Unintended pregnancy

Unintended pregnancies are pregnancies that are 2 Causes

mistimed, unplanned or unwanted at the time of
conception.[1] Unintended pregnancy mainly results from
Not using contraception or family planning
engaging in vaginal sexual activity without the use of
services.[6]
contraception, or due to incorrect use of a contraceptive method,[1] but may also arise from the fail Using contraception inconsistently or incorrectly.[6]
ure of the contraception method when used correctly
Contraceptive failure (the method was used corto prevent pregnancy. Available contraception methrectly, but did not work.)[6] Contraceptive failure acods include use of birth control pills, a condom,
counts for a relatively small fraction of unintended
intrauterine device (IUD, IUC, IUS), contraceptive
pregnancies when modern highly eective contraimplant (implanon/nexplanon), hormonal patch, horceptives are used.[10] A condom breaking during inmonal ring, cervical caps, diaphragms, spermicides, or
tercourse or using a condom with a hole in it can
sterilization.[2] Women choose to use a contraceptive
lead to malfunctioning contraceptives.
method based on method ecacy, medical considerations, side eects, convenience, availability, friends or
family members experience, religious views, and many Reasons contraceptives might not have been used or been
other factors.[3] Some cultures limit or discourage access used incorrectly include:
to birth control because they consider it to be morally
or politically undesirable.[4] Unintended pregnancies may
Coercion. Rape, or even forced pregnancy, which
also result from rape, incest or various other forms of
sometimes happens in the context of domestic vioforced or unwanted sex.
lence. Unintended pregnancies are more likely to be
associated with abuse than intended pregnancies.[11]
Unintended pregnancies may be unwanted pregnancies
[5]
This may also include birth control sabotage, which
or mistimed pregnancies. Worldwide, 38% of pregis the manipulation of someones use of birth control
nancies (about 80 million pregnancies) were unintended
to undermine eorts to prevent pregnancy.
in 1999.[6][7] Unintended pregnancies are the main reason for induced abortions,[5] resulting in about 42 million
Lack of knowledge about sex and reproduction, ininduced abortions;[6] not all unintended pregnancies recluding erroneous beliefs.
sult in abortions or unwanted children. Unintended pregnancy has been linked to numerous maternal and child
Lack of knowledge or experience with the contrahealth problems.[5]
ceptive or lack of motivation to use it correctly.

Lack of planning or ambivalence about whether to

have a child.

Intention

Lack of over-the-counter availability of contraceptives.

An intended pregnancy is one that is consciously desired

at the time of conception.[5] A pregnancy is intended if
either partner intended or desired a pregnancy to occur,
though the other partner may not want a pregnancy either
at all or at that time, or he/she may be ambivalent to a
pregnancy.[5]

Inability or unwillingness to attend healthcare appointments to obtain contraceptives.

A mistaken belief that the woman is infertile, e.g.
post-menopausal, previous diagnosis of infertility

Feelings towards a pregnancy can change during the

course of a pregnancy. For instance, a change of circumstances might lead to the continued pregnancy being 3 Facts
unwanted and perhaps a desire to terminate an initially
intended pregnancy. On the other hand, an initially unin- Live births: Unless the fetus dies in utero, the result of
tended pregnancy might later be welcomed.
unintended pregnancies is unintended births. According
Couples often desire to control not just the number of to one study, over one third of living people in the US
under 31 years of age (born since 1982) were the result of
children, but also the timing.[8][9]
1

unintended pregnancies, a rate that has remained largely

unchanged to date.[12]
Pregnancy has risks and potential complications. On average, unintended pregnancies result in poorer outcomes
for the mother and for the child, if birth occurs. Unintended pregnancy usually precludes pre-conception counseling and pre-conception care, and sometimes delays initiation of prenatal care.[13] The great majority of abortions result from unintended pregnancies.
Results of unintended pregnancy include:

FACTS

Greater infant mortality.[5][16] If all sexually active

couples in the US had routinely used eective contraception in 1980, there would have been 1 million
fewer abortions, 340,000 fewer live births that were
unintended at conception, 5,000 fewer infant deaths,
and the infant mortality rate would have been 10%
lower.[5]
Likely to be less mentally and physically healthy during childhood.[17]
At higher risk of child abuse and neglect.[5][18]

Prenatal care initiated later, and less adequate.[5]

Adversely aects health of woman and of child and
less preparation for parenthood.[5] Delay from unintended pregnancy is in addition to that from other
risk factors for delay.[5] Unwanted pregnancies have
more delay than mistimed.[5]
Unintended pregnancies preclude chance to resolve sexually transmitted diseases (STD) before
pregnancy.[5] Untreated STD in pregnant woman
can result in premature delivery, infection in newborn or infant death.[5]

Less likely to succeed in school,[19]

More likely to live in poverty and need public assistance.[19]
More likely to have delinquent and criminal
behavior.[19] (see also Legalized abortion and crime
eect)
Signicantly lower test scores[15]
Less likely to have a close relationship with their
mother.[15]

Preclude use of genetic testing to help make deciUnintended pregnancies lead to higher rates of matersions about whether to become pregnant.
nal morbidity, and threaten the economic viability of
[16]
Women with an unintended pregnancy are more families.
likely to suer depression during or after preg- Women with unintended pregnancies have less education
nancy.[13][14]
and participate less in the workforce than women whose
pregnancies are intended.[19]

Poorer maternal mental health[13]

Increased risk
pregnancy.[13]

of

physical

violence

during

3.1 Induced abortions

Reduced likelihood of breastfeeding, resulting in Main article: Abortion

less healthy children.[13]
Lower mother-child relationship quality.[13] (see Abortion, the voluntary termination of pregnancy, is one
also Maternal bond)
of the primary consequences of unintended pregnancy.[5]
A large proportion of induced abortions worldwide are
More likely that mother smokes tobacco (about 30%
[20][21]
Unin[5] due to unwanted or mistimed pregnancy.
more likely in the US) or drinks during pregnancy,
tended pregnancies result in about 42 million induced
which results in poorer health outcomes and addiabortions per year worldwide.[6] In the United States,
tional costs for welfare system.[5] (see also Fetal alover 92% of abortions are the result of unintended
cohol syndrome, Fetal alcohol spectrum disorder)
pregnancy.[19]
[15]
Greater relationship and stability
Abortion carries few health risks when performed in accordance with modern medical technique.[5][22][23] It is
safer for the pregnant woman than childbirth.[5][24][25]
However where safe abortions are not available, abortion
Children whose births were unintended are:
can contribute signicantly to maternal mortality[26] and
[22]
Greater likelihood of low birth weight, particu- morbidity.
larly for unwanted pregnancies.[5][16] This may be While decisions about abortion may cause some indithrough increased risk of preterm delivery.[5] In the viduals psychological distress,[27] some nd a reduction
US, eliminating all unwanted pregnancies would re- in distress after abortion.[5][28] There is no evidence of
duce rate of low birth weight by 7% for blacks, and widespread psychological harm from abortion.[5][29][30]
4% for whites, helping to decrease the large dispar- Unwanted pregnancy and births resulting from these
pregnancies are also psychologically distressing, so
ity in rates for whites vs. blacks.[5]
More likely to delay initiation of prenatal care[15]

3
considerations of psychological impact of abortion have little income, so even though contraceptives are
should be in comparison to potential harm from these highly cost-eective,[35] up front cost can be a barrier.
stressors.[31][32]
Subsidized family planning services improve the health
governments and
[5]
Some nd abortion morally objectionable. This could of the population and saves money for[13]
health
insurers
by
reducing
medical,
education and
be due to religious beliefs, ones own personal beliefs or
other
costs
to
society.
the context of the situation.

3.2

Maternal deaths

Main article: Maternal death

Providing modern contraceptives to the 201 million

women at risk of unintended pregnancy in developing
countries who do not have access to contraception would
cost an estimated US$3.9 billion per year.[36] 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).[36] Reduced illness related
to pregnancy would preserve 27 million healthy life years,
at a cost of $144 per year of healthy life.[36]

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).[33] These unwanted
pregnancies resulted in nearly 700,000 maternal deaths It is theorized that reducing unintended pregnancies could
(approximately one-fth of maternal deaths during that help break the cycle of poverty.[37]
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
5 Epidemiology
unsanitary abortion.[33] Most of the deaths occurred in
less developed parts of the world, where family planning
Note: Numbers and rates are for detected pregnancies.
and reproductive health services were less available.[33]
A large proportion of pregnancies miscarry before the
In cultures that practice honor killing, unintended pregwoman is aware of the pregnancy.
nancy may increase the womans chance of being killed.

Prevention

5.1 Incidence

The global rate of unintended pregnancy was 55 per 1,000

women aged 1544 in 2008, of which 26 per 1,000 ended
in abortion.[38] The rate of intended pregnancy was 79
per 1,000.[38] The estimated 208 million pregnancies in
Prevention includes comprehensive sexual education, 2008 resulted in 102 million intended births, 41 million
availability of family planning services, abstinence and induced abortions, 33 million unintended births, and 31
increased access to a range of eective birth control million miscarriages.[38]
methods. Most unintended pregnancies result from not
using contraception, and many result from using contra- Globally, the proportion of married women practicing
ceptives inconsistently or incorrectly. Though, increased contraception increased from 54% in 1990 to 63% in
2003.[38] The global rate of unintended pregnancy derates of sexual activity are also a factor.[34]
clined from 69 per 1,000 women in 1995.[38] The decline
Increasing use of long-acting reversible contraceptives was greatest in the more developed world.[38]
(such as IUD and contraceptive implants) decreases the
chance of unintended pregnancy by decreasing the chance Worldwide, 38% of pregnancies were unintended in 1999
[6][7]
of incorrect use. Method failure is relatively rare with (some 80 million unintended pregnancies in 1999).
modern, highly eective contraceptives, and is much In developed world an estimated 49% of pregnancies
[7]
more of an issue when such methods are unavailable or were unintended, 36% in the developing world.
not used. (See comparison of contraceptive methods).
Main article: Family planning

In the United States, women who have an unintended

pregnancy are more likely to have subsequent unplanned 6 By country/region
pregnancies.[14] Providing family planning and contraceptive services as part of prenatal, postpartum and post 6.1 Europe
abortion care can help reduce recurrence of unintended
pregnancy.
6.1.1 Britain
Providing contraceptives and family planning services at
low or no cost to the user helps prevent unintended preg- In Britain, approximately 16% of pregnancies are unnancies. Many of those at risk of unintended pregnancy planned, 29% ambivalent, and 55% planned.[39]

4
6.1.2

6 BY COUNTRY/REGION
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).[40]

6.1.3

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.[41]

6.2

United States of America

The United States rate of unintended pregnancies is

higher than the world average, and much higher than that
in other industrialized nations.[42] Almost half (49%) of
U.S. pregnancies are unintended, more than 3 million unintended pregnancies per year.[10][35]
A 2011 study by the Guttmacher Institute based on data
from the Centers for Disease Control and Prevention and
other sources determined that the average U.S. rate of
unintended pregnancies was 51 per 1,000 women ages
15 to 44 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, 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).[43][44]
Over 92% of abortions are the result of unintended
pregnancy,[19] unintended pregnancies result in about 1.3
million abortions/year.[6] In 2001, 44% of unintended
pregnancies resulted in births, and 42% resulted in induced abortion and the rest in miscarriage.[42] It is estimated that more than half of US women have had an
unintended pregnancy by age 45.[45] 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 (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 (5 to 6 abortions per 1,000 women). [46][47]

6.2.1 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, which
was completed in 1973. The decline in birth rate was associated with reductions in the number of children put up
for adoption and reduction in the rate of neonaticide.
It is unclear to what extent legalization of abortion may have increased the availability of the
procedure.[5] It is estimated that before legalization about 1 million abortions were performed
annually.[5] Before legalization, abortion was probably one of the most common criminal activities.[5]
Before legalization, an estimated 1,000 to 10,000
women died each year from complications of poorly
performed abortions.[5] 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, conditions more
common than induced abortion.[5]
The infanticide rate during the rst hour of life
dropped from 1.41 per 100,000 during 1963 to 1972
to 0.44 per 100,000 for 1974 to 1983; the rate during the rst month of life also declined, whereas the
rate for older infants rose during this time.[48]
The rate of unintended pregnancy declined signicantly
from 1987 until 1994, due to increased contraceptive
use.[49][50] Since then until 2001 the rate has remained
relatively unchanged.[50]
The proportion of births that were unintended at time of
conception decreased during the 1970s and early 1980s.
Between 1982 and 1988 the proportion of births that were
unintended began increasing.[5] In 1990 about 44% of
births were unintended at time of conception.[5] The fraction of births that were unintended at time of conception was even higher among lower class women (almost
60%), never-married women (73%) and unmarried teens
(86%).[5]
Among lower class women, the rate of unintended pregnancy and unintended birth rose from 1994 to 2001,
while it declined for the more auent women (those
>200% of federal poverty level).[50] (Unintended pregnancy rose almost 30% and unintended births rose 50%
for those below federal poverty level.) Contraceptive use
had been increasing for years, but stopped in the 1990s,
and began to decline among lower class women.[51] Cuts
in federal and state family planning programs may ac-

5
count for the decreased use of contraceptives and increase nancies result from couples not using contraception in the
in unintended pregnancies.[51]
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
6.2.2 Costs and potential savings
Guttmacher Institute.[6] Contraceptive use saved an estimated $19 billion in direct medical costs from unintended
The public cost of unintended pregnancy is estimated to pregnancies in 2002.[52]
be about 11 billion dollars per year in short term medical costs.[19] This includes costs of births, one year of In 2006, publicly funded family planning services (Title
infant medical care and costs of fetal loss.[19] Prevent- X, medicaid, and state funds) helped women avoid 1.94
ing unintended pregnancy would save the public over 5 million unintended pregnancies, thus preventing about
[59]
billion dollars per year in short term medical costs.[19] 860,000 unintended births and 810,000 abortions.
Savings in long term costs and in other areas would be Without publicly funded family planning services, the
much larger.[19] By another estimate, the direct medi- number of unintended pregnancies and abortions in the
cal costs of unintended pregnancies, not including infant United States would be nearly two-thirds higher among
medical care, was $5 billion in 2002.[52] The Brookings women overall and among teens; the number of unamong lower class women would
Institution conducted a research and their results show intended pregnancies
[59]
nearly
double
The
services
provided at publicly funded
that taxpayers spend more than $12 billion each year on
clinics
saved
the
federal
and
state governments an estiunintended pregnancies. They also nd that, if all unmated
$5.1
billion
in
2008
in
short
term medical costs.[59]
intended pregnancies were prevented, the resulting savings on medical spending alone would equal more than Nationally, every $1.00 invested in helping women avoid
expendithree quarters of the federal FY 2010 appropriation for unintended pregnancy saved $3.74 in Medicaid
[59]
tures
that
otherwise
would
have
been
needed.
the Head Start and Early Head Start programs and would
be roughly equivalent to the amount that the federal gov- Reducing unintended pregnancy in the United States
ernment spends each year on the Child Care and Devel- would be particularly desirable since abortion is such a
opment Fund (CCDF).[53]
politically divisive issue.[5]
6.2.3

Teens

See also: Adolescent sexuality in the United States

The CDC encourages men and women to formulate a

reproductive life plan, to help them in avoiding unintended pregnancies and to improve the health of women
and reduce adverse pregnancy outcomes.[60]

Of the 800,000 teen pregnancies per year,[54] over 80%

were unintended in 2001.[6] One-third of teen pregnancies result in abortion.[54] In 2002, about 9% of women
at risk for unintended pregnancy were teenagers,[40] but
about 20% of the unintended pregnancies in the United
States are to teenagers.[55] A somewhat larger proportion of unintended births are reported as mistimed, rather
than unwanted, for teens compared to women in general
(79% mistimed for teens vs. 69% among all women in
1998).[56]

6.2.5 Rape

In 2011, a total of 329,797 babies were born to women

aged 1519 years, for a live birth rate of 31.3 per 1,000
women in this age group.1 This is a record low for U.S.
teens in this age group, and a drop of 8% from 2010.
Birth rates fell 11% for women aged 1517 years, and
7% for women aged 1819 years. While reasons for the
declines are not clear, teens seem to be less sexually active, and more of those who are sexually active seem to
be using birth control than in previous years.[57]

A longitudinal study in 1996 of over 4000 women in the

United States followed for 3 years found that the raperelated pregnancy rate was 5.0% among victims 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.[62]

Main article: Pregnancy from rape

Rape is dened as sexual intercourse that is forced on
a person without his or her permission. It may involve
physical force, the threat of force, or it may be done
against someone who is unable to give consent. Sexual
intercourse may be vaginal, anal, or oral, and may involve
the use of a body part or an object.[61]

7 History
6.2.4

Prevention

See also: History of abortion, History of condoms and

Abstinence from sexual activity is the only 100 percent Timeline of reproductive rights legislation
eective way to avoid unintended pregnancy.[58]
In the US it is estimated that 52% of unintended preg- Early ways of preventing unwanted pregnancy included

10

withdrawal and various alternatives to intercourse; they

are dicult to use correctly and, while much better than
no method, have high failure rates compared to modern
methods.[8][63] 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,[5] abortion methods are described in some
of the earliest medical texts.[63] The degree of safety
of early methods relative to the risks of child birth is
unclear.[63]
Infanticide (customary neonaticide) or abandonment
(sometimes in the form of exposure) are other traditional
way of dealing with babies that were not wanted or that a
family could not support.[63] Opinions on the morality or
desirability of the practices have changed through history.
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.[8] In many cases, as contraceptives became more
available the rate of unintended pregnancy and abortion
dropped rapidly during the 1990s.[8]
In the 19th and 20th century, the desired number of pregnancies has declined as reductions in infant and childhood
mortality have increased the probability that children will
reach adulthood. Other factors, such as level of education
and economic opportunities for women, have also lead to
reductions in the desired number of children.[8] As the
number of desired number of children decreases, couples
spend more of their reproductive lives trying to avoid unintended pregnancies.[8]

See also
Contraceptive mandate
Demographic dividend
Epidemiology of teenage pregnancy
Feminization of poverty
Healthy People
International Conference on Population and Development
Legalized abortion and crime eect
The Impact of Legalized Abortion on Crime
Millennium Development Goals
Miscarriage

REFERENCES

Nutrition and pregnancy

Religious views on birth control
Take Charge

9 Additional reading
Eisenberg, Leon; Brown, Sarah Hart (1995). The
best intentions: unintended pregnancy and the wellbeing of children and families. Washington, D.C:
National Academy Press. ISBN 0-309-05230-0.
Mosher, William D., Jo Jones, and Joyce C. Abma.
(2012). Intended and unintended births in the
United States, 1982-2010. Hyattsville, Md.: U.S.
Department of Health and Human Services, Centers
for Disease Control and Prevention, National Center
for Health Statistics.

10 References
[1] Unintended Pregnancy Prevention. Centers for Disease
Control and Prevention. Retrieved November 13, 2013.
[2] Dawn Stacey: Contraception. About.com. Retrieved 11
October 2009.
[3] Wyatt, Kirk D; Anderson, Ryan T; Creedon, Douglas;
Montori, Victor M; Bachman, John; Erwin, Patricia;
LeBlanc, Annie (2014). Womens values in contraceptive choice: a systematic review of relevant attributes included in decision aids. BMC Womens Health 14 (1): 28.
doi:10.1186/1472-6874-14-28. PMID 3932035.
[4] Hanson, S.J.; Burke, Anne E. (21 December 2010).
Fertility control: contraception, sterilization, and abortion. In Hurt, K. Joseph; Guile, Matthew W.; Bienstock, Jessica L.; Fox, Harold E.; Wallach, Edward E. The
Johns Hopkins manual of gynecology and obstetrics (4th
ed.). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins. pp. 382395. ISBN 978-1-60547433-5.
[5] Eisenberg, Leon; Brown, Sarah Hart (1995). The best intentions: unintended pregnancy and the well-being of children and families. Washington, D.C: National Academy
Press. ISBN 0-309-05230-0. Retrieved 2011-09-03.
[6] J. Joseph Speidel, Cynthia C. Harper, and Wayne
C. Shields (September 2008).
The Potential of
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200. doi:10.1016/j.contraception.2008.06.001. PMID
18692608.
[7] Sharing Responsibility:Women, Society and Abortion
Worldwide (PDF) (Report). 1999.
[8] Abortion in Context: United States and Worldwide.
Alan Guttmacher Institute. May 1999. Retrieved 201108-28.

[9] Healthy Timing and Spacing of Pregnancy: HTSP Messages. USAID. Retrieved 2008-05-13.
[10] Hatcher, Robert D. (2011). Contraceptive Technology
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11

External links

CDC:Unintended Pregnancy Prevention

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12

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