Half Of US Pregnancies Unintended

An article in the Health Journal portion of the 20 April 2010 Wall Street Journal, The Birth-Control Riddle by Melinda Beck, offers these impressive statistics regarding unintended pregnancies:

Almost half of all pregnancies in the U.S.—some 3.1 million a year—are unintended, according to the most recent government survey, from 2001. ((The same article goes on to note: “An updated version of those numbers from the 2006 National Survey of Family Growth is expected to be released next month. But population experts don’t anticipate much change; the rate of unplanned pregnancy was the same in 1994, and smaller studies have found that even newer birth control methods haven’t made much of a dent.”)) One out of every two American women aged 15 to 44 has at least one unplanned pregnancy in her lifetime. Among unmarried women in their 20s, seven out of 10 pregnancies are unplanned.

While the causes of the problem may be, as the article’s title indicates, a riddle, its mechanics are not:

Almost half (48%) of unintended pregnancies involve contraceptive failures. In 52% of cases, couples used no birth control at all. Cost is a factor for some of them. Even though most insurers now cover contraceptives, co-pays and deductibles can still present obstacles.

And many young people are in “the fog zone” in which their beliefs about pregnancy don’t match their behaviors, according to a 2009 report by the National Campaign to End Teen and Unplanned Pregnancy. In a survey conducted by the Guttmacher Institute of 1,800 single men and women aged 18 to 29, more than 80% of both sexes said it was important to them to avoid pregnancy right now, yet 43% of those who are sexually active said they used no contraception or used it inconsistently.

The following chart from the CDC (not in the WSJ article) offers confirmation of the premise that most couple incidents of unintended pregnancy were the result of not using any contraceptives.

The CDC 2002 PRAMS Surveillance Report: Multistate Exhibits – Unintended Pregnancy and Contraceptive Use also provides these sobering indicators that the problem is not lessening: ((Note: PRAMS data is not collected in all states. In 1999, for example, data was collected in 17 states: Alabama, Alaska, Arkansas, Colorado, Florida, Illinois, Louisiana, Maine, New Mexico, New York, North Carolina, Ohio, Oklahoma, South Carolina, Utah, Washington, and West Virginia))

In 2002, among women who reported that their pregnancy was unintended, the prevalence of contraceptive (any method) use at the time of pregnancy ranged from 38.7% (Hawaii) to 53.3% (Vermont).

During 2000–2002, the prevalence of contraceptive (any method) use at the time of pregnancy among women with an unintended pregnancy decreased in 4 states (Florida, New Mexico, New York, and North Carolina).

Education And Technology As Solutions

After delineating the problem, the article (The Birth-Control Riddle) notes,

Some population experts say the rates of unintended pregnancy would be far lower if more women used IUDs and implants that prevent pregnancy for years at a time. Only about 3% of American women currently do.

“There are terrible misperceptions about these methods— and about all forms of contraception,” says James Trussell, director of the Office of Population Research at Princeton University.

Many traditional forms of contraception have been updated in recent years. Here’s a look at the latest developments: …

A summary of the pros and cons of various contraceptive methodologies, under the headings, The New IUDs, The Implant , Hormone Pills, Patches And Rings,Condoms, Caps And Sponges, Emergency Contraception, Permanent Birth Control, and Vasectomy Variations, completes the piece.

The Problem With Education And Technology As Solutions To Noncompliance

The advancements in effectiveness, safety, and ease of use of contraceptive technology are important and may well trigger incremental improvements in the rate of use of these methods. Nonetheless, the emphasis on improved technology begs the question of why none of the previously available, well publicized contraceptive methods (e.g., birth control pills, abstinence, diaphragms) were used in half of all unintended pregnancies.

And, educating patients beyond the basics (i.e., the instructions for safe and effective treatment implementation and a simple explanation of how the medication, diet, surgical procedure, etc. works) has rarely proved successful in significantly ameliorating noncompliance.

The most problematic aspect of the focus on education and technology, however, is that it distracts from other possible factors, including the cultural, socioeconomic, and psychological issues that may prevent a woman and her partner from using any contraceptive method regardless of their understanding or appreciation of the technology.

Given that unintended pregnancy has been shown to influence a woman’s behavior and experiences during pregnancy and in the post-natal period to the detriment of the health of her infant, this is a noncompliance problem that merits a more inclusive response than appeals for more education and tbetter technology, however worthy those efforts may themselves be.