The proportions of women in a given state who receive Medicaid and who are uninsured are strongly associated with the state’s unintended pregnancy rate, according to "Variation in State Unintended Pregnancy Rates in the United States," by Kathryn Kost et al., of the Guttmacher Institute. Notably, although initial analyses revealed a strong relationship between the black or Hispanic composition of states’ populations and unintended pregnancy rates, most of that relationship was accounted for by differences in state-level measures of women’s age, marital status, health insurance coverage and receipt of Medicaid. The greater the proportion of women who lacked insurance, or the lower the proportion covered by Medicaid, the higher the unintended pregnancy rate.

Previous research from the Guttmacher Institute found large variations in rates of unintended pregnancy across states. Nationally, rates of unintended pregnancy are higher among black and Hispanic women than they are among white women, and poor women have much higher rates of unintended pregnancy than those with incomes of at least 200% of the poverty line. Young women and unmarried women also experience relatively high unintended pregnancy rates. Given these disparities, Kost and her colleagues sought to examine whether a state’s demographic and socioeconomic composition was related to variations in rates across states.

The authors did not find a relationship between the proportion of women at risk of unintended pregnancy in the state who are contraceptive users and levels of unintended pregnancy after controlling for demographic or socioeconomic characteristics within each state. They explain that this finding is not surprising. "It does not mean that contraceptive use has no relationship to unintended pregnancy," says Dr. Kost. "It means that the relationship between contraceptive use and unintended pregnancy does not differ across states." The authors speculate that what does differ among states is "the extent to which vulnerable populations have access to insurance and Medicaid, and hence to contraception and other family planning services."

These findings, according to the authors, suggest that efforts to expand insurance and Medicaid coverage among groups with high levels of unintended pregnancy merit examination as ways to lower rates. Understanding variations in unintended pregnancy by state is crucial to helping policymakers and program planners design interventions that most effectively reduce unintended pregnancy.

"Variation in State Unintended Pregnancy Rates in the United States" is currently available online and will appear in the March 2012 issue of Perspectives on Sexual and Reproductive Health.

For more information on this topic, click here for Facts on Unintended Pregnancy in the United States.