Sexual and reproductive health and rights (SRHR) are integral to social and economic development, human rights and gender equality. SRHR and universal access to sexual and reproductive health services are also essential to fulfilling the 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDG) adopted by all UN member governments in 2015, which include such goals as universal health coverage, climate change resilience, peace and security, and inclusive economic growth.^1–2

The 2025 UN Sustainable Development Goals Report warns that only 35% of all SDG targets are on track to be achieved by 2030, with progress across many goals remaining fragile and uneven.³ In particular, progress toward SDG 3, on good health and well-being, and SDG 5, on gender equality, is slowing down and at significant risk of backsliding unless global efforts are considerably accelerated.^4–5

Universal access to sexual and reproductive health care services and women’s ability to make decisions about their own reproductive lives are essential components of health and gender equality. Research has shown that reproductive agency and access to SRH care are closely associated with a variety of factors, including access to education, economic empowerment and personal autonomy in decision-making.¹ This relationship is reflected, in part, through pregnancy intention. Unintended pregnancy can follow from multiple factors, including limited reproductive autonomy, limited access to quality services or contraceptive failure, and it can compromise women’s and girls’ ability to continue their education, participate in social and economic activities and pursue the lives they want. Estimates of unintended pregnancy therefore provide an important measure of how fully women and girls are able to exercise their reproductive rights. However, new research from the Guttmacher Institute shows that some standard metrics have masked the strength of the relationship between unintended pregnancy and gender inequality.

Background on the Study

The Guttmacher Institute conducted an analysis to explore whether and how gender inequality is associated with unintended pregnancy across 132 countries over a 30-year time period (1990–2019). The scope of this study reflects diverse experiences across different regions and levels of development.

Unintended pregnancy is a helpful metric to measure women’s ability to determine freely whether and when to have children and to exercise their right to bodily autonomy, which is an integral part of gender equality. The standard measure used to estimate a country’s Unintended Pregnancy Rate (UPR) looks at the number of unintended pregnancies for every 1,000 women of reproductive age (15–49 years old).

The Guttmacher study builds on previous bodies of research and examines more deeply the correlation between gender inequality and unintended pregnancy. Drawing on the UN Development Program’s Gender Inequality Index and Gender Development Index, the study seeks to provide better understanding of this relationship by looking at the two main outcomes of unintended pregnancy—unplanned birth and abortion—and using a refined measure to estimate unintended pregnancy called the Conditional Unintended Pregnancy Rate (CUPR).

A New Approach to Measuring Unintended Pregnancy

Estimating the number of unintended pregnancies is critical to understanding the extent to which women are able to prevent a pregnancy if they desire and whether they can have healthy pregnancies. While the standard UPR measurement assumes that all women of reproductive age (15–49) are at risk of unintended pregnancy, the actual picture is more complex.⁶ The UPR does not account for differences across settings in the proportion of women who wish to avoid pregnancy, which can obscure the strength of the observed relationship between measures of gender inequality and unintended pregnancy.

By focusing on women at risk of becoming pregnant who reported wanting to avoid pregnancy, the CUPR provides a more refined metric that can capture previously masked associations and trends. For some regions, the CUPR has identified sharper declines in unintended pregnancy over the time period studied than the UPR, demonstrating the progress that sexual and reproductive health programs have made in providing individuals and couples with the resources they need to avoid pregnancy. In this Guttmacher study, the CUPR yielded critical new insights into the relationship between unintended pregnancy and key components of gender inequality, such as gender gaps in economic opportunity, education, health and political leadership. To assess these relationships, three composite measures of gender inequality were used: the Gender Inequality Index (GII), the Gender Development Index (GDI), and the Global Gender Gap Index (GGI).

Key Findings

• The study found that in all time periods from 1990 to 2019, gender inequality was strongly correlated with the incidence of unintended pregnancy among women wanting to avoid pregnancy. This held true even after accounting for economic development, which often occurs alongside improvements in gender equality.
• The component of gender inequality most strongly correlated with unintended pregnancy was educational attainment: countries where women had lower educational attainment than men were found to have higher rates of unintended pregnancy.
• Using the new CUPR measure, the study found the relationship between gender inequality and unintended pregnancy to be even stronger than previously estimated. As gender inequality decreases, educational and employment opportunities for women increase and women may have more control over their reproductive decision-making.
• The strong relationship between gender inequality and unintended pregnancy suggests that social and structural barriers impact women’s desires for pregnancy while also limiting their ability to act on their reproductive preferences, make informed decisions about their reproductive health, and access necessary care. By accounting for changes over time that impact the number of women wanting to avoid pregnancy, the CUPR more clearly measures the relationship between gender inequality and unintended pregnancy.

Recommendations

• The new CUPR measure should be applied alongside the standard UPR when assessing needs, tracking progress and mapping investments in relevant SRH programs. The standard UPR measure can provide insight into the overall prevalence of unintended pregnancy, while the CUPR can reveal differences across settings and highlight trends over time in reproductive health outcomes. Leveraging both measures can strengthen advocacy, inform evidence-based policymaking and help target resources more effectively.  
• Decision-makers and advocates working on development priorities and the implementation of the SDGs should address gender inequality as a structural determinant of reproductive health, given its impact on women’s ability to prevent unintended pregnancies and to access quality sexual and reproductive health services.
• Research on global health and development priorities should recognize that investments in reducing gender inequality are also investments in reproductive health. And that when women have access to quality reproductive health services, they are better able to take advantage of new opportunities in education and employment.  
• Efforts to change patriarchal social norms and values should be understood as public health priorities and funded alongside campaigns to expand contraceptive access and advance other SRH goals.  
• Gender equality and sexual and reproductive health and rights should not be treated as isolated priorities, especially in the development context. Progress on SDG 3 (health) and on SDG 5 (gender equality) are deeply interconnected, and investments in one area reinforce gains in the other. Recognizing this interdependence is essential to accelerating progress across the 2030 Agenda.