Despite a drop in global rates of pregnancy and unintended pregnancy, the proportion of pregnancies that are unintended remains high, especially in the developing world, according to a study of worldwide trends in pregnancy levels.1 The study, the first to evaluate global pregnancy levels by intention and outcome, found that from 1995 to 2008, the global pregnancy rate declined by 17% in both developed and developing regions. The unintended pregnancy rate dropped to an even greater degree—by 29% and 20%, ?respectively—in developed and developing areas. Yet, roughly four in 10 pregnancies worldwide were unintended in 2008, and the proportion was substantially higher in South America and southern Africa, where six in 10 were unintended.
Unintended pregnancy and unplanned birth can endanger the health of women and their families, and reflect, among other factors, barriers to contraceptive access and use. To identify the regions most in need of improved contraceptive services, investigators estimated global, regional and subregional levels of pregnancies, unintended pregnancies, unplanned births, induced abortions and miscarriages. Estimates of unplanned births were calculated by combining United Nations estimates of numbers of live births in 2008 with findings on the intention status of births from more than 70 national demographic, health and population surveys, most of which were conducted between 2000 and 2007. For countries that lacked data on unplanned births, the researchers used the weighted averages of findings for countries with available data in their subregion.
Abortion estimates for 2008 were derived by projecting trends between 1995 and 2003 for all regions except eastern Europe, where the decline in abortion incidence from 1995 to 2003 was extremely rapid and not expected to continue at the same pace; the researchers assumed that the rate of decline in the region in 2003–2008 was half of the earlier rate. The number of miscarriages was estimated using a standard formula.
Nearly 90% (185 million) of the estimated 208 million pregnancies in 2008 occurred in the developing world. Globally, 86 million pregnancies were unintended; of these, 41 million ended in abortion, 33 million in unplanned birth and 11 million in miscarriage.
Overall, pregnancy rates were higher in the developing world than in developed countries, for both intended pregnancies (85 vs. 48 pregnancies per 1,000 women aged 15–44) and unintended ones (57 vs. 42 per 1,000). Regionally, Africa had the highest rates of intended and unintended pregnancy (136 and 86, respectively), and Europe had the lowest (49 and 38). Rates were intermediate in North America (53 and 48), Oceania (74 and 44), Asia (78 and 49), and Latin America and the Caribbean (52 and 72); the last was the only region with a higher unintended than intended pregnancy rate.
Subregional variation was greater in Africa and Asia than in Latin America and Europe. For example, overall pregnancy rates in northern and southern Africa were 147 and 140, respectively, compared with rates of 243–263 in eastern, central and western Africa. Similarly, the rate in East Asia (93)—which mainly reflects the situation in China—was considerably lower than the rates in south central, southeastern and western Asia (136–150). Subregional rates covered a narrower span in Europe (75–97) and Latin America and the Caribbean (122–127).
Between 1995 and 2008, pregnancy rates declined by 17% in both developed regions (from 108 to 90 per 1,000) and developing areas (from 173 to 143). The rate of unintended pregnancy fell to a greater extent in the developed world (29%) than in the developing world (20%), while the reverse was true for intended pregnancies (2% and 17%, respectively). Thus, in developed regions, the reduced pregnancy rate largely stemmed from a drop in unintended pregnancies, most strikingly in eastern Europe. North America (whose data mainly reflect the rates in the United States) was the only region where rates of intended and unintended pregnancy were essentially unchanged.
Still, the global proportion of pregnancies that were unintended in 2008 was high (41%)—and even higher in such developing regions and subregions as Latin America and the Caribbean (58%), South America (64%) and southern Africa (59%). The proportion was also high in North America (48%), exceeding the proportions in Europe's northern, southern and western regions (39–42%).
Approximately half of all unintended pregnancies ended in induced abortion. The proportion was greater in developed than in developing regions (53% vs. 48%); it was much lower in North America than in Europe (38% vs. 64%).
The proportion of pregnancies ending in unplanned birth was greatest in Latin America and the Caribbean (28%) and lowest in Asia (12%) and Europe (11%). At the subregional level, the proportions were lowest in East Asia (4%) and eastern Europe (5%).
The investigators note that although increased contraceptive use has helped to reduce rates of unintended pregnancy, roughly 140 million women in developing countries were not practicing contraception in 2008, despite their desire to delay or stop childbearing, and 75 million more were using traditional, failure-prone methods. This unmet need for effective contraception, together with incorrect and inconsistent use among modern method users and the desire for large families, may explain regional variations in levels of unintended pregnancy.
This study had some limitations, including its reliance on retrospective data on pregnancy intentions (which may underestimate levels of unintended pregnancy) and the lack of survey data regarding men's pregnancy intentions. Pregnancy rates in the major regions and subregions were approximate, because assumptions were made for countries that lacked survey data. Additionally, the current measure for unintended pregnancy does not account for ambivalence about pregnancy or degrees of intention.
Nevertheless, the study findings present a detailed global, regional and subregional picture of trends in unintended pregnancies and their outcomes. Even though the recent decline in unintended pregnancies is encouraging, as the authors note, further reductions will require improved access to and quality of contraceptive care. "Efforts to improve family planning services on a global scale would go a long way toward alleviating existing unmet need for contraception, and would make a large contribution to reducing unintended pregnancy."
1. Singh S et al., Unintended pregnancy: worldwide levels, trends and outcomes, Studies in Family Planning, 2010, 41(4):241–250.