Some 58-67% of women who were exposed to sexual abuse or to frequent psychological or physical abuse as children have an unintended first pregnancy during adulthood, compared with 37-41% of their peers who experienced no such abuse. Similarly, women whose mother was frequently abused by her partner or who lived with a substance abuser or with a mentally ill household member also have a higher likelihood of an unintended first pregnancy (48-64%) than other women (42-43%). Furthermore, an estimated 20% of unintended first pregnancies among adult women are related to childhood experiences of abuse or household dysfunction. These are some of the findings of a study conducted among reproductive-age women in San Diego.1

The researchers analyzed data from a sample of women enrolled in a large health maintenance organization who had received medical examinations between August and November 1995 or January and March 1996. Study participants completed a mailed survey that included questions about their background characteristics, pregnancy history and exposure to various forms of abuse and household dysfunction during childhood (i.e., through age 18). In all, 1,193 women aged 20-50 who had had a first pregnancy at or after age 20 were included in the analyses.

The majority of respondents were white (61%), had at least some college education (81%), had been married at the time of their first pregnancy (73%) and had been 18 or older at first intercourse (70%). More than half had had their first pregnancy between ages 20 and 24 (57%). Sixty-four percent were aged 40-50 at the time of the survey.

Women who reported that they had not intended to conceive at the time their first pregnancy began were considered to have had an unintended first pregnancy. The researchers measured four types of childhood abuse (psychological abuse, physical abuse, sexual abuse by someone at least five years older than the woman was at the time of the incident and peer sexual assault) and three types of household dysfunction (physical abuse of the mother by her partner, substance abuse by a household member and mental illness of a household member).

Overall, 82% of respondents reported having experienced at least one form of childhood abuse or household dysfunction; 66% had experienced two or more types. The majority had experienced childhood psychological or physical abuse (52-64%), and close to one-third had been sexually abused (29%). Fourteen percent of women had had forced sexual contact with someone their own age. At least one-third of respondents had experienced some form of household dysfunction: Twenty-six percent had lived with a mentally ill household member, 29% had had mothers who were physically abused and 36% had lived with a substance abuser.

More than 45% of respondents reported that their first pregnancy had been unintended. A woman's likelihood of having had an unintended pregnancy rose from 32% to 64% as the number of types of abuse or dysfunction she had experienced increased from zero to four or more. Women who had experienced any type of abuse or dysfunction were significantly more likely than those who had not to have had an unintended first pregnancy. The proportion increased from 37% to 59% for frequent psychological abuse, from 39% to 67% for frequent physical abuse, from 41% to 58% for sexual abuse and from 43% to 61% for peer sexual assault. For measures of household dysfunction, the proportion of women reporting an unintended pregnancy rose from 42% to 48% of those who lived with a substance abuser, from 43% to 53% of those who lived with a mentally ill person and from 42% to 64% of those whose mother was frequently physically abused.

Using logistic regression analyses, the researchers estimated risk ratios measuring the effect of each type of abuse and dysfunction on the likelihood that a woman's first pregnancy was unintended, taking into account various factors that might influence this outcome. Women who had experienced sexual abuse (risk ratio, 1.2) or frequent psychological (1.4) or physical abuse (1.5) were significantly more likely than their peers to have had an unintended first pregnancy. There were no significant associations between household dysfunction and unintended pregnancy, except for frequent physical abuse of a woman's mother (1.4). Given these results, the researchers estimated that one in five unintended first pregnancies during adulthood were associated with childhood experiences of abuse or household dysfunction.

The researchers conclude that the effects of childhood abuse and household dysfunction on women's sexual behavior continue past adolescence into adulthood. They believe medical care providers should be aware that the experience of childhood abuse and family dysfunction is common and may affect women's "ability or motivation to prevent an unintended first pregnancy."--I. Olenick


1. Dietz PM et al., Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood, Journal of the American Medical Association, 1999, 282(14):1359-1364.