Elsevier

Contraception

Volume 84, Issue 5, November 2011, Pages 478-485
Contraception

Original research article
Unintended pregnancy in the United States: incidence and disparities, 2006

https://doi.org/10.1016/j.contraception.2011.07.013Get rights and content

Abstract

Background

The incidence of unintended pregnancy is among the most essential health status indicators in the field of reproductive health. One ongoing goal of the US Department of Health and Human Services is to reduce unintended pregnancy, but the national rate has not been estimated since 2001.

Study Design

We combined data on women's pregnancy intentions from the 2006–2008 and 2002 National Survey of Family Growth with a 2008 national survey of abortion patients and data on births from the National Center for Health Statistics, induced abortions from a national abortion provider census, miscarriages estimated from the National Survey of Family Growth and population data from the US Census Bureau.

Results

Nearly half (49%) of pregnancies were unintended in 2006, up slightly from 2001 (48%). The unintended pregnancy rate increased to 52 per 1000 women aged 15–44 years in 2006 from 50 in 2001. Disparities in unintended pregnancy rates among subgroups persisted and in some cases increased, and women who were 18–24 years old, poor or cohabiting had rates two to three times the national rate. The unintended pregnancy rate declined notably for teens 15–17 years old. The proportion of unintended pregnancies ending in abortion decreased from 47% in 2001 to 43% in 2006, and the unintended birth rate increased from 23 to 25 per 1000 women 15–44 years old.

Conclusions

Since 2001, the United States has not made progress in reducing unintended pregnancy. Rates increased for nearly all groups and remain high overall. Efforts to help women and couples plan their pregnancies, such as increasing access to effective contraceptives, should focus on groups at greatest risk for unintended pregnancy, particularly poor and cohabiting women.

Introduction

Preventing unintended pregnancy is a personal goal for most couples, and reducing the national level of unintended pregnancy is one of the most important reproductive health goals identified by the US Department of Health and Human Services [1]. Women who have an unintended pregnancy are also at risk for unintended childbearing, which is associated with a number of adverse maternal behaviors and child health outcomes, including inadequate or delayed initiation of prenatal care, smoking and drinking during pregnancy, premature birth and lack of breast-feeding, as well as negative physical and mental health effects on children [2], [3], [4], [5], [6], [7], [8], [9].

While the unintended pregnancy rate in the United States decreased between the late 1980s and mid 1990s [10], it stalled by 2001, the last year for which estimates are available [11]. Recent decreases in births and abortions have occurred among some population subgroups (e.g., teens) [12], but it is unclear if unintended pregnancy rates have also changed. The recent release of new data on pregnancy intentions has made it possible to determine the incidence of unintended pregnancy for 2006. We calculated unintended pregnancy rates for all women of reproductive age and for key population subgroups, including race and ethnicity and relationship status, because previous studies indicate strong associations between unintended pregnancy and these groups [11]. We also present information on outcomes of unintended pregnancy, including the percentage of unintended pregnancies that ended in abortion and the rate of births that followed unintended pregnancy. These estimates are some of the most essential indicators in the field of reproductive health, and periodic trend assessments provide valuable information for public health officials and policy makers who monitor progress toward reducing unintended pregnancy.

Section snippets

Overview

For all US women and by key population subgroups (age, educational attainment, race and ethnicity, income, relationship status, parity and religious affiliation), we determined the number of pregnancies that ended in birth, induced abortion and miscarriage1; calculated the proportion of each of these outcomes that were unintended; and then divided the total number of unintended pregnancies by the population of women aged 15–44 years to

Proportion of unintended pregnancies and unintended pregnancy rates

There were 6.7 million pregnancies in the United States in 2006 (Table 1), up from 6.4 million in 2001 (data not shown). Some 3.2 million pregnancies were unintended in 2006, compared with 3.1 million in 2001 (data not shown). The percentage of pregnancies that were unintended increased slightly between 2001 (48%) and 2006 (49%), and the unintended pregnancy rate also increased during this time period: In 2006, there were 52 unintended pregnancies for every 1000 women aged 15–44 years, compared

Discussion

The US unintended pregnancy rate increased slightly between 2001 and 2006, a worrisome trend, and remains significantly higher than the rate in many other developed countries [24]. Population shifts — for example, increases in groups with high rates, such as poor and minority women — may have contributed to the overall increase. In addition, the overall increase could have occurred if the trend toward later childbearing [25] has led to a longer period before childbearing when relatively

Acknowledgments

The authors would like to thank Stanley Henshaw, Rachel Jones and Megan Kavanaugh for reviewing the manuscript, as well as Jacqueline Darroch and Susheela Singh for providing guidance on study methodology. This study was supported by award R01HD059896 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD or the National Institutes of

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