Unintended Pregnancy in the United States | Guttmacher Institute

On average, U.S. women want to have two children. To accomplish that goal, a woman will spend close to three years pregnant, postpartum or attempting to become pregnant, and about three decades—more than three-quarters of her reproductive life—trying to avoid pregnancy.1

DEFINING PREGNANCY DESIRES

Although researchers have been measuring unintended pregnancy for decades, the conventional approach to categorizing recalled pregnancy desires does not capture the complexities of women’s and couples’ desires, their experiences prior to pregnancy or the context in which a pregnancy occurs. As a result, sources of data available to characterize pregnancy desires and experiences are limited. The Guttmacher Institute is aware of these limitations, and our experts are working to address them in our work. The findings included in this fact sheet are the most current available.

An unintended pregnancy is one that occurred when a woman wanted to become pregnant in the future but not at the time she became pregnant (“wanted later”) or one that occurred when she did not want to become pregnant then or at any time in the future (“unwanted”). In this fact sheet, births resulting from unintended pregnancies are referred to as “unplanned.”

All other pregnancies are often termed “intended,” including those that were desired at the time they occurred or were wanted sooner than they occurred (“then or sooner”). At the national level, pregnancies to women who were indifferent or unsure about becoming pregnant are typically combined with pregnancies that were wanted then or sooner. It is important to note that women defined as having an “intended” pregnancy have not necessarily expressed an intention or plan to become pregnant.

PREGNANCY INCIDENCE

• In 2011, there were 98 pregnancies for every 1,000 women aged 15–44 in the United States.2
• In 2011, there were 45 unintended pregnancies for every 1,000 women aged 15–44 in the United States. In other words, nearly 5% of reproductive-age women have an unintended pregnancy each year.2
• The unintended pregnancy rate is significantly higher in the United States than in many other developed countries.3
• In 2011, nearly half (45%, or 2.8 million) of the 6.1 million pregnancies in the United States were unintended. Specifically, 27% of all pregnancies were “wanted later” and 18% of pregnancies were “unwanted.”2

DEMOGRAPHIC differences

Understanding demographic differences in unintended pregnancy helps to identify where to focus policy and programmatic interventions, and highlights areas of inequality. These differences do not occur in a vacuum; they reflect differences in social, cultural, structural, economic and political contexts, which influence health behaviors, access to services and outcomes.

• Unintended pregnancy rates are highest among low-income women (i.e., women with incomes less than 200% of the federal poverty level), women aged 18–24, cohabiting women and women of color.2 Rates tend to be lowest among higher-income women (at or above 200% of poverty), white women, college graduates and married women.
• The rate of unintended pregnancy among women with incomes less than 100% of the poverty was 112 per 1,000 in 2011, more than five times the rate among women with incomes of at least 200% of poverty (20 per 1,000 women). 2
• The proportion of pregnancies that are unintended generally decreases with age. The highest unintended pregnancy rate in 2011 was among women aged 20–24 (81 per 1,000 women).2 However, traditional estimates understate the risk of unintended pregnancy among adolescents because these estimates typically include all women, whether or not they are sexually active. When rates are recalculated including only those sexually active, women aged 15–19 have the highest unintended pregnancy rate of any age-group.4
• Cohabiting women had a higher rate of unintended pregnancy compared with both unmarried noncohabiting women (141 vs. 36–54 per 1,000) and married women (29 per 1,000).2
• At 79 per 1,000, the unintended pregnancy rate for non-Hispanic black women in 2011 was more than double that of non-Hispanic white women (33 per 1,000). 2
• Women without a high school degree had the highest unintended pregnancy rate among those of any educational level in 2011 (73 per 1,000), and rates were lower with each level of educational attainment.2
• There are also differences in rates of outcomes of unintended pregnancies across population groups. In 2011, women with incomes below 100% of poverty had an unplanned birth rate nearly seven times that of women at or above 200% of poverty. 2

TRENDS

• In the United States, the proportion of pregnancies that were unintended increased slightly between 2001 and 2008 (from 48% to 51%), but, by 2011, the proportion decreased to 45%.2,5
• Following a long period of minimal change, the overall unintended pregnancy rate (the number of unintended pregnancies per 1,000 women aged 15–44) decreased substantially from 54 in 2008 to 45 in 2011, a decline of 18%. This is the lowest rate since at least 1981 and is likely due to an overall increase in contraceptive use and the use of highly effective contraceptive methods.2
• Between 1981 and 2008, the unintended pregnancy rate among low-income women rose, while the rate among higher-income women declined steadily. Between 2008 and 2011, however, the rate among women with incomes below poverty dropped from 137 per 1,000 women aged 15–44 to 112 per 1,000—an 18% decline in just three years. The rate among women at or above 200% of poverty decreased 20% between 2008 and 2011.2,5
• The unintended pregnancy rate among adolescents has been declining since the late 1980s. Between 2008 and 2011, the unintended pregnancy rate among women aged 18–19 declined 20%, and the unplanned birth rate declined 21%. Among women aged 15–17, the unintended pregnancy rate declined 44% during the same period, and the unplanned birth rate declined 47%.2

OUTCOMES OF UNINTENDED PREGNANCY

• In 2011, 42% of unintended pregnancies (excluding miscarriages) 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 15–44.8 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 (50%) than among women in other racial and ethnic groups (36–40%).2
• In 2011, a lower proportion of women below poverty (38%) than of women at 100–199% of poverty (44%) or of higher-income women (48%) chose to end an unintended pregnancy by abortion. Consequently, women below poverty had a relatively high unplanned birth rate compared with women above poverty (60 vs. 9–28 per 1,000 women aged 15–44).2
• The proportion of births that fathers report as unplanned—about four in 10 in a 2006–2010 study—is similar to that reported by mothers. The proportion varied significantly according to fathers’ union status, age, education level, and race and ethnicity.7

PREVENTING UNINTENDED PREGNANCY

• Publicly funded family planning services help women avoid pregnancies they do not want and plan pregnancies they do want. In 2014, these services helped women avoid two million unintended pregnancies, which would likely have resulted in 900,000 births and nearly 700,000 abortions.8
• Without publicly funded family planning services, U.S. rates of unintended pregnancy, and resulting births and abortions for 2014 would have been 68% higher.8
• In 2010, the nationwide public investment in family planning services resulted in $13.6 billion in net savings from helping women avoid unintended pregnancies and a range of other negative reproductive health outcomes, such as HIV and other STIs, cervical cancer and infertility.9

References

1. Sonfield A, Hasstedt K and Gold RB, Moving Forward: Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014, https://www.guttmacher.org/report/moving-forward-family-planning-era-hea....

2. Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, doi:10.1056/NEJMsa1506575.

3. Singh S, Sedgh G and Hussain R, Unintended pregnancy: worldwide levels, trends, and outcomes, Studies in Family Planning, 2010, 41(4):241–250.

4. Finer LB, Unintended pregnancy among U.S. adolescents: accounting for sexual activity, Journal of Adolescent Health, 2010, 47(3):312–314, doi:10.1016/j.jadohealth.2010.02.002.

5. Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, 104(Suppl 1):S43–S48, doi:10.2105/AJPH.2013.301416.

6. Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, 46(1):3–14, doi:10.1363/46e0414.

7. Lindberg LD and Kost K, Exploring U.S. men’s birth intentions, Maternal and Child Health Journal, 2014, 18(3):625–633, doi:10.1007/s10995-013-1286-x.

8. Frost JJ, Frohwirth LF and Zolna MR, Contraceptive Needs and Services, 2014 Update, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/contraceptive-needs-and-services-2014-....

9. Frost JJ et al., Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program, Milbank Quarterly, 2014, 92(4):696–749, doi:10.1111/1468-0009.12080.

Figure 1: Unintended Pregnancy Rates
Source: Special tabulations of data from Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, doi:10.1056/NEJMsa1506575.