Guttmacher Institute Releases New Data on Pregnancies in the United States by Desire for Pregnancy
A new Guttmacher study published in the journal Demography examines whether population-level trends in US pregnancy, birth and abortion rates reflect changes in retrospectively reported pregnancy desires. The article represents a shift from previous Guttmacher Institute research focused on the national unintended pregnancy rate.
In this study, researchers examined a range of pregnancy desire categories captured in two national surveys: Individuals reported their past pregnancies as having occurred at about the right time, later than wanted or sooner than wanted; as being not wanted at all; or as being associated with feelings such as uncertainty, ambivalence or indifference. Widening the research lens beyond unintended pregnancy better captures the complex and varied circumstances of pregnancy experiences.
“Our analysis benefited greatly from the contributions of reproductive justice scholars, advocates and other researchers who have long critiqued the measure of unintended pregnancy as failing to be a useful and equitable indicator of reproductive health and well-being,” says Kathryn Kost, director of domestic research and lead scientist on the study. “By studying a wider range of pregnancy desires, and not just whether a pregnancy is unintended, we can also improve understanding of patterns and trends in population-level US fertility experiences.”
Key Report Findings
The study estimated the incidence of pregnancies, births and abortions in 2009, 2011, 2013 and 2015 by desire categories, and calculated proportions of all pregnancies and rates among all women of reproductive age (15–44) to examine how these pregnancies were characterized by individuals who experienced them, how common these pregnancy experiences were in the population and whether these measures changed over time. While cisgendered women, transmen, nonbinary people and other gender-nonconforming individuals experienced pregnancies, this work refers to women because the data relied on in this study was not able to identify the gender identity of all individuals who could have become pregnant.
The largest proportion of pregnancies were reported to have occurred at about the right time (ranging from 44% to 48% across the four time points).
The largest proportion of births were also reported to have occurred at the right time (54–58%).
The largest proportion of abortions were pregnancies that were reported as occurring too soon (48–49%), followed by those that had not been wanted (42–43%).
Between 2009 and 2015, the rate of pregnancies reported as having occurred too soon decreased by 25% and the rate of pregnancies reported as not wanted decreased by 14%.
“A decrease from 2009 to 2015 in the rate of pregnancies that occurred too soon or were not wanted corresponds with increased usage of the most effective contraceptive methods and improved access to these methods, following implementation of the Affordable Care Act’s contraceptive coverage guarantee, which requires insurance plans to cover contraceptives without copayments,” says Kost. “Any new barriers to contraceptive access could jeopardize an individual’s ability to exercise control over their reproductive lives.”
Differing Patterns by Age-Group
Building on previous Guttmacher research showing that rates of pregnancy, birth and abortion declined between 2009 and 2015, the current study found a decrease in the pregnancy rate for particular categories of pregnancy desire among women aged 15–19 and 20–24.
The decrease in the overall pregnancy rate over this time period can be attributed to decreased rates of pregnancies categorized as occurring too soon among these age-groups.
The rate of pregnancies characterized as having occurred too soon among women aged 15–19 and 20–24 decreased substantially between 2009 and 2015, falling by 47% among 15–19-year-old women and 23% among 20–24-year-old women. There was no meaningful change in the proportions of pregnancies in these two categories for these age-groups over this period.
The rate of unwanted pregnancies also decreased significantly for these two age-groups, falling 46% among 15–19-year-old women and 29% among 20–24-year-old women.
Previous Guttmacher research also found that pregnancy rates and birthrates increased from 2009 to 2015 among women aged 35–44. The current study found:
A 26% decline in the proportion of pregnancies reported as having occurred at the right time
A 39% decline in the proportion of pregnancies that occurred too soon
An 84% increase in the proportion that occurred later than wanted
A doubling of the birthrate for pregnancies that occurred later than wanted
“These data suggest that an increasing share of women experiencing pregnancies at older ages may be facing barriers in getting pregnant and having children on their own timeline,” says Mia Zolna, senior research associate and study coauthor. “Supporting individuals to have the families they want means ensuring access to the full spectrum of reproductive health care and related structural support, including improving access to fertility treatments, quality prenatal care and affordable childcare.”
Following the overturning of Roe and the onslaught of state-level abortion bans and restrictions, the need for scientifically robust and accurate data on the full range of pregnancy experiences and desires is more critical than ever. These findings provide evidence to bolster public health policies that support individuals to become pregnant when they want to, avoid becoming pregnant or terminate a pregnancy and reduce barriers that prevent people from having families if and when they want them.