As of 2011, the last year for which data is available, the unintended pregnancy rate in the U.S. was 45%. Source. That means that 45% of all pregnancies were unplanned or mistimed. While that’s high, it’s an improvement — in the early 1980s it was a shocking 60%.
According to a widely cited study in the New England Journal of Medicine, in 2011 there were 6.1 million pregnancies in the U.S., of which 2.8 million were unintended. Of the unintended pregnancies about 40% resulted in abortion while the remaining 60% are split between live births and miscarriages.
Why the High Unintended Pregnancy Rate Matters
Unintended pregnancies are associated with negative consequences. Below are just some of them.
Health Risks to the Mother and Baby.
According to the United Health Foundation, “Births resulting from unintended pregnancies are associated with adverse health outcomes for mother and baby, including:
- Delayed prenatal care
- Preterm birth
- Low birthweight
- Shorter duration of breastfeeding
- Increased risk of postpartum depression and parenting stress
- Negative physical and mental impacts for children, such as poor development and potential behavioral health issues”
Expense to Society
“Public insurance programs such as Medicaid pay for 68 percent of unplanned births. In 2010, expenditures on unintended pregnancies by Medicaid and other public programs were estimated to be $21 billion.” Source. Add to that what private insurance covers plus out-of-pocket expenses.
Number of Abortions
As the unintended pregnancy rate comes down, so does the number of abortions. Source.
Lifestyle and Economic Factors
According to the Brookings Institution, “more intentional childbearing can increase the probability that a child is born into a stable family situation and avoids poverty.” Plus, intentional childbearing has educational and labor market benefits to the the mother (and the father if he’s in the picture). An unplanned live birth can derail the mother’s education and/or career opportunities.
An Important Caveat: These negative consequences are generalizations and on a society-wide basis. There are all sorts of situations where an unintended pregnancy doesn’t have negative effects and the child that results from such a situation is considered a blessing. Personally, I know some lovely people who resulted from unplanned pregnancies.
Why is the Unintended Pregnancy Rate So High?
The cause of the high unintended pregnancy rate is a complex topic with a lot of variables/causes.
- Primary reasons for the high rate are lack of use of contraception and the failure of contraception when it is used. Here are the cumulative failure rates for the most common forms of contraception:
- Education is a factor. There is a “a strong inverse association between both income level and educational attainment and the rate of unintended pregnancy.” Source.
- Unintended pregnancies also vary by income. Females with incomes less than the poverty level have 5x the unintended pregnancy rate of women with incomes greater than 200% of the poverty level. According to the Brookings Institution, “low-income women tend to have the least access to contraception through employer-sponsored health insurance, and many rely on publicly subsidized family planning services.”
How to Reduce the Number of Unplanned Pregnancies
- Change the Type of Contraception Used. As shown in the chart above, both the pill and condoms have a high failure rate over time. “The American College of Obstetricians and Gynecologists recommends that providers encourage patients to consider long-acting and reversible contraceptive (LARC) methods such as intrauterine devices (IUDs) and implants. The use of LARCs over short-acting contraceptive methods could significantly reduce the direct medical cost of unintended pregnancies in the United States.” Source.
- Make Contraception Accessible and Cheap/Free. “Guttmacher Institute estimates that 1.3 million unwanted pregnancies were averted in 2014 by publicly-funded clinics. Every public dollar spent helping women avoid unintended pregnancies saves about $5 in Medicaid expenditures for pregnancy-related care, which is a net government saving of $10.5 billion per year.” Source.
An effective way to reduce unintended pregnancies (and abortions) is to increase the number of, and access to, clinics that provide family-planning, education and contraceptive counseling. Women who visit these clinics commonly decide to use the much more reliable LARCs (like IUDs and injectables) which greatly reduce the unintended pregnancy rate. Providing funding for these more effective forms of birth control removes a big barrier for low-income women. Unfortunately, funding to such clinics has been cut over the past few decades. The Affordable Care Act mandated that health insurance cover contraceptives and that has had a positive impact on reducing unintended pregnancies.
- Education and Social Messaging. The use of billboards and targeted social media providing education which types of contraception are effective and which types tend to fail reduces the unintended pregnancy rates. Source. More/better education in schools is important as is education/counseling from doctors. Thus, primary care/gynecologist access and coverage is imperative.
Super interesting! A few other interesting facts on the subject: Regarding education, Title V federal funding for health education programs required adherence to a strict abstinence-only curriculum outlined by the “A-H clauses.” (https://aspe.hhs.gov/report/impacts-four-title-v-section-510-abstinence-education-programs/title-v-section-510-funding) Abstinence only education has been shown to be largely ineffective in reducing unintended pregnancies. Contraception education and access is essential. LARCs are a key piece, but one important point from a public health paper I read a while back is that the introduction of LARC contraception must be guided by respect for patient autonomy, especially in communities where there is a history of forced sterilization. Finally, Margret Sanger who founded planned parenthood in the early 1900s has a great quote about the pill (which actually first was developed to treat amenorrhea) essentially saying it is a key piece of women’s economic liberation!