• Most American families want two children. To achieve this, the average woman spends about five years pregnant, postpartum or trying to become pregnant, and three decades—more than three-quarters of her reproductive life—trying to avoid an unintended pregnancy.
• Most individuals and couples want to plan the timing and spacing of their childbearing and to avoid unintended pregnancies, for a range of social and economic reasons. In addition, unintended pregnancy has a public health impact: Births resulting from unintended or closely spaced pregnancies are associated with adverse maternal and child health outcomes, such as delayed prenatal care, premature birth, and negative physical and mental health effects for children.[2,3,4]
• For these reasons, reducing the unintended pregnancy rate is a national public health goal. The U.S. Department of Health and Human Services’ Healthy People 2020 campaign aims to reduce unintended pregnancy by 10% between 2010 and 2020.
• In 2011, there were 45 unintended pregnancies for every 1,000 women aged 15–44. In other words, nearly 5% of reproductive-age women have an unintended pregnancy each year.
• By age 45, more than half of all American women will have experienced an unintended pregnancy, and three in 10 will have had an abortion..
• The unintended pregnancy rate is significantly higher in the United States than in many other developed countries.
INCIDENCE OF UNINTENDED PREGNANCY
• At least 36% of pregnancies in every U.S. state are unintended. In 28 states and the District of Columbia, more than half of pregnancies are unintended.
• The states with the highest unintended pregnancy rates in 2010 were Delaware (62 per 1,000 women aged 15–44), Hawaii (61), New York (61) and Maryland (60).
• The lowest unintended pregnancy rates in 2010 were found in New Hampshire (32 per 1,000 women aged 15–44), Minnesota (36), Vermont (36) and Maine (37).
• Unintended pregnancy rates are highest among poor and low-income women, women aged 18–24, cohabiting women and minority women. Rates tend to be lowest among higher-income women, white women, college graduates and married women. For example, in 2011, the rate of unintended pregnancy among higher-income white women was less than half the national rate (18 vs. 45 per 1,000).
• The rate of unintended pregnancy among poor women (those with incomes at or below the federal poverty level) was 112 per 1,000 women aged 15–44 in 2011, more than five times the rate among women at the highest income level (20 per 1,000).
• Black women had the highest unintended pregnancy rate of any racial or ethnic group. At 79 per 1,000 women aged 15–44, it was more than double that of non-Hispanic white women (33 per 1,000).
• Women without a high school degree had the highest unintended pregnancy rate among all educational levels (73 per 1,000 women aged 15–44), and rates were lower for women with more years of education.
• The proportion of pregnancies that are unintended generally decreases as age increases. The highest unintended pregnancy rate in 2011 was among women aged 20–24 (81 per 1,000 women).
• Traditional estimates understate the extent to which sexually active teens experience unintended pregnancies, because they typically include all women, whether or not they are sexually active. While most older women are sexually active, many teens are not. The unintended pregnancy rate among only those teens who are sexually active is more than twice the rate among all women.
• There are also disparities in the outcomes of unintended pregnancies across subgroups. In 2011, poor women had an unplanned birth rate nearly seven times that of higher-income women (those at or above 200% of the federal poverty level).
TRENDS IN UNINTENDED PREGNANCY
• The proportion of pregnancies that were unintended increased slightly between 2001 and 2008 (from 48% to 51%), but, by 2011, it decreased to 45%.[6, 11]
• Following a long period of minimal change, the overall unintended pregnancy rate in the United States decreased substantially from 54 per 1,000 women aged 15–44 in 2008 to 45 in 2011, a decline of 18%. This is the lowest rate since at least 1981.
• After rising for most of the 30-year period beginning in 1981, unintended pregnancy rates among poor women have recently begun to decrease; during the same period, the rate among higher-income women has continued to decline steadily. In 2008, the unintended pregnancy rate among women with incomes below the federal poverty level was 137 per 1,000 women aged 15–44; it decreased to 112 per 1,000 women in 2011—an 18% decline in just three years. The rate among higher-income women decreased 20% between 2008 and 2011.[6, 11]
• The unintended pregnancy rate among teens has been declining since the late 1980s. Between 2008 and 2011, the unintended pregnancy rate among women aged 18–19 declined 20%, and the unintended birth rate declined 21%.
OUTCOMES OF UNINTENDED PREGNANCY
• In 2011, 42% of unintended pregnancies (excluding miscarriages) ended in abortion, and 58% ended in birth. This was a small shift from 2008, when 40% ended in abortion, and 60% ended in birth.
• The rate of unintended pregnancies ending in birth decreased across all racial and ethnic subgroups. However, the proportion of women experiencing unintended pregnancy and choosing to end it in abortion was higher among black women than among women in other racial and ethnic groups.
• In 2011, lower proportions of poor and low-income women than of higher-income women chose to end an unintended pregnancy by abortion. Consequently, poor women had a relatively high unintended birth rate.
• The proportion of births that fathers report as unintended—about four in 10—is similar to that reported by mothers. The proportion varies significantly according to fathers’ union status, age, education level, and race and ethnicity.
• More than one in 10 single men indicated that they did not know about the pregnancy until after the child was born. Single men aware of their pregnancy reported nearly three out of four births as having resulted from unintended pregnancies.
COST OF UNINTENDED PREGNANCY
• In 2010, two-thirds (68%) of the 1.5 million unplanned births were paid for by public insurance programs, primarily Medicaid. In comparison, 51% of births overall and 38% of planned births were funded by these programs.
• Of the two million publicly funded births, about one million were unplanned. By comparison, 1.5 million out of 4.0 million total births nationwide were unplanned (38%).
• In eight states and the District of Columbia, at least 75% of unplanned births were paid for by public programs. This proportion was highest in Mississippi (82%) and the District of Columbia (85%). All but two of those nine jurisdictions are in the South, a region with high levels of poverty.
• Total public expenditures on unintended pregnancies nationwide were estimated to be $21.0 billion in 2010—$14.6 billion in federal expenditures and $6.4 billion in state expenditures.
• In 19 states, public expenditures related to unintended pregnancies exceeded $400 million in 2010. Texas spent the most ($2.9 billion), followed by California ($1.8 billion), New York ($1.5 billion) and Florida ($1.3 billion). Those four states are also the nation’s most populous.
PREVENTING UNINTENDED PREGNANCY
• Two-thirds (68%) of U.S. women at risk for unintended pregnancy use contraceptives consistently and correctly throughout the course of any given year; these women account for only 5% of all unintended pregnancies. In contrast, the 18% of women at risk who use contraceptives inconsistently or incorrectly account for 41% of all unintended pregnancies. The 14% of women at risk who do not practice contraception at all or who have gaps of a month or more during the year account for 54% of all unintended pregnancies (see graph).
• Publicly funded family planning services help women avoid pregnancies they do not want and plan pregnancies they do want. In 2013, these services helped women avoid two million unintended pregnancies, which would likely have resulted in about one million unintended births and nearly 700,000 abortions.
• Without publicly funded family planning services, the number of unintended pregnancies, unplanned births and abortions occurring in the United States would be 60% higher.
• The costs associated with unintended pregnancy would be even higher if not for continued federal and state investments in family planning services. In 2010, the nationwide public investment in family planning services resulted in $13.6 billion in net savings from helping women avoid unintended pregnancies and a range of other negative reproductive health outcomes, such as HIV and other STIs, cervical cancer and infertility.
• In the absence of the current U.S. publicly funded family planning effort, the public costs of unintended pregnancies in 2010 might have been 75% higher.
1. The Alan Guttmacher Institute (AGI), Fulfilling the Promise: Public Policy and U.S. Family Planning Clinics, New York: AGI, 2000.
2. Mayer JP, Unintended childbearing, maternal beliefs, and delay of prenatal care, Birth, 1997, 24(4):247–252.
3. Orr ST et al., Unintended pregnancy and preterm birth, Paediatric Perinatal Epidemiology, 2000, 14(4):309–313.
4. Barber JS, Axinn WG and Thornton A, Unwanted childbearing, health, and mother-child relationships, Journal of Health and Social Behavior, 1999, 40(3):231–257.
5. HealthyPeople.gov, Healthy People 2020, Family planning objectives, 2011, http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=137.
7. Jones RK and Kavanaugh ML, Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion, Obstetrics & Gynecology, 2011, 117(6):1358–1366.
8. Singh S, Sedgh G and Hussain R, Unintended pregnancy: worldwide levels, trends and outcomes, Studies in Family Planning, 2010, 41(4):241–250.
10. Finer LB, Unintended pregnancy among U.S. adolescents: accounting for sexual activity, Journal of Adolescent Health, 2010, 47(3):312–314.
11. Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, 104(S1):S44–S48.
12. Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, 46(1):3–14.
13. Special tabulations of data from Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, http://nejm.org/doi/full/10.1056/NEJMsa1506575.
14. Lindberg LD and Kost K, Exploring U.S. men’s birth intentions, Maternal and Child Health Journal, 2013, http://link.springer.com/article/10.1007/s10995-013-1286-x.
15. 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, http://www.guttmacher.org/pubs/public-costs-of-UP-2010.pdf.
16. Sonfield A, Hasstedt K and Gold RB, Moving Forward: Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014.
17. Frost JJ, Frohwirth L and Zolna MR, Contraceptive Needs and Services, 2013 Update, New York: Guttmacher Institute, 2015, http://www.guttmacher.org/pubs/win/contraceptive-needs-2013.pdf.
18. Frost JJ et al., Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program, Milbank Quarterly, 2014, http://onlinelibrary.wiley.com/enhanced/doi/10.1111/1468-0009.12080/.
Figure 1: Pregnancies by Intention Status
Source: Special tabulations of data from Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, http://nejm.org/doi/full/10.1056/NEJMsa1506575.
Figure 2: Unintended Pregnancy Rates, by State, in 2010
Source: Kost K, Unintended Pregnancy Rates at the State Level: Estimates for 2010 and Trends Since 2002, New York: Guttmacher Institute, 2015, http://www.guttmacher.org/pubs/StateUP10.pdf.
Figure 3: Unintended Pregnancy Rates, 1981–2011
Source: Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, http://nejm.org/doi/full/10.1056/NEJMsa1506575.
Figure 4: Contraception Works
Source: Sonfield A, Hasstedt K and Gold RB, Moving Forward: Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014.