New Estimates From Guttmacher Institute And Who Indicate Major Inequities In Access To Sexual And Reproductive Health Services Including Contraceptive And Abortion Care
TheGuttmacher Institute, the World Heath Organization and the UNs Human Reproduction Programme today released the first-ever model-based estimates of unintended pregnancy and abortion rates for 150 countries, highlighting major disparitiesin access to sexual and reproductive health care.
The study, published in BMJ Global Health, analyzes rates from 2015 to 2019, with the aim of providing deeper insights into access to sexual and reproductive health services in countries of all income levels across the globe.
To build sexual and reproductive health policies that are truly inclusive and equitable, we need to understand what is happening at a country level, said Dr Herminia Palacio, President and CEO of the Guttmacher Institute. Having current and reliable data at hand will not only help identify and find solutions to disparities, but also make a case for smarter investments that deliver impact.
Alongside the estimates, Guttmacher has published more detailed country profiles to allow decision makers and health advocates to better understand and act on sexual and reproductive health needs in their countries, particularly for family planning, includingcontraception and comprehensive abortion care.
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The Women Who Choose Abortion
Abortion is a routine part of reproductive health care. Approximately 25 percent of women in the U.S. will undergo an abortion before the age of 45. The Guttmacher Institute, a research and policy institute in New York City, has been tracking these data for the last 50 years.
American women have abortions with similar frequency to women living in other developed nations. The bulk of abortion patients are in their 20s.
Women of all races and ethnicities choose abortion. In 2014, 39 percent of abortion patients were white, 28 percent were black and 25 percent were Latinx. Similarly, women of all religious affiliations choose to end their pregnancies at similar frequencies.
Most of these women understand what it means to parent a child. More than half of abortion patients in 2014 were already mothers.
Poor women account for the majority of abortion patients. Fifty-three percent of women pay out-of-pocket for their abortion. The rest use private or state-funded insurance plans.
Women choose abortion for multiple reasons. The most common reason cited is that pregnancy would interfere with education, work or ability to care for dependents.
Financial stress also plays a major role in womens decision-making. Seventy-three percent of women reported that they could not afford a baby at the time. Nearly half cited relationship difficulties or wanting to avoid single motherhood. More than a third of women felt their families were complete.
Young Women In Their Twenties Experience Many Unintended Pregnancies
- One-third of all unintended pregnancies are to young women in their twenties. Eighty-six percent of pregnancies among unmarried women in their twenties are unplanned.
- Women in their twenties account for 57 percent of abortions in the U.S and have the highest abortion rates of any age group 29.4 abortions per 1,000 women aged 2024 years and 21.4 abortions per 1,000 women aged 2529 years.
- Unintended pregnancy among young women in their twenties affects women of all races, education levels, and income levels.
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Unplanned Pregnancies In Us At 40 Percent
About 40 percent of pregnancies across the United States were unwanted or mistimed, according to the first-ever state-by-state analysis of unintended pregnancies.
According to the analysis released Thursday, the highest rates were in the South, Southwest and in states with large urban populations. Highest was Mississippi with 69 per 1,000 women ages 15-44 lowest was New Hampshire, with 36 per 1,000.
“There are many, many reasons why people don’t plan ahead, even when it’s such a crucial decision,” says Claire Brindis, director of the Bixby Center for Global Reproductive Health at the University of California-San Francisco, who was not involved in the analysis.
Brindis says difficulty in finding family planning services and lack of access to birth control contribute to the high numbers of unintended pregnancies. There is “a very strong denial factor – ‘this won’t happen to me,’ ” she says.
The analysis, based on 2006 data, the most recent available, used national and state surveys on pregnancy intentions, births, abortions and miscarriages, including data from 86,000 women who gave birth and 9,000 women who had abortions. It is published online in the journal Perspectives on Sexual and Reproductive Health.
“We know we have very high levels of unintended pregnancy in the U.S., much higher than in most places around the developed world,” says Kelly Musick, a sociologist at Cornell University in Ithaca, N.Y., who was not involved in the analysis.
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Proportion Of Unplanned Pregnancy
Majority of pregnancies were planned at the time of conception whereas the proportion of unplanned pregnancies were 17.2% and 12.7% were ambivalent.
The mean LMUP score was 8.97 with a standard deviation of 3.914. Median was 11 and the interquartile range was 612. Distribution was negatively skewed .
Fig. 1
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Women At Risk Of Unintened Pregnancy
In analyzing which women contribute to this pool of unintended pregnancies, it is helpful to begin with the profile of women at risk of such pregnancies. The definition of women at risk of unintended pregnancy is multifacted. They are women who have had sexual intercourse are fertile, that is, neither they nor their partners have been contraceptively sterilized and they do not believe that they are infertile for any other reason and are neither intentionally pregnant nor have they been trying to become pregnant during any part of the year.5 In 1990, about 31 million women met these criteria and could therefore be considered at risk of unintended pregnancy . These 31 million women represented about half of the 62 million women in the reproductive age range, defined as ages 1344.
Not surprisingly, among women of reproductive age, the highest proportions at risk of unintended pregnancy are found at ages 1829, the age range in which most women are fertile, have usually begun sexual activity but often prefer to delay pregnancy, and are generally too young to seek sterilization . Seventy percent of women in this age category are at risk of unintended pregnancy. This proportion drops dramatically among women age 30 and over, many of whom have been sterilized or have partners who have been sterilized. Nevertheless, nearly 12 million women aged 3044 remain at risk of unintended pregnancy, compared with nearly 17 million women aged 1829.
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Unplanned Pregnancy Is ‘a Crisis All Around Us’
A report from the UN’s Population Fund says pregnancy is an inevitability, not a choice, for many women lacking education, autonomy or contraception.
Unintended pregnancies are common in crisis situations that cause mass migration, like the war in Ukraine
Pregnancy isn’t always planned. For many women, it is because they can’t access contraception. For some, it is because their contraception fails. And for others, it is because they don’t have a choice.
Each year, about 121 million pregnancies across the globe are unintended, according to a report published Wednesday by the United Nation’s Population Fund . The UNFPA studies, among other things, sexual and reproductive health trends. The figure amounts to nearly half of all pregnancies worldwide.
“This is a crisis that’s all around us,” said UNFPA Executive Director Natalia Kanem in an interview with DW. “But it’s unseen. It’s unrecognized and that is part of a global failure to prioritize women and girls and to uphold the basic human rights for women and adolescents.”
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Dismantling Structural Barriers To Prevention
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Largely due to increased contraceptive use, teen pregnancy and birth rates have declined since their peak in 1990. But 750,000 teens become pregnant each year the vast majority of these pregnancies unintended. Teens need youth-friendly services and complete, accurate information about abstinence, condoms, and contraception in order to protect themselves from unintended pregnancy. But they also need to be able to envision a positive future for themselves: one in which education, employment, and healthy relationships are possible. Helping young people prevent unintended pregnancy is a challenge that teens, parents, youth serving professionals, policy makers, and society as a whole must face.
Unintended Pregnancy Rates In America
In 2011, the rates of unintended pregnancy among African-American, Hispanic and Caucasian women that ended in birth were 33, 31, and 17% respectively in the United States . Using data from the National Survey of Family Growth from 2006 to 2010, Kim et al. observed 50% of the 3577 pregnancies were unintended . The study notes that women of color, particularly black women had higher rates than whites 63% , 48% and 42% . Although the rates were higher among black and Hispanic women, the difference was not statistically significant . However, even the lowest rate of unintended pregnancy, 42%, would be considered unacceptable high by most healthcare providers. This number is particularly alarming given the failure rate of less than 1% for highly effective contraceptives .
Fig. 1
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Drivers Of Unintended Pregnancy
At the individual level, poverty, lack of autonomy and low education attainment limit womens and girls access to accurate contraceptive information and services. Some women and girls simply cannot afford to pay for contraceptives. In places where contraceptives are freely available, some women lack accurate knowledge of them and how they work.
In some settings, people interpret religion as prohibiting contraceptive use. They use religion to deny young people accurate contraceptive information. When women and girls lack access to accurate contraceptive information and services, their risk of unintended pregnancy increases.
In a study conducted by the African Population and Health Research Center, adolescent girls in Kenya told us they got pregnant because they were young and naive about relationships and contraceptives. Some of them had to exchange sex for their basic needs. Others were sexually violated. Because they did not seek care in clinics or know about emergency contraception, they were vulnerable to unintended pregnancy. Some had dropped out of school.
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However, access to quality services is lacking in many African communities. Stock-outs remain a problem for family planning programmes. The COVID-19 pandemic also disrupted the supply of contraceptives and services.
Many Pregnancies End In Unsafe Abortions
Over 60% of those unplanned pregnancies end in abortion. The rest are carried to term.
For women in rich countries where abortion is legal, termination procedures are largely safe. But nearly half the UNFPA says it’s 45% are unsafe abortions.
Those unsafe abortions account for up to 13% of maternal deaths worldwide.
In developed countries, the number of unintended pregnancies has fallen dramatically since the 1990s. That is due in part, says the report, to an increase in the availability of contraceptives and sexual education.
That is not the case in sub-Saharan Africa, where the number of unintended pregnancies has fallen by a mere 12%. And when you account for global population growth, the report says the absolute number of women who experience an unintended pregnancy worldwide has in fact increased by 13%.
Women often feel at a loss if they get pregnant unintentionally. They don’t know how to feel or what to do about it. The UN report says that although some pregnancies are terminated and others are celebrated, many are met with ambivalence.
“These pregnancies may be not quite unintended but not fully deliberate either, taking place when an individual lacks the possibility to fully articulate what they want in their lives or even to imagine a life in which pregnancy is a choice,” write the report authors.
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Outcomes Of Unintended Pregnancy
- In 2011, 42% of unintended pregnancies ended in abortion, and 58% ended in birth. This was a small shift from 2008, when 40% ended in abortion and 60% ended in birth.2
- The unplanned birth rate in 2011 was 22 per 1,000 women aged 1544.8 In that same year, the abortion rate was 17 per 1,000 women.6
- The proportion of unintended pregnancies ending in birth decreased across all racial and ethnic groups between 2008 and 2011. The proportion of women experiencing an unintended pregnancy and choosing to end it in abortion was higher among black women than among women in other racial and ethnic groups .2
- In 2011, a lower proportion of women below poverty than of women at 100199% of poverty or of higher-income women chose to end an unintended pregnancy by abortion. Consequently, women below poverty had a relatively high unplanned birth rate compared with women above poverty .2
- The proportion of births that fathers report as unplannedabout four in 10 in a 20062010 studyis similar to that reported by mothers. The proportion varied significantly according to fathers union status, age, education level, and race and ethnicity.7
Approaches To Preventing Unintended Pregnancy Among Young People Must Include Dismantling Structural Barriers
- Barriers to contraceptive access, poverty, and structural exclusion and disadvantage all contribute to young peoples ability and motivation to prevent unintended pregnancy.
- Among teens, pregnancy is both a cause and a result of poverty and low academic achievement. Teen pregnancy is part of the cycle of poverty in which very young mothers often stay poor, and their children are at increased risk for teen pregnancy, poverty, and lower academic outcomes.
- Teens are more likely to become pregnant as teens if their mother or sister gives birth as a teen, or if teen pregnancy is common in their community.
- Teens who have low expectations for their futures or feel that they lack control over their lives are more likely to experience pregnancy.
- Teen pregnancy can also be impacted by immigration status. For instance, Latino immigrant youth have lower rates of sexual activity and later sexual debut than non-immigrant children, but also fewer resources for obtaining quality health care and education they subsequently have higher teen pregnancy rates than white youth.
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What Are The Negative Effects Of Unplanned Pregnancy
Unintended pregnancy can result from contraceptive failure, non-use of contraceptive services, and, less commonly, rape. Abortion is a frequent consequence of unintended pregnancy and, in the developing world, can result in serious, long-term negative health effects including infertility and maternal death.
Contraception: From Access To Misconception
Methods for contraception exist. But the report says that many women are prevented from exercising a basic right to bodily autonomy for example, a right to choose to use contraception if they want. That is why, say the report authors, there is no material “magic bullet” or solution to “solve” the problem.
Some women who can access contraception methods abstain from using them. There are many reasons for this, ranging from stigmatization in certain communities or misconceptions such as some perimenopausal women think they don’t need contraception.
Many other women are in relationships with men who want children and deny their partners a right to birth control. That can either force the women to use birth control in secret or carry children for whom they feel unprepared.
The report notes that the responsibility to prevent pregnancy falls, in most cases, on women. But that does not mean they always have a choice. The report cites data collected in sub-Saharan Africa between the mid-1990s to the mid-2000s, which showed that the majority of men desired children more than women desired them.
Kanem told DW this indicated a “mismatch between what women want and need and what men believe to be the ideal.”
“It’s the mother of the family who typically is selfless. She plans the meals. She decides who is going to get which shoes to go to school. And she’s a realist when it comes to : How much can I bear? What is the investment in each of my children going to cost?” Kanem said.
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Improving Access To Effective Contraception
Providing contraceptives and family planning services at low or no cost to the user helps prevent unintended pregnancies. Many of those at risk of unintended pregnancy have little income, so even though contraceptives are highly cost-effective, up-front cost can be a barrier. Subsidized family planning services improve the health of the population and saves money for governments and health insurers by reducing medical, education, and other costs to society.
In 2006, publicly funded family planning services helped women avoid 1.94 million unintended pregnancies, thus preventing about 860,000 unintended births and 810,000 abortions. Without publicly funded family planning services, the number of unintended pregnancies and abortions in the United States would be nearly two-thirds higher among women overall and among teens, and the number of unintended pregnancies among lower-class women would nearly double. The services provided at publicly funded clinics saved the federal and state governments an estimated $5.1 billion in 2008 in short term medical costs. Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed.
I Am Going To Give The Baby Up For Adoption What Do I Do Now
If you have decided that the best choice is to give your baby to adoptive parents, you can meet with a social worker or crisis pregnancy specialist to receive counselling and help you through the process. You may pursue an open adoption, where you exchange contact information with the adoptive parents, or a closed adoption, where no contact with the adoptive parents occurs. Usually you can be involved in choosing adoptive parents for your baby. Adoption processes vary from province to province.
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