National Background and Context
Unintended pregnancy can have significant, negative consequences for individual women, their families and society as a whole. An extensive body of research links births resulting from unintended or closely spaced pregnancies to adverse maternal and child health outcomes and myriad social and economic challenges.[1,2] In 2011, the most recent year for which national-level data are available, 45% of all pregnancies in the United States were unintended, including three out of four pregnancies to women younger than 20, and there were 45 unintended pregnancies per every 1,000 women aged 15–44, a rate significantly higher than that in many other developed countries.[3,4] If current trends continue, more than half of all women in the United States will experience an unintended pregnancy by the time they reach age 45. And economically disadvantaged women are disproportionately affected by unintended pregnancy and its consequences: In 2011, the unintended pregnancy rate among women with a family income lower than the federal poverty level, at 112 per 1,000, was more than five times the rate among women with an income greater than 200% of poverty (20 per 1,000).
In any given year, two-thirds of women in the United States at risk of unintended pregnancy use contraceptives consistently throughout the year. These women account for only 5% of all unintended pregnancies, while the remaining 95% of unintended pregnancies are attributable to the one-third of women who do not use contraceptives or who use them inconsistently. Public programs—notably Medicaid and the Title X national family planning program—are central to women's access to affordable contraceptive services and supplies and their ability to use contraceptives effectively. In 2014, 7.8 million women received publicly funded family planning services; these services helped women avoid 2 million unintended pregnancies, which would likely have resulted in 914,000 unplanned births and nearly 680,000 abortions (the remainder would have resulted in miscarriages). In the absence of publicly funded family planning services, the numbers of unintended pregnancies, unplanned births and abortions in the United States would have been 68% higher—and the pregnancy rate for adolescents aged 15–19 would have been 73% higher—than they currently are.
Unintended pregnancies are also costly to the federal and state governments, resulting in $21.0 billion in public expenditures in 2010. Yet, these costs could have been considerably higher: By helping women avoid unintended pregnancies, publicly funded family planning services saved taxpayers $13.6 billion in 2010, or $7.09 for every $1 spent.
Incidence and Outcomes of Unintended Pregnancy in Massachusetts
• In 2010, 47% of all pregnancies (54,000) in Massachusetts were unintended.
• Massachusetts’s unintended pregnancy rate in 2010 was 40 per 1,000 women aged 15–44. Nationally, rates among the states ranged from a low of 32 per 1,000 in New Hampshire to a high of 62 per 1,000 in Delaware.
• The adolescent pregnancy rate in Massachusetts was 24 per 1,000 women aged 15–19 in 2013. The national rate was 43 per 1,000, and state rates ranged from 22 per 1,000 in New Hampshire to 62 per 1,000 in New Mexico. The majority (75%) of adolescent pregnancies in the United States are unintended, and adolescents account for about 15% of all unintended pregnancies annually. Services are needed to support pregnant or parenting young people, regardless of the planned or unintended nature of the pregnancy.
• In 2010, 43% of unintended pregnancies in Massachusetts resulted in births and 44% in abortions; the remainder resulted in miscarriages.
Public Cost of Unintended Pregnancy in Massachusetts
• In 2010, 13,100 or 56.4% of unplanned births in Massachusetts were publicly funded, compared with 68% nationally.
• In Massachusetts in 2010, the federal and state governments spent $357.9 million on unintended pregnancies; of this, $219.6 million was paid by the federal government and $138.3 million was paid by the state.
• The total public costs for unintended pregnancies in 2010 was $264 per woman aged 15–44 in Massachusetts, compared with $201 per woman nationally.
Preventing Unintended Pregnancy in Massachusetts
• In 2014, 373,060 Massachusetts women aged 13–44 were in need of publicly funded family planning services.
• Publicly supported family planning centers in Massachusetts served 92,200 female contraceptive clients in 2014. They met 25% of Massachusetts women’s need for contraceptive services and supplies. Across the United States, such centers met 26% of need.
• In 2010, public expenditures for family planning client services in Massachusetts totaled $50.9 million; this includes $40.7 million through Medicaid and $6.5 million through Title X. Most states also use some of their own money (in addition to funds required to match federal grants) for family planning services. In 2010, Massachusetts contributed $3.7 million. 
• Publicly funded family planning centers in Massachusetts helped avert 22,300 unintended pregnancies in 2014, which would have resulted in 10,800 unplanned births and 8,000 abortions.
• By averting unintended pregnancies and other negative reproductive health outcomes, publicly funded family planning services provided by safety-net health centers in Massachusetts helped save the federal and state governments $230.2 million in 2010.
1. Guttmacher Institute, Testimony of Guttmacher Institute, Submitted to the Committee on Preventive Services for Women, Institute of Medicine, 2011, https://www.guttmacher.org/article/2011/01/testimony-guttmacher-institute-subcommittee-preventive-services-womens-institute.
2. Sonfield A et al., The Social and Economic Benefits of Women’s Ability to Determine Whether and When to Have Children, New York: Guttmacher Institute, 2013, https://www.guttmacher.org/report/social-and-economic-benefits-womens-ability-determine-whether-and-when-have-children.
4. Singh S, Sedgh G and Hussain R, Unintended pregnancy: worldwide levels, trends, and outcomes, Studies in Family Planning, 2010, 41(4):241–250.
5. Sonfield A, Hasstedt K and Gold RB, Moving Forward, Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014, https://www.guttmacher.org/report/moving-forward-family-planning-era-health-reform.
6. Frost JJ, Frohwirth L and Zolna MR, Contraceptive Needs and Services, 2014 Update, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/contraceptive-needs-and-services-2014-update.
7. Sonfield A and Kost K, Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010, New York: Guttmacher Institute, 2015, https://www.guttmacher.org/report/public-costs-unintended-pregnancies-and-role-public-insurance-programs-paying-pregnancy.
8. Frost JJ, Sonfield A, Zolna MR and Finer LB, Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program, Milbank Quarterly, 2014, 92(4):696–749, http://onlinelibrary.wiley.com/enhanced/doi/10.1111/1468-0009.12080/.
9. Kost K, Unintended Pregnancy Rates at the State Level: Estimates for 2010 and Trends Since 2002, New York: Guttmacher Institute, 2015, https://www.guttmacher.org/report/unintended-pregnancy-rates-state-level-estimates-2010-and-trends-2002.
10. Kost K, Maddow-Zimet I and Arpaia A, Pregnancies, Births and Abortions Among Adolescents and Young Women in the United States, 2013: National and State Trends by Age, Race and Ethnicity, New York: Guttmacher Institute, 2017, https://www.guttmacher.org/report/us-adolescent-pregnancy-trends-2013.
11. Sonfield A and Gold RB, Public Funding for Family Planning Sterilization and Abortion Services, FY 1980–2010, New York: Guttmacher Institute, 2012, https://www.guttmacher.org/report/public-funding-family-planning-sterilization-and-abortion-services-fy-1980-2010.