Unintended pregnancy
Encyclopedia
Unintended pregnancies are those in which conception
was not intended by the female sexual partner
. Worldwide, 38% of pregnancies
were unintended in 1999 (some 80 million unintended pregnancies in 1999). Unintended pregnancies are the primary cause of induced abortion
, resulting in about 42 million induced abortions per year. Unintended pregnancy is also linked to higher rates of maternal
and infant
deaths.
The use of modern contraceptive methods has greatly reduced the incidence of unintended pregnancy, particularly in more developed countries. However the United States has an unusually high rate of unintended pregnancy, especially among the poor.
Unintended pregnancies may arise within a committed relationship
, such as marriage, as well as resulting from casual sexual activity, or as a result of rape.
Reasons contraceptives might not have been used or been used incorrectly include:
, and pre-conception care, and delays initiation of prenatal care
. The great majority of abortions result from unintended pregnancies.
Results of unintended pregnancy include:
Children whose births were unintended are:
Unintended pregnancies lead to higher rates of maternal morbidity, and threaten the economic viability of families.
Women with unintended pregnancies have less education and participate less in the workforce than women whose pregnancies are intended.
. A large proportion of induced abortions worldwide are due to unwanted or mistimed pregnancy.
Unintended pregnancies result in about 42 million induced abortion
s per year worldwide. In the United States, over 92% of abortions are the result of unintended pregnancy.
Abortion carries few health risks when performed in accordance with modern medical technique. It is far safer than child birth. However where safe abortions are not available, abortion can contribute significantly to maternal mortality and morbidity.
While decisions about abortion may cause some individuals psychological distress, some find a reduction in distress after abortion. There is no evidence of widespread psychological harm from abortion. Unwanted pregnancy and unwanted birth are also psychologically distressing, so considerations of psychological impact of abortion should be in comparison to potential harm from these stressors.
Some find abortion morally objectionable.
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
. Most of the deaths occurred in less developed parts of the world, where family planning
and reproductive health
services were less available.
Pre and postnatal depression contributes to increased risk of suicide among pregnant women and mothers. Suicide contributes to the rate of maternal mortality; where the rate of maternal deaths from physical causes is reduced by medically safe abortions and child delivery, the proportion from psychological problems can become more significant.
In cultures that practice honor killing
, unintended pregnancy may increase the woman's chance of being killed.
. Unwanted children may also be abandoned
, especially where social structures to handle adoption are not available.
Unwanted children are sometimes put up for adoption
.
(Related , Unwanted child.)
services, including access to a range of effective birth control
methods. Most unintended pregnancies result from not using contraception, many more result from using contraceptives inconsistently or incorrectly. Increasing use of long-acting reversible contraceptives (such as IUD and contraceptive implant
s) decreases the chance of unintended pregnancy by decreasing the chance of incorrect use. Method failure is relatively rare with modern, highly effective contraceptives, and is much more of an issue when such methods are unavailable, unaffordable, or not used. (See comparison of contraceptive methods).
In the United States, women who have an unintended pregnancy are more likely to have subsequent unplanned pregnancies. Providing family planning and contraceptive services as part of prenatal, postpartum and post abortion care can help reduce recurrence of unintended pregnancy.
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, 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, education and other costs to society.
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. 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). Reduced illness related to pregnancy would preserve 27 million healthy life years, at a cost of $144 per year of healthy life.
It is theorized that preventing unintended pregnancies could help break the cycle of poverty
.
Affordable contraceptive
services should form the basis for child abuse prevention. "The starting point for effective child abuse programming is pregnancy planning
" US Surgeon General C. Everett Koop
Globally, the proportion of married women practicing contraception increased from 54% in 1990 to 63% in 2003.
The global rate of unintended pregnancy declined from 69 per 1,000 women in 1995. The decline was greatest in the more developed world.
Worldwide, 38% of pregnancies were unintended in 1999 (some 80 million unintended pregnancies in 1999). In developed world an estimated 49% of pregnancies were unintended, 36% in the developing world.
Unintended pregnancy is more likely among the poor, who have less access to contraceptives, less education about sexuality and family planning, and may have fewer career opportunities. In the United States, teen pregnancies are more likely than others to be unintended. Often as a result of lack of knowledge about sexuality and contraceptives, inexperience using contraceptives, difficulty getting contraceptives, or lack of planning. Women nearing menopause also have an increased risk of unintended pregnancy; as periods become less regular, a woman may assume that she can no longer have children, and stop using contraceptives, or use them less consistently.
s (IUDs).
. It is estimated that more than half of US women have had an unintended pregnancy by age 45.
in 1970; 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.
The rate of unintended pregnancy declined significantly from 1987 until 1994, due to increased contraceptive use Since then until 2001 the rate has remained relatively unchanged.
Among poor women, the rate of unintended pregnancy and unintended birth rose from 1994 to 2001, while it declined for the more affluent women (those >200% of federal poverty level). (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 poorer women. Cuts in federal and state family planning programs may account for the decreased use of contraceptives and increase in unintended pregnancies.
By another estimate, the direct medical costs of unintended pregnancies, not including infant medical care, was $5 billion in 2002.
per year, over 80% were unintended in 2001. One-third of teen pregnancies result in abortion. In 2002, about 9% of women at risk for unintended pregnancy were teenagers, but about 20% of the unintended pregnancies in the United States are to teenagers. 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).
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
. Contraceptive use saved an estimated $19 billion in direct medical costs from unintended pregnancies in 2002.
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. 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; the number of unintended pregnancies among poor women would nearly double
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. Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed.
Reducing unintended pregnancy in the United States would be particularly desirable since abortion is such a politically divisive issue.
and various alternatives to intercourse; they are difficult to use correctly and, while much better than no method, have high failure rates compared to modern methods. 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, abortion methods are described in some of the earliest medical texts. The degree of safety of early methods relative to the risks of child birth is unclear.
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. 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 unwanted 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. In many cases, as contraceptives became more available the rate of unintended pregnancy and abortion dropped rapidly during the 1990s.
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. As the number of desired number of children decreases, couples spend more of their reproductive lives trying to avoid unintended pregnancies.
, which may carry social stigma, result in persecution or honor killing
. Sometimes, in order to prevent illegitimate children, forced marriage
s result. Such marriages typically have poorer outcomes than voluntary marriage.
In many industrialized nations there is increasing acceptance of premarital sex, single parent
ing, and children born outside wedlock.
Unintended pregnancy is common as a cause of stress or social stigma in fictional works. It plays a role in many portrayals of illegitimacy
and teen pregnancy.
Human fertilization
Human fertilization is the union of a humanoid egg and sperm, usually occurring in the ampulla of the uterine tube. The result of this union is the production of a zygote, or fertilized egg, initiating prenatal development...
was not intended by the female sexual partner
Sexual partner
Sexual partners are people who engage in sexual activity together. The sexual partners can be of any gender or sexual orientation. The sexual partners may be in a committed relationship, either on an exclusive basis or not, or engage in the sexual activity on a casual basis...
. Worldwide, 38% of pregnancies
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
were unintended in 1999 (some 80 million unintended pregnancies in 1999). Unintended pregnancies are the primary cause of induced abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
, resulting in about 42 million induced abortions per year. Unintended pregnancy is also linked to higher rates of maternal
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...
and infant
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
deaths.
The use of modern contraceptive methods has greatly reduced the incidence of unintended pregnancy, particularly in more developed countries. However the United States has an unusually high rate of unintended pregnancy, especially among the poor.
Unintended pregnancies may arise within a committed relationship
Committed relationship
A committed relationship is an interpersonal relationship based upon a mutually agreed-upon commitment to one another involving exclusivity, honesty, openness, or some other agreed-upon behavior. Forms of committed relationships are: close friendship, courtship, long-term relationships ,...
, such as marriage, as well as resulting from casual sexual activity, or as a result of rape.
Family planning
Becoming pregnant and having a baby are major events in a female's life, as well as that of her partner and family. Couples desire to control not just the number of children, but also the timing. Health outcomes for the child and for the mother are improved by not starting to have children too early, and by allowing adequate spacing between births. Economic and social factors, such as completing education and achieving a level of economic security, also play roles in desires when to have children.Causes
- Not using contraception.
- Using contraception inconsistently or incorrectly.
- Contraceptive failure (the method was used correctly, but did not work.) Accounts for relatively small fraction of unintended pregnancies when modern highly effective contraceptives are used.
Reasons contraceptives might not have been used or been used incorrectly include:
- Coercion. RapeRapeRape is a type of sexual assault usually involving sexual intercourse, which is initiated by one or more persons against another person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority or with a person who is incapable of valid consent. The...
or involuntary sex which sometimes happens in the context of domestic violenceDomestic violence and pregnancyPregnancy when coupled with domestic violence is a form of intimate partner violence where health risks may be amplified. Abuse during pregnancy, whether physical, verbal or emotional, produces many adverse physical and psychological effects for both the mother and fetus...
. Unintended pregnancies are more likely to be associated with abuse than intended pregnancies. This may also include birth control sabotageBirth control sabotageBirth control sabotage, or reproductive coercion, refers to efforts to manipulate another person's use of birth control or to undermine efforts to prevent an unwanted pregnancy. Examples include replacing birth control pills with fakes, puncturing condoms and diaphragms, or threats and violence to...
- manipulation of someone's use of birth control to undermine efforts to prevent pregnancy. - Lack of knowledge about sex and reproduction. Including erroneous beliefs.
- Lack of knowledge or experience with the contraceptive, or lack of motivation to use it correctly.
- Lack of planning or ambivalence about whether to have a child.
Results
Unintended pregnancies result in poorer outcomes for the mother and for the child, if birth occurs. Unintended pregnancy precludes pre-conception counselingPre-conception counseling
Pre-conception counseling is based on the medical theory that all women of child-bearing years should be pre-screened for health and risk potentials before attempting to become pregnant...
, and pre-conception care, and delays initiation of prenatal care
Prenatal care
Prenatal care refers to the medical and nursing care recommended for women before and during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible , and to direct the woman to appropriate specialists, hospitals, etc...
. The great majority of abortions result from unintended pregnancies.
Results of unintended pregnancy include:
- Prenatal care initiate later, and less adequate. Adversely affects health of woman and of child and less preparation for parenthood. Delay from unintended pregnancy is in addition to that from other risk factors for delay. Unwanted pregnancies have more delay than mistimed.
- Unintended pregnancies preclude chance to resolve sexually transmitted diseases (STD) before pregnancy. Untreated STD in pregnant woman can result in premature delivery, infection in newborn or infant death.
- Preclude use of genetic testing to help make decisions about whether to become pregnant.
- Women with an unintended pregnancy are more likely to suffer depression during or after pregnancyPostpartum depressionPostpartum depression , also called postnatal depression, is a form of clinical depression which can affect women, and less frequently men, typically after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual...
. - Poorer maternal mental health
- Increased risk of physical violence during pregnancy
- Reduced likelihood of breastfeedingBreastfeedingBreastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
, resulting in less healthy children - Lower mother-child relationship quality (see also Maternal bondMaternal bondThe maternal bond is typically the relationship between a mother and her child.While it typically occurs due to pregnancy and childbirth, it may also occur between a woman and an unrelated child, such as in adoption...
) - More likely that mother smokes tobaccoSmoking and pregnancyTobacco smoking and pregnancy is related to many effects on health and reproduction, in addition to the general health effects of tobacco. A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other...
(about 30% more likely in the US) or drinks during pregnancy. Which results in poorer health outcomes and additional costs for welfare system. (see also Fetal alcohol syndromeFetal alcohol syndromeFetal alcohol syndrome is a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy. Current research also implicates other lifestyle choices made by the prospective mother...
, Fetal alcohol spectrum disorderFetal alcohol spectrum disorderFetal Alcohol Spectrum Disorders describes a continuum of permanent birth defects caused by maternal consumption of alcohol during pregnancy, which includes, but is not limited to fetal alcohol syndrome...
)
Children whose births were unintended are:
- Greater liklihood of low birth weight, particularly for unwanted pregnancies. In US eliminating all unwanted pregnancies would reduce rate of low birth weight by 7% for blacks, and 4% for whites, helping to decrease the large disparity in rates for whites vs. blacks. May be through increased risk preterm delivery.
- Greater infant mortality. If all sexually active couples in the US had routineley used effective contrectiption 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.
- likely to be less mentally and physically healthy during childhood,
- at higher risk of child abuseChild abuseChild abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...
and neglectChild neglectChild neglect is defined as:# "the failure of a person responsible for a child’s care and upbringing to safeguard the child’s emotional and physical health and general well-being"...
, - less likely to succeed in school,
- more likely to live in povertyChild povertyChild poverty refers to the phenomenon of children living in poverty. This applies to children that come from poor families or orphans being raised with limited, or in some cases absent, state resources. Children that fail to meet the minimum acceptable standard of life for the nation where that...
, - more likely to need public assistance,
- more likely to have delinquentJuvenile delinquencyJuvenile delinquency is participation in illegal behavior by minors who fall under a statutory age limit. Most legal systems prescribe specific procedures for dealing with juveniles, such as juvenile detention centers. There are a multitude of different theories on the causes of crime, most if not...
and criminal behavior. (see also Legalized abortion and crime effectLegalized abortion and crime effectThe effect of legalized abortion on crime is the theory that legal abortion reduces crime. Proponents of the theory generally argue that since unwanted children are more likely to become criminals and that an inverse correlation is observed between the availability of abortion and subsequent crime...
)
Unintended pregnancies lead to higher rates of maternal morbidity, and threaten the economic viability of families.
Women with unintended pregnancies have less education and participate less in the workforce than women whose pregnancies are intended.
Induced abortions
A woman who finds herself pregnant may terminate the pregnancy by an abortionAbortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
. A large proportion of induced abortions worldwide are due to unwanted or mistimed pregnancy.
Unintended pregnancies result in about 42 million induced abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
s per year worldwide. In the United States, over 92% of abortions are the result of unintended pregnancy.
Abortion carries few health risks when performed in accordance with modern medical technique. It is far safer than child birth. However where safe abortions are not available, abortion can contribute significantly to maternal mortality and morbidity.
While decisions about abortion may cause some individuals psychological distress, some find a reduction in distress after abortion. There is no evidence of widespread psychological harm from abortion. Unwanted pregnancy and unwanted birth are also psychologically distressing, so considerations of psychological impact of abortion should be in comparison to potential harm from these stressors.
Some find abortion morally objectionable.
Maternal deaths
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). 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
Unsafe abortion
An unsafe abortion is the termination of an unwanted pregnancy by persons lacking the necessary skills, or in an environment lacking minimal medical standards, or both...
. Most of the deaths occurred in less developed parts of the world, where family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
and reproductive health
Reproductive health
Within the framework of the World Health Organization's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system...
services were less available.
Pre and postnatal depression contributes to increased risk of suicide among pregnant women and mothers. Suicide contributes to the rate of maternal mortality; where the rate of maternal deaths from physical causes is reduced by medically safe abortions and child delivery, the proportion from psychological problems can become more significant.
In cultures that practice honor killing
Honor killing
An honor killing or honour killing is the homicide of a member of a family or social group by other members, due to the belief of the perpetrators that the victim has brought dishonor upon the family or community...
, unintended pregnancy may increase the woman's chance of being killed.
Unwanted births
Infants whose births were not wanted are more likely to die of infanticideInfanticide
Infanticide or infant homicide is the killing of a human infant. Neonaticide, a killing within 24 hours of a baby's birth, is most commonly done by the mother.In many past societies, certain forms of infanticide were considered permissible...
. Unwanted children may also be abandoned
Child abandonment
Child abandonment is the practice of relinquishing interests and claims over one's offspring with the intent of never again resuming or reasserting them. Causes include many social and cultural factors as well as mental illness. An abandoned child is called a foundling .-Causes:Poverty is often a...
, especially where social structures to handle adoption are not available.
Unwanted children are sometimes put up for adoption
Adoption
Adoption is a process whereby a person assumes the parenting for another and, in so doing, permanently transfers all rights and responsibilities from the original parent or parents...
.
(Related , Unwanted child.)
Prevention
Prevention includes comprehensive sexual education, availability of family planningFamily planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
services, including access to a range of effective birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
methods. Most unintended pregnancies result from not using contraception, many more result from using contraceptives inconsistently or incorrectly. Increasing use of long-acting reversible contraceptives (such as IUD and contraceptive implant
Contraceptive implant
A contraceptive implant is a birth control device inserted under the skin. Brands include:*Norplant and Jadelle *Implanon*Sino-implant marketed as Zarin, Femplant and Trust*Nexplanon Implanon replacement...
s) decreases the chance of unintended pregnancy by decreasing the chance of incorrect use. Method failure is relatively rare with modern, highly effective contraceptives, and is much more of an issue when such methods are unavailable, unaffordable, or not used. (See comparison of contraceptive methods).
In the United States, women who have an unintended pregnancy are more likely to have subsequent unplanned pregnancies. Providing family planning and contraceptive services as part of prenatal, postpartum and post abortion care can help reduce recurrence of unintended pregnancy.
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, 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, education and other costs to society.
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. 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). Reduced illness related to pregnancy would preserve 27 million healthy life years, at a cost of $144 per year of healthy life.
It is theorized that preventing unintended pregnancies could help break the cycle of poverty
Cycle of poverty
In economics, the cycle of poverty is the "set of factors or events by which poverty, once started, is likely to continue unless there is outside intervention."...
.
Affordable contraceptive
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
services should form the basis for child abuse prevention. "The starting point for effective child abuse programming is pregnancy planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
" US Surgeon General C. Everett Koop
C. Everett Koop
Charles Everett Koop, MD is an American pediatric surgeon and public health administrator. He was a vice admiral in the Public Health Service Commissioned Corps, and served as thirteenth Surgeon General of the United States under President Ronald Reagan from 1982 to 1989.-Early years:Koop was born...
Epidemiology
Note: Numbers and rates are for detected pregnancies. A large proportion of pregnancies miscarry before the woman is aware of the pregnancy.Incidence
The global rate of unintended pregnancy was 55 per 1,000 women aged 15–44 in 2008, of which 26 per 1,000 ended in abortion. The rate of intended pregnancy was 79 per 1,000. The estimated 208 million pregnancies in 2008 resulted in 102 million intended births, 41 million induced abortions, 33 million unintended births, and 31 million miscarriages.Globally, the proportion of married women practicing contraception increased from 54% in 1990 to 63% in 2003.
The global rate of unintended pregnancy declined from 69 per 1,000 women in 1995. The decline was greatest in the more developed world.
Worldwide, 38% of pregnancies were unintended in 1999 (some 80 million unintended pregnancies in 1999). In developed world an estimated 49% of pregnancies were unintended, 36% in the developing world.
Unintended pregnancy is more likely among the poor, who have less access to contraceptives, less education about sexuality and family planning, and may have fewer career opportunities. In the United States, teen pregnancies are more likely than others to be unintended. Often as a result of lack of knowledge about sexuality and contraceptives, inexperience using contraceptives, difficulty getting contraceptives, or lack of planning. Women nearing menopause also have an increased risk of unintended pregnancy; as periods become less regular, a woman may assume that she can no longer have children, and stop using contraceptives, or use them less consistently.
Europe
In France, 33% of pregnancies are unintended. Of women at risk for unintended pregnancy, only 3% do not use contraception, and 20% use Intrauterine deviceIntrauterine device
A copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
s (IUDs).
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. Almost half (49%) of U.S. pregnancies are unintended, more than 3 million unintended pregnancies per year. Over 92% of abortions are the result of unintended pregnancy, unintended pregnancies result in about 1.3 million abortions/year. The rate of abortions is high in the United States than in other developed countries because of the higher rate of unintended pregnancies in the US. In 2001, 44% of unintended pregnancies resulted in births, and 42% resulted in induced abortion and the rest in miscarriageMiscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
. It is estimated that more than half of US women have had an unintended pregnancy by age 45.
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 XTitle X
The Title X Family Planning Program, officially known as Public Law 91-572 or “Population Research and Voluntary Family Planning Programs” was enacted under President Richard Nixon in 1970 as part of the Public Health Service Act...
in 1970; 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. It is estimated that before legalization about 1 million abortions were performed annually. Before legalization, aboriton was probably one of the most common criminal activities. Before legalization, an estimated 1,000 to 10,000 women died each year from complications of poorly preformed abortions. 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.
- The infanticide rate during the first 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 first month of life also declined, whereas the rate for older infants rose during this time.
The rate of unintended pregnancy declined significantly from 1987 until 1994, due to increased contraceptive use Since then until 2001 the rate has remained relatively unchanged.
| Year | Unintended pregnancies | Unintended births |
|---|---|---|
| 1981 | 54.2 | 25 |
| 1987 | 53.5 | 27 |
| 1994 | 44.7 | 21 |
| 2001 | 51 |
Among poor women, the rate of unintended pregnancy and unintended birth rose from 1994 to 2001, while it declined for the more affluent women (those >200% of federal poverty level). (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 poorer women. Cuts in federal and state family planning programs may account for the decreased use of contraceptives and increase in unintended pregnancies.
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. This includes costs of births, one year of infant medical care and costs of fetal loss. Preventing unintended pregnancy would save the public over 5 billion dollars per year in short term medical costs. Savings in long term costs and in other areas would be much larger.By another estimate, the direct medical costs of unintended pregnancies, not including infant medical care, was $5 billion in 2002.
Teens
Of the 800,000 teen pregnanciesTeenage pregnancy
Teenage pregnancy is a pregnancy of a female under the age of 20 when the pregnancy ends. It generally refers to a female who is unmarried and usually refers to an unplanned pregnancy...
per year, over 80% were unintended in 2001. One-third of teen pregnancies result in abortion. In 2002, about 9% of women at risk for unintended pregnancy were teenagers, but about 20% of the unintended pregnancies in the United States are to teenagers. 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).
Prevention
In the US it is estimated that 52% of unintended pregnancies result from couples not using contraceptionBirth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
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
Guttmacher Institute
The Guttmacher Institute is a non-profit organization which works to advance sexual and reproductive health. The institute operates in the United States and globally "through an interrelated program of social science research, policy analysis and public education." According to their mission...
. Contraceptive use saved an estimated $19 billion in direct medical costs from unintended pregnancies in 2002.
In 2006, publicly funded family planning services (Title X
Title X
The Title X Family Planning Program, officially known as Public Law 91-572 or “Population Research and Voluntary Family Planning Programs” was enacted under President Richard Nixon in 1970 as part of the Public Health Service Act...
, medicaid, and state funds) helped women avoid 1.94 million unintended pregnancies, thus preventing about 860,000 unintended births and 810,000 abortions. 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; the number of unintended pregnancies among poor women would nearly double
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. Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed.
Reducing unintended pregnancy in the United States would be particularly desirable since abortion is such a politically divisive issue.
Rape
A longitudinal study in 1996 of over 4000 women in the United States followed for 3 years found that the rape-related 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.History
Early ways of preventing unwanted pregnancy included withdrawalWithdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...
and various alternatives to intercourse; they are difficult to use correctly and, while much better than no method, have high failure rates compared to modern methods. 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, abortion methods are described in some of the earliest medical texts. The degree of safety of early methods relative to the risks of child birth is unclear.
Infanticide
Infanticide
Infanticide or infant homicide is the killing of a human infant. Neonaticide, a killing within 24 hours of a baby's birth, is most commonly done by the mother.In many past societies, certain forms of infanticide were considered permissible...
(‘customary neonaticide
Neonaticide
Neonaticide is the killing of a newborn infant less than 24 hours old. It can be divided into criminal neonaticide, which is usually by a mother under severe psychological stress, and customary neonaticide, a practice used in certain cultures at certain times to limit the population.Neonaticide is...
’) or abandonment
Child abandonment
Child abandonment is the practice of relinquishing interests and claims over one's offspring with the intent of never again resuming or reasserting them. Causes include many social and cultural factors as well as mental illness. An abandoned child is called a foundling .-Causes:Poverty is often a...
(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. 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 unwanted 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. In many cases, as contraceptives became more available the rate of unintended pregnancy and abortion dropped rapidly during the 1990s.
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. As the number of desired number of children decreases, couples spend more of their reproductive lives trying to avoid unintended pregnancies.
In society and culture
Unintended pregnancy can be an indicator of premarital sexPremarital sex
Premarital sex is sexual activity, including vaginal intercourse, oral sex, and anal sex, practiced by persons who are unmarried. Although it has always been practiced, in the West it has increased in prevalence since the mid-1950s...
, which may carry social stigma, result in persecution or honor killing
Honor killing
An honor killing or honour killing is the homicide of a member of a family or social group by other members, due to the belief of the perpetrators that the victim has brought dishonor upon the family or community...
. Sometimes, in order to prevent illegitimate children, forced marriage
Forced marriage
Forced marriage is a term used to describe a marriage in which one or both of the parties is married without his or her consent or against his or her will...
s result. Such marriages typically have poorer outcomes than voluntary marriage.
In many industrialized nations there is increasing acceptance of premarital sex, single parent
Single parent
Single parent is a term that is mostly used to suggest that one parent has most of the day to day responsibilities in the raising of the child or children, which would categorize them as the dominant caregiver...
ing, and children born outside wedlock.
Unintended pregnancy is common as a cause of stress or social stigma in fictional works. It plays a role in many portrayals of illegitimacy
Illegitimacy in fiction
This is a list of fictional stories in which illegitimacy features as an important plot element. Passing mentions are omitted from this article. Many of these stories deal with the social pain and exclusion felt by illegitimate "natural children"....
and teen pregnancy.
See also
- Demographic dividendDemographic dividendThe demographic dividend is a rise in the rate of economic growth due to a rising share of working age people in a population. This usually occurs late in the demographic transition when the fertility rate falls and the youth dependency rate declines. During this demographic window of opportunity,...
- Epidemiology of teenage pregnancy
- International Conference on Population and DevelopmentInternational Conference on Population and DevelopmentThe United Nations coordinated an International Conference on Population and Development in Cairo, Egypt from 5–13 September 1994. Its resulting Program of Action is the steering document for the United Nations Population Fund ....
- Legalized abortion and crime effectLegalized abortion and crime effectThe effect of legalized abortion on crime is the theory that legal abortion reduces crime. Proponents of the theory generally argue that since unwanted children are more likely to become criminals and that an inverse correlation is observed between the availability of abortion and subsequent crime...
- The Impact of Legalized Abortion on CrimeThe Impact of Legalized Abortion on Crime"The Impact of Legalized Abortion on Crime" is a controversial paper by John J. Donohue III of Yale University and Steven Levitt of University of Chicago that argues that the legalization of abortion in the 1970s contributed significantly to reductions in crime rates experienced in the 1990s...
- The Impact of Legalized Abortion on Crime
- MiscarriageMiscarriageMiscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
- Millennium Development GoalsMillennium Development GoalsThe Millennium Development Goals are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015...
- Nutrition and pregnancyNutrition and pregnancyNutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy.In a precursory study into the link between nutrition and pregnancy in 1950 women who consumed minimal amounts over the eight week period had a higher mortality or...
- Religious views on birth controlReligious views on birth controlReligious adherents vary widely in their views on birth control. This can be true even between different branches of one faith, as in the case of Judaism...
- Reproductive life planReproductive life planA reproductive life plan is a plan for when, how and whether to have children. The plan is based on a person's priorities and goals with regards to life and children. The plan may take into account their resources, commitments and values. Reproductive life plan serves as a basis for acting to...
- Take ChargeTake ChargeTake Charge is a government program that provides free family planning and pregnancy prevention services to low-income residents of Washington State. The program expands Medicaid coverage for family planning services to individuals whose income is 200% or lower than the federal poverty level...
- Wrongful birthWrongful birthWrongful birth is a legal cause of action in some common law countries in which the parents of a congenitally diseased child claim that their doctor failed to properly warn of their risk of conceiving or giving birth to a child with serious genetic or congenital abnormalities...
- legal cause of action by parents of congenitally diseased child who would have chosen not to have the pregnancy or child had their practitioner followed the standard of care in informing them of the risks of the congenital disease.