New evidence reveals stark disparities across countries and over time in women’s ability to avoid unintended pregnancies.
More than one in 10 women worldwide who want to avoid pregnancy experience an unintended pregnancy each year, according to “Alignment Between Desires and Outcomes Among Women Wanting to Avoid Pregnancy: A Global Comparative Study of ‘Conditional’ Unintended Pregnancy Rates,” by Guttmacher researcher Jonathan Bearak and colleagues Leontine Alkema, Vladimíra Kantorová and John Casterline.
The study unveiled a new indicator of women’s ability to prevent unintended pregnancies, referred to as the conditional unintended pregnancy rate. The standard rate—the number of unintended pregnancies per 1,000 women of reproductive age—while still a valuable measure, does not account for the fact that many women are not at risk of having an unintended pregnancy in the first place, for example because they want to have a child or are not sexually active. For this reason, the study estimated the number of unintended pregnancies among women who were sexually active and wanted to avoid pregnancy. The resulting estimates shed greater light on women's ability to exercise their reproductive autonomy.
“Women's right to determine whether and when to have children hinges in part on individuals’ ability to prevent unintended pregnancies. There are substantial disparities among countries and regions in women’s success in exercising this fundamental right,” says study lead Dr. Bearak. Although the global conditional unintended pregnancy rate was 112 per 1,000 women at risk of unintended pregnancy annually in 2015–2019, subregional rates varied widely. In Western Europe, the rate was 35 per 1,000, meaning that fewer than one in 20 women wanting to avoid a pregnancy had an unintended pregnancy; whereas in Middle Africa, where the rate was 258 per 1,000, that same figure was one in four. Put another way, in 2015–2019, women in Western Europe were more than seven times as successful in avoiding unintended pregnancies, compared with women in Middle Africa.
Such disparities were much greater in the past. In the early 1990s, more than three in 10 women wanting to avoid pregnancy experienced an unintended pregnancy each year in Eastern Africa, Middle Africa and Western Asia. Rates in these regions have since fallen 39%, 20% and 40%, respectively, while the lowest rate—that of Western Europe—has remained steady. As a result, in general, differences between higher and lower-resourced regions have become smaller.
Unintended pregnancy rates declined by two-thirds in Eastern Europe, more than in any other region. Although the declines in Africa, Asia and Latin America were smaller, these regions made substantial progress that was not fully reflected in earlier research using the standard unintended pregnancy rate. In Sub-Saharan Africa, because the proportion of women who wanted to avoid pregnancy has increased sharply, the standard rate showed a 12% decline, while the new measure revealed a 29% decline. These gains in reproductive autonomy speak to the success of international family planning programs, and yet the sizable disparities that still exist illustrate the need for greater investment in comprehensive sexual and reproductive health services worldwide.
“Alignment Between Desires and Outcomes Among Women Wanting to Avoid Pregnancy: A Global Comparative Study of ‘Conditional’ Unintended Pregnancy Rates,” by Jonathan Bearak et al., is published in Studies in Family Planning. The article is part of an ongoing study that aims to provide stakeholders with evidence about and insights into disparities in unintended pregnancy and its outcomes in low-, middle- and high-income countries. The keystone work of this project has been producing global, regional, and country-specific estimates of unintended pregnancy and abortion incidence, and estimates of abortion safety, developed collaboratively by the Guttmacher Institute and the World Health Organization.