Between 1994 and 2001, the rate of unintended pregnancy increased by 29% among U.S. women whose income was below the poverty line, while it decreased 20% among women with incomes at least twice the federal poverty level. Although the overall nationwide unintended pregnancy rate remained virtually unchanged over this period, this stagnation masks growing disparities by income and education, according to Disparities in Rates of Unintended Pregnancy in the United States, 1994 and 2001,” by Lawrence B. Finer and Stanley K. Henshaw, published in the June 2006 issue of Perspectives on Sexual and Reproductive Health. “Overall, our nation’s progress on unintended pregnancy has stalled, and some groups of women are actually moving backward,” notes Finer.
This study, based on data from the federally supported National Survey of Family Growth and other sources, finds that 5% of U.S. women of reproductive age have an unintended pregnancy each year (for a rate of 51 unintended pregnancies per 1,000 women aged 15–44), and that of the 6.4 million pregnancies in 2001, half (49%) were unintended. Although some unintended pregnancies are accepted or even welcomed, almost half (48%) end in abortion. Unintended pregnancy rates are substantially higher among women aged 18–24, unmarried (particularly cohabiting) women, low-income women, women who did not complete high school and minority women than among other groups. In addition to increased disparities by income, the unintended pregnancy rate rose among women without a high school diploma but fell among college graduates between 1994 and 2001.
Because poor women have a high rate of unintended pregnancy (112 per 1,000 women 15–44, more than double the national average), they have high—and increasing—rates of both abortions and unplanned births. In 2001, a poor woman was four times as likely to have an unintended pregnancy, five times as likely to have an unintended birth and more than three times as likely to have an abortion as her higher-income counterpart.
Most unintended pregnancies could be prevented with consistent, correct use of modern contraceptives. Finer and Henshaw find that about half of women experiencing unintended pregnancies had used birth control during the month in which they became pregnant. Other research has documented that although contraceptive use among lower-income women rose between 1982 and 1995, poor and low-income women are still less likely than better-off women to use contraceptives, and the disparity by income grew between 1995 and 2002. Moreover, poor and low-income women experience markedly higher rates of method failure. The authors argue for increased access to and use of highly effective birth control methods, such as the IUD, that are underutilized in the United States.
Finer and Henshaw suggest that these disparities may also be partly explained by differences in insurance coverage: Poor women are twice as likely as women overall to lack health insurance, and spending under Title X, the only federal source of funding dedicated to family planning services for low-income women, declined between 1994 and 2001 after controlling for inflation. “Given the enormous personal and social burdens of unintended pregnancies, it is unfortunate that some sources of public financial support and services for family planning are actually being cut back,” said Finer. “Our study makes it clear that we need to be doing more, not less, to provide women—particularly the most disadvantaged women—with the information and services they need to plan their families.”