A new analysis from the Guttmacher Institute, just published in the American Journal of Public Health, shows that large disparities in unintended pregnancy by income level further increased between 2001 and 2008. According to "Shifts in Intended and Unintended Pregnancies in the United States, 2001–2008," by Lawrence B. Finer and Mia R. Zolna, in 2008, the national unintended pregnancy rate was 54 per 1,000 women aged 15–44, meaning that about 5% of women of reproductive age had an unplanned pregnancy each year. Among poor women, however, the rate of unintended pregnancy was more than five times that of women with an income of at least 200% of the federal poverty level (137 vs. 26 per 1,000 women aged 15–44).

"These figures reflect the vastly different experiences of women in different socioeconomic situations in the United States," said Finer. "The rate among wealthier women is comparable to those of many of our Northern and Western European counterparts, while the rate among poor women is higher than those in many developing countries."

The authors found a previously unobserved shift: Between 2001 and 2008, the national unintended pregnancy rate increased from 49 to 54 per 1,000 women aged 15–44, while the intended pregnancy rate decreased slightly from 54 to 51. This shift from intended to unintended pregnancies, which the authors suggest may be related to the economic recession, was most prominent for women in their 20s and for poor women.

"The U.S. recession led many women to want to delay pregnancy," says Finer. "Those who were unsuccessful might have been more likely to report the resulting pregnancy as mistimed or unwanted. We are hopeful that recent improvements in contraceptive use mean this increase in unintended pregnancy is just a blip rather than the beginning of an upward trend."

Analyzing U.S. government data from the National Survey of Family Growth and the Guttmacher Institute's Abortion Patient Survey, Finer and Zolna found that of the 6.6 million pregnancies in 2008, more than half (51%) were unintended. Although many unintended pregnancies are accepted or even welcomed, 40% end in abortion.

The authors also examined rates of unintended pregnancy by both race and income simultaneously, and found that unintended pregnancy rates varied by race and ethnicity even when controlling for income. Black women had the highest rate of unintended pregnancy, while Hispanic women had the highest rate of unintended birth. Previous Guttmacher work has suggested that higher unintended pregnancy rates among these groups reflect the particular difficulties that many women in minority communities face in accessing high-quality contraceptive services and in using their chosen method of birth control consistently and effectively over the long term. Moreover, these realities must be seen in a larger context in which significant racial and ethnic disparities extend to a wide range of health outcomes.

Large disparities persist by educational attainment and relationship status as well. Women with less than a high school education had unintended pregnancy rates three times that of women with a college degree (101 vs. 29 per 1,000). In 2008, the proportion of pregnancies among married women that were unintended was less than half that of unmarried women. Cohabiting women had the highest rates of unintended pregnancy and unintended birth in the analysis (198 and 101 per 1,000), each more than four times the rate of noncohabiting women.

The authors suggest that shifts in underlying population demographics toward groups with high unintended pregnancy rates, such as women who are cohabiting, may have contributed to the overall increase in unintended pregnancy, likely offsetting increases in use of effective contraceptive methods reported in other research.

The authors also suggest that broader social and economic inequities must be remedied to adequately address the persistent problem of unintended pregnancy in the United States. They argue that at a minimum, all women, and particularly those who are most vulnerable, need to be able to access reproductive health services and supplies in order to plan the pregnancies they want and prevent the ones they don't.

"Shifts in Intended and Unintended Pregnancies in the United States, 2001–2008" is currently available online and will appear in the January 9, 2014, issue of the American Journal of Public Health. Note: The version of the article currently posted online is an uncorrected proof; In Table 1, the first and second data columns, Number of Total and Unintended Pregnancies, should read "in thousands".

For more information:
Facts on Unintended Pregnancy in the United States