Unintended pregnancy

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. Conversely, an "intended pregnancy" is one that is consciously desired at the time of conception or sooner. 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. 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. 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. == 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 and 44 years old. While unintended pregnancy rates have been slowly declining in most areas of the world, 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. 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. 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. 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). Sweden One study from Sweden (2008–2010) showed that the prevalence of unintended pregnancies was 23.2%. 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". Asia From 2010–2014, approximately 5.4% of women aged 15–44 years old got pregnant unintentionally, and the number of unintended pregnancies was 53.8 million each year in Asia. 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). 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. South Korea South Korea has the most serious problem of unintended pregnancy among developed countries. The reason lies in South Korea's inadequate sex education. Because South Korea doesn't provide comprehensive sexuality education (CSE), it doesn't provide detailed instruction on contraception methods or the responsibility for responsibility. This is due to the influence of conservative groups, such as parent groups and Christian organizations. Africa A quarter of unintended pregnancies happen in Africa, and the average unintended pregnancy rate in Sub-Saharan Africa is 33.9%. 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. Over 92% of abortions are the result of unintended pregnancy, and unintended pregnancies result in about 1.3 million abortions per year. In 2001, 44% of unintended pregnancies resulted in births, 42% resulted in induced abortion, and the rest in miscarriage. It is estimated that more than half of US women have had an unintended pregnancy by age 45. 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. == 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 used contraception inconsistently or not at all accounted for 41% and 54% of all unintended pregnancies, respectively. Many factors 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 a higher likelihood of having an unintended pregnancy, as follows. Younger age Studies across the globe consistently find that younger age (adolescence or young adulthood) increases the likelihood of a pregnancy being unintended or unplanned. 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. Of the estimated 574,000 teen pregnancies (to young women aged 15–19) in the US in 2011, 75% were unintended. In 2011, the unintended pregnancy rate was 41 per 1,000 women aged 15–19. About one-third of unintended teen pregnancies end in abortion. 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, some find that not living with a partner increases the likelihood, 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). 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. as well as prior abuse 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. 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. Multiparity / Already having children 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. == 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). 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 the chance to resolve sexually transmitted infections (STIs) before pregnancy; untreated STIs may be associated with premature delivery or later infection of the newborn. Relationship stress Women with unintended pregnancy are at increased risk of physical violence during pregnancy Substance use during pregnancy promoting zero alcohol during pregnancy Women with unintended pregnancies are more likely to smoke tobacco, and binge drink during pregnancy, particularly for unwanted pregnancies. Poorer long-term developmental outcomes Children born of unintended pregnancies are less likely to succeed in school, In the United States alone, 135,000 children are adopted each year 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. 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. 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. Unintended pregnancies result in about 42 million induced abortions per year worldwide. Abortion carries few health risks when performed in accordance with modern medical techniques. In higher resource areas where abortion is legal, it has lower morbidity and mortality for the pregnant woman than childbirth. However, where safe abortions are not available, abortion can contribute significantly to maternal mortality and morbidity. some find a reduction in distress after abortion. There is no evidence of widespread psychological harm from abortion. 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. 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. The Brookings Institution conducted research, and its 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). Contraceptive use saved an estimated $19 billion in direct medical costs from unintended pregnancies in 2002. == Prevention ==

Most unintended pregnancies result from not using contraception, or from using contraceptives inconsistently or incorrectly. 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. 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. Some cultures limit or discourage access to birth control because they consider it to be morally or politically undesirable. While not yet available commercially, the future introduction of effective LARCs for men could have a positive effect on unintended pregnancies. 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. 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, 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, 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. 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). School-based interventions for adolescents (ages 19 or younger) include any form of education on contraception use in elementary, middle, or high school. This form of intervention provides significant effects on pregnancy, contraception use, correct use of contraception, and contraceptive effectiveness. Programs that covered both STD prevention and pregnancy, rather than just one topic alone, had more positive effects on teenagers' use of effective contraception, as did programs that had interactive elements when compared to programs that did not. For young adults, ages 18-25, education on effective contraception use occurs in clinics and family planning centers and includes oral, written, and digital communication such as texting or email. Counseling, in addition to other education method, has the greatest effects on future use of effective contraception. This includes following up with a phone call, providing an educational packet, and using audiovisual tools while counseling. == History ==

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. 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, As the desired number of children decreases, couples spend more of their reproductive lives trying to avoid unintended pregnancies. The rate of unintended pregnancy declined significantly from 1987 until 1994, due to increased contraceptive use. Since then, the rate has remained relatively unchanged, as described above. == See also ==