Unintended pregnancy rates on the decline

1. Unintended pregnancy rates in 15-44 year old women in the United States declined by 18% from 2008-2011.

2. In women living below the federal poverty level, unintended pregnancy rates were 2 to 3 times the national average.

Evidence Rating Level: 2 (Good)

Study Rundown: In 2008, more than half of all pregnancies in the United States were unplanned. The unintended pregnancy rate in the United States is substantially higher than in other industrialized countries. Unintended pregnancy is a substantial public health concern as women with unintended pregnancies are more likely to have delayed or scant prenatal care, more likely to smoke and/or drink during pregnancy, and more likely to have premature and low-birth-weight infants. In recent years numerous publications have been published that promote the notion that unintended pregnancies are high-risk pregnancies. Many United States policies, including provisions in the Affordable Care Act, have been created in attempts to combat the rising unintended pregnancy rate. National trends have not been reported since 2008. In the current study, researchers used the most recent data from the National Center for Health Statistics (NCHS) to calculate the incidence of unintended pregnancy in 2011.

From 2008-2011, the rate of unintended pregnancy in females 15-44 years old declined by 18%, reaching the lowest rate in the past three decades. However, the incidence of unintended pregnancy in women living below the federal poverty level, although lower than in 2008, remained 2 to 3 times higher than the national average. Strengths included the use of multiple, large, nationally representative datasets. A limitation of the analysis was that it did not account for factors like changes in sexual behavior, access to contraception, and efficacy of contraceptive methods. These results preceded the 2014 implementation of the Affordable Care Act, which included provisions to increase access to highly effective contraceptive methods, like IUDs and Implants.

Click to read the study in NEJM

Relevant Reading: Shifts in Intended and Unintended Pregnancies in the United States, 2001-2008

In-Depth [cross-sectional study]: Using a combination of data from the National Survey of Family Growth, a national survey of patients who had abortions, the National Center for Health Statistics, and the national census of abortion providers, researchers calculated rates of pregnancy in both 2008 and 2011 according to women’s pregnancy intentions and outcomes.

In 2011 there were 6.1 million pregnancies in the United States, 2.8 million of which were unintended (45%), compared to 51% in 2008. Rates of unintended pregnancy declined across all population subgroups, but rates remained 2 to 3 times higher in women living below the federal poverty level compared to the national average. Of all unintended pregnancies, the percent ending in abortion remained stabled at 42% compared to 40% in 2008.

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