)62071-1. PMC   3898922 . PMID   24286786.
11. Trussell J, Wynn LL (January 2008). "Reducing unintended pregnancy in the United States". Contraception. 77 (1): 1–5. doi:10.1016/j.contraception.2007.09.001. PMID   18082659.
12. Lukasse M, Laanpere M, Karro H, Kristjansdottir H, Schroll AM, Van Parys AS, et al. (Bidens study group) (May 2015). "Pregnancy intendedness and the association with physical, sexual and emotional abuse - a European multi-country cross-sectional study". BMC Pregnancy and Childbirth. 15 (1): 120. doi: 10.1186/s12884-015-0558-4 . PMC   4494794 . PMID   26008119.
13. Stern J, Salih Joelsson L, Tydén T, Berglund A, Ekstrand M, Hegaard H, et al. (February 2016). "Is pregnancy planning associated with background characteristics and pregnancy-planning behavior?". Acta Obstetricia et Gynecologica Scandinavica. 95 (2): 182–189. doi:10.1111/aogs.12816. PMC   4737297 . PMID   26566076.
14. National Human Development Report Russian Federation (PDF). UNDP (Report). 2008. pp. 47–49. Retrieved 10 October 2009.
15. Basu M (2022-03-31). "Of world's 12.1 cr unplanned pregnancies every year, 1 in 7 occurs in India, says UNFPA report". ThePrint. Retrieved 2023-03-04.
16. Patel SK, Pradhan MR, Patel S (2020-01-17). "Water, Sanitation, and Hygiene (WASH) Conditions and Their Association with Selected Diseases in Urban India". Journal of Population and Social Studies. 28 (2): 103–115. doi: 10.25133/jpssv28n2.007 . ISSN   2465-4418. S2CID   213395741.
17. Singh S, Shekhar C, Acharya R, Moore AM, Stillman M, Pradhan MR, et al. (January 2018). "The incidence of abortion and unintended pregnancy in India, 2015". The Lancet. Global Health. 6 (1): e111–e120. doi:10.1016/S2214-109X(17)30453-9. PMC   5953198 . PMID   29241602.
18. Bain LE, Zweekhorst MB, de Cock Buning T (June 2020). "Prevalence and Determinants of Unintended Pregnancy in Sub -Saharan Africa: A Systematic Review". African Journal of Reproductive Health. 24 (2): 187–205. OCLC   1246228179. PMID   34077104.
19. "Unintended Pregnancy Rates at the State Level". JournalistsResource.org, retrieved 20 March 2012
20. Finer LB, Kost K (June 2011). "Unintended pregnancy rates at the state level". Perspectives on Sexual and Reproductive Health. 43 (2): 78–87. doi: 10.1363/4307811 . PMID   21651706.
21. Monea E, Thomas A (June 2011). "Unintended pregnancy and taxpayer spending". Perspectives on Sexual and Reproductive Health. 43 (2): 88–93. doi:10.1363/4308811. PMID   21651707. S2CID   16230025.
22. Speidel JJ, Harper CC, Shields WC (September 2008). "The potential of long-acting reversible contraception to decrease unintended pregnancy". Contraception. 78 (3): 197–200. doi:10.1016/j.contraception.2008.06.001. PMID   18692608.
23. "Emergency Contraception: Unintended Pregnancy in the United States" . Retrieved 2009-01-25.
24. Singh R, Frost J, Jordan B, Wells E (January 2009). "Beyond a prescription: strategies for improving contraceptive care". Contraception. 79 (1): 1–4. doi:10.1016/j.contraception.2008.09.015. PMID   19041434.
25. Stokes T (2012-07-24). "Oopsie babies? A third of U.S. births unintended, study finds". NBC News. Retrieved 2023-07-15.
26. Mosher WD, Jones J, Abma JC (July 2012). "Intended and unintended births in the United States: 1982-2010" (PDF). National Health Statistics Reports (55): 1–28. PMID   23115878.
27. Henshaw SK (1998). "Unintended pregnancy in the United States". Family Planning Perspectives. 30 (1): 24–9, 46. doi:10.2307/2991522. JSTOR   2991522. PMID   9494812. S2CID   17427653.
28. Finer LB, Zolna MR (February 2014). "Shifts in intended and unintended pregnancies in the United States, 2001-2008". American Journal of Public Health. 104 (Suppl 1): S43–S48. CiteSeerX   10.1.1.642.9200 . doi:10.2105/ajph.2013.301416. PMC   4011100 . PMID   24354819.
29. "Contraceptive Use in the United States". Guttmacher Institute. July 2018. Retrieved 27 August 2019.
30. Hohmann-Marriott BE (April 2018). "Unplanned pregnancies in New Zealand". The Australian & New Zealand Journal of Obstetrics & Gynaecology. 58 (2): 247–250. doi:10.1111/ajo.12732. PMID   29094755.
31. Enthoven CA, El Marroun H, Koopman-Verhoeff ME, Jansen W, Lambregtse-van den Berg MP, Sondeijker F, et al. (October 2022). "Clustering of characteristics associated with unplanned pregnancies: the generation R study". BMC Public Health. 22 (1): 1957. doi: 10.1186/s12889-022-14342-y . PMC   9590126 . PMID   36274127.
32. Aziz Ali S, Aziz Ali S, Khuwaja NS (2016). "Determinants of Unintended Pregnancy among Women of Reproductive Age in Developing Countries: A Narrative Review". Journal of Midwifery and Reproductive Health. 4 (1). doi:10.22038/jmrh.2016.6206.
33. Jones J, Mosher W, Daniels K (October 2012). "Current contraceptive use in the United States, 2006-2010, and changes in patterns of use since 1995". National Health Statistics Reports (60): 1–25. PMID   24988814.
34. Finer LB, Zolna MR (March 2016). "Declines in Unintended Pregnancy in the United States, 2008-2011". The New England Journal of Medicine. 374 (9): 843–852. doi:10.1056/NEJMsa1506575. PMC   4861155 . PMID   26962904.
35. Finer LB (September 2010). "Unintended pregnancy among U.S. adolescents: accounting for sexual activity". The Journal of Adolescent Health. 47 (3): 312–314. doi:10.1016/j.jadohealth.2010.02.002. PMID   20708573.
36. Lindberg L, Santelli J, Desai S (November 2016). "Understanding the Decline in Adolescent Fertility in the United States, 2007-2012". The Journal of Adolescent Health. 59 (5): 577–583. doi:10.1016/j.jadohealth.2016.06.024. PMC   5498007 . PMID   27595471.
37. Goossens J, Van Den Branden Y, Van der Sluys L, Delbaere I, Van Hecke A, Verhaeghe S, et al. (December 2016). "The prevalence of unplanned pregnancy ending in birth, associated factors, and health outcomes". Human Reproduction. 31 (12): 2821–2833. doi:10.1093/humrep/dew266. PMID   27798048.
38. Martin-de-las-Heras S, Velasco C, Luna Jd, Martin A (June 2015). "Unintended pregnancy and intimate partner violence around pregnancy in a population-based study". Women and Birth. 28 (2): 101–105. doi:10.1016/j.wombi.2015.01.003. PMID   25622887.
39. Woodward VM (December 1995). "Psychosocial factors influencing teenage sexual activity, use of contraception and unplanned pregnancy". Midwifery. 11 (4): 210–216. doi:10.1016/0266-6138(95)90006-3. PMID   8569522.
40. Font-Ribera L, Pérez G, Salvador J, Borrell C (January 2008). "Socioeconomic inequalities in unintended pregnancy and abortion decision". Journal of Urban Health. 85 (1): 125–135. doi:10.1007/s11524-007-9233-z. PMC   2430141 . PMID   18038210.
41. Hathaway JE, Mucci LA, Silverman JG, Brooks DR, Mathews R, Pavlos CA (November 2000). "Health status and health care use of Massachusetts women reporting partner abuse". American Journal of Preventive Medicine. 19 (4): 302–307. doi:10.1016/s0749-3797(00)00236-1. PMID   11064235.
42. Dietz PM, Spitz AM, Anda RF, Williamson DF, McMahon PM, Santelli JS, et al. (October 1999). "Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood". JAMA. 282 (14): 1359–1364. doi:10.1001/jama.282.14.1359. PMID   10527183.
43. Holmes MM, Resnick HS, Kilpatrick DG, Best CL (August 1996). "Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women". American Journal of Obstetrics and Gynecology. 175 (2): 320–4, discussion 324–5. doi:10.1016/S0002-9378(96)70141-2. PMID   8765248.
44. Grace KT, Anderson JC (October 2018). "Reproductive Coercion: A Systematic Review". Trauma, Violence & Abuse. 19 (4): 371–390. doi:10.1177/1524838016663935. PMC   5577387 . PMID   27535921.
45. "Maternal and Infant Health and the Benefits of Birth Control in America" (PDF). Power to Decide. Retrieved 2019-09-03.
46. Delvaux T, Buekens P, Godin I, Boutsen M (July 2001). "Barriers to prenatal care in Europe". American Journal of Preventive Medicine. 21 (1): 52–59. doi:10.1016/S0749-3797(01)00315-4. PMID   11418258.
47. "Family Planning – Healthy People 2020". HealthyPeople.gov. Retrieved 2011-08-18. This reference cites:
    • Logan C, Holcombe E, Manlove J, et al. (May 2007). The consequences of unintended childbearing: A white paper (PDF) (Report). Washington: Child Trends. Archived from the original (PDF) on July 2, 2010.
    • Cheng D, Schwarz EB, Douglas E, Horon I (March 2009). "Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors". Contraception. 79 (3): 194–198. doi:10.1016/j.contraception.2008.09.009. PMID   19185672.
    • Kost K, Landry DJ, Darroch JE (Mar–Apr 1998). "Predicting maternal behaviors during pregnancy: does intention status matter?". Family Planning Perspectives. 30 (2): 79–88. doi:10.2307/2991664. JSTOR   2991664. PMID   9561873. S2CID   29117714.
    • D'Angelo DV, Gilbert BC, Rochat RW, Santelli JS, Herold JM (Sep–Oct 2004). "Differences between mistimed and unwanted pregnancies among women who have live births". Perspectives on Sexual and Reproductive Health. 36 (5): 192–197. doi:10.1363/3619204. PMID   15519961. S2CID   29285899.
48. "Providers miss opportunities to prevent depression in and discuss birth control with women with unplanned pregnancies". Research Activities (372). Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services: 15. August 2011. Archived from the original on 18 January 2013.
49. Nelson HD, Darney BG, Ahrens K, Burgess A, Jungbauer RM, Cantor A, et al. (November 2022). "Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes: A Systematic Review and Meta-analysis". JAMA. 328 (17): 1714–1729. doi:10.1001/jama.2022.19097. PMC   9627416 . PMID   36318133.
50. "Unplanned Pregnancy" (PDF). The National Campaign. Archived from the original (PDF) on 2012-05-10. Retrieved 2013-11-21.
51. "Intended and Unintended Births in the United States: 1982–2010" (PDF). Centers for Disease Control. July 24, 2012. Retrieved 2019-09-03.
52. Hall JA, Benton L, Copas A, Stephenson J (March 2017). "Pregnancy Intention and Pregnancy Outcome: Systematic Review and Meta-Analysis". Maternal and Child Health Journal. 21 (3): 670–704. doi:10.1007/s10995-016-2237-0. PMC   5357274 . PMID   28093686.
53. Bethea L (March 1999). "Primary prevention of child abuse". American Family Physician. 59 (6): 1577–85, 1591–2. PMID   10193598. Archived from the original on 2010-12-28. Retrieved 2011-08-31.
54. "Unplanned Pregnancy Options". Adoption Network. Archived from the original on 2020-08-19. Retrieved 2017-09-12.
55. "Adoption Fact Sheet". Off and Running. Public Broadcasting System. 2010-01-18. Archived from the original on 2018-10-10. Retrieved 2017-09-17.
56. "Adopted Children and Stepchildren: 2010" (PDF). US Census.
57. "Open Adoption" (PDF). Child Welfare.
58. Bankole A, Singh S, Haas T (1998). "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries". International Family Planning Perspectives. 24 (3): 117–152. doi:10.2307/3038208. JSTOR   3038208. Archived from the original on 2006-01-17. Retrieved 2009-01-26.
59. Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM (September 2005). "Reasons U.S. women have abortions: quantitative and qualitative perspectives". Perspectives on Sexual and Reproductive Health. 37 (3): 110–118. doi:10.1111/j.1931-2393.2005.tb00045.x. PMID   16150658.
60. "Abortion Incidence and Access to Services in the United States". JournalistsResource.org, retrieved 20 March 2012
61. Jones RK, Kooistra K (March 2011). "Abortion incidence and access to services in the United States, 2008". Perspectives on Sexual and Reproductive Health. 43 (1): 41–50. doi:10.1363/4304111. PMID   21388504. S2CID   2045184.
62. Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, et al. (November 2006). "Unsafe abortion: the preventable pandemic". Lancet. 368 (9550): 1908–1919. doi:10.1016/S0140-6736(06)69481-6. PMID   17126724. S2CID   6188636.
63. Grimes DA, Creinin MD (April 2004). "Induced abortion: an overview for internists". Annals of Internal Medicine. 140 (8): 620–626. doi:10.7326/0003-4819-140-8-200404200-00009. PMID   15096333.
64. Raymond EG, Grimes DA (February 2012). "The comparative safety of legal induced abortion and childbirth in the United States". Obstetrics and Gynecology. 119 (2 Pt 1): 215–219. doi:10.1097/AOG.0b013e31823fe923. PMID   22270271. S2CID   25534071.
65. Grimes DA (January 2006). "Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999". American Journal of Obstetrics and Gynecology. 194 (1): 92–94. doi:10.1016/j.ajog.2005.06.070. PMID   16389015.
66. Haddad LB, Nour NM (2009). "Unsafe abortion: unnecessary maternal mortality". Reviews in Obstetrics & Gynecology. 2 (2): 122–126. PMC   2709326 . PMID   19609407.
67. Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE (April 1990). "Psychological responses after abortion". Science. 248 (4951): 41–44. Bibcode:1990Sci...248...41A. doi:10.1126/science.2181664. PMID   2181664.
68. Templeton A, Grimes DA (December 2011). "Clinical practice. A request for abortion". The New England Journal of Medicine. 365 (23): 2198–2204. doi:10.1056/NEJMcp1103639. PMID   22150038.
69. "More on Koop's study of abortion". Family Planning Perspectives. 22 (1): 36–39. 1990. doi:10.2307/2135437. JSTOR   2135437. PMID   2323405.
70. Cockburn J, Pawson ME (2007). Psychological Challenges to Obstetrics and Gynecology: The Clinical Management . Springer. p.  243. ISBN   978-1-84628-807-4.
71. Williams LJ (25 September 2002). "Press Release: Promises to Keep: The Toll of Unintended Pregnancies on Women's Lives in the Developing World". Global Health Council. Archived from the original on 6 December 2008. Retrieved 2009-01-22.
72. "Does Restricted Access to Abortion Truly Increase the Number of Suicides of Women?". Alliance VITA. 22 June 2023. Retrieved 27 March 2024.
73. Trussell J (March 2007). "The cost of unintended pregnancy in the United States". Contraception. 75 (3): 168–170. doi:10.1016/j.contraception.2006.11.009. PMID   17303484.
74. "The High Cost of Unintended Pregnancy". Brookings. The Brookings Institution. 2001-11-30.
75. "How effective are IUDs?". Planned Parenthood. Retrieved 2019-09-22.
76. Stacey D. "Contraception". About.com. Archived from the original on 12 May 2011. Retrieved 11 October 2009.
77. Wyatt KD, Anderson RT, Creedon D, Montori VM, Bachman J, Erwin P, et al. (February 2014). "Women's values in contraceptive choice: a systematic review of relevant attributes included in decision aids". BMC Women's Health. 14 (1): 28. doi: 10.1186/1472-6874-14-28 . PMC   3932035 . PMID   24524562.
78. Hanson SJ, Burke AE (21 December 2010). "Fertility control: contraception, sterilization, and abortion". In Hurt KJ, Guile MW, Bienstock JL, Fox HE, Wallach EE (eds.). The Johns Hopkins manual of gynecology and obstetrics (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. 382–95. ISBN   978-1-60547-433-5.
79. Dorman E, Perry B, Polis CB, Campo-Engelstein L, Shattuck D, Hamlin A, et al. (January 2018). "Modeling the impact of novel male contraceptive methods on reductions in unintended pregnancies in Nigeria, South Africa, and the United States". Contraception. 97 (1): 62–69. doi:10.1016/j.contraception.2017.08.015. PMC   5732079 . PMID   28887053.
80. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. (A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care) (April 2006). "Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care". MMWR. Recommendations and Reports. 55 (RR-6): 1–23. PMID   16617292.
81. Trussell J, Lalla AM, Doan QV, Reyes E, Pinto L, Gricar J (January 2009). "Cost effectiveness of contraceptives in the United States". Contraception. 79 (1): 5–14. doi:10.1016/j.contraception.2008.08.003. PMC   3638200 . PMID   19041435.
82. "Facts on Publicly Funded Contraceptive Services in the United States". Guttmacher Institute. February 2011. Archived from the original on September 26, 2008. Retrieved August 12, 2011.
83. Singh S, Darroch JE, Ashford LS (2003). Adding it Up: The Benefits of Investing In Sexual and Reproductive Health Care (Report). The Alan Guttmacher Institute and UNFPA. ISBN   0-939253-62-3. Archived from the original on 2009-04-22.
84. "Abortion in Context: United States and Worldwide". Alan Guttmacher Institute. May 1999. Archived from the original on 2011-10-06. Retrieved 2011-08-28.
85. Potts M, Campbell M (2009). "History of contraception". Glob. Libr. Women's Med. doi:10.3843/GLOWM.10376. ISSN   1756-2228.
86. Paul M (2009-05-11). Management of unintended and abnormal pregnancy: comprehensive abortion care . Wiley-Blackwell. p.  34. ISBN   978-1-4051-7696-5.
87. Finer LB, Henshaw SK (June 2006). "Disparities in rates of unintended pregnancy in the United States, 1994 and 2001". Perspectives on Sexual and Reproductive Health. 38 (2): 90–96. doi:10.1363/3809006. PMID   16772190. S2CID   1137347.

Further reading

• Eisenberg L, Brown SH (1995). The best intentions: unintended pregnancy and the well-being of children and families . Washington, D.C.: National Academy Press. ISBN   978-0-309-05230-6.
• Mosher WD, Jones J, Abma JC (July 2012). "Intended and unintended births in the United States: 1982-2010". National Health Statistics Reports (55): 1–28. PMID   23115878.

External links

• CDC:Unintended Pregnancy Prevention
• Ways to prevent pregnancy Archived 2017-08-17 at the Wayback Machine