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Not All Unintended Births Are Alike

Once upon a time, deciding whether a pregnancy was unintended was a simple and uncontroversial task; today, researchers face the challenges of measuring ambiguity and of interpreting apparent contradictions in behaviors, plans and emotions. But once researchers categorize births as unintended, they tend to treat them all alike—or, at most, to classify them as either mistimed or unwanted. A 2010 article in Perspectives by Elizabeth Wildsmith and colleagues was notable for taking a more nuanced approach.

First, the authors considered whether mistimed births had been seriously mistimed—by two or more years—on the grounds that a birth that occurs years before the woman intended is more likely to result in poor outcomes than one that occurs only a little earlier than desired. Second, the authors looked at repeat unintended births, because women who are at risk for such births may especially benefit from interventions.

The study, which examined the reproductive histories of two cohorts of women, roughly seven years apart, who were largely finished with childbearing, found that more than a third of births had been unintended, and that more than 70% of those births were either seriously mistimed or completely unwanted. Moreover, about two-fifths of women who had one unintended birth later had another. Repeat unintended births were more prevalent among black women than among their white or Hispanic peers, and were more common in the later cohort than in the earlier one, a trend the authors speculated was due in part to growing income inequality, declines in marriage rates and desired family size, and reductions in public funding of family planning programs.

Nearly a decade after the article’s appearance, studies that examine repeat unintended births continue to be uncommon, although members of the original research team reexplored the issue (as well as the degree of mistiming) in a Perspectives article in 2018.

Perspectives on Sexual and Reproductive Health and Family Planning Perspectives may be accessed through Wiley Online Library (2003–) and JSTOR (1969–2011).

Cover illustrations of Margaret Sanger © Matthew and Eve Levine