Category Archives: Unintended pregnancies

Unintended pregnancy happens at all reproductive ages, with a peak in women aged 20-24 years.1

During a woman’s mid-20s it is quite usual for relationships and contraception to be changing. Condoms are frequently used. It is important to recognize that these factors inevitably put women in this age bracket at risk of unintended pregnancy, despite responsible attitudes and sensible use of contraception.

4.Web unintended pregnancy by age

References

1. Finer L and Henshaw S. Perspectives on Sexual and Reproductive Health 2006; 38(2): 90-96.

Although unintended pregnancy happens most often when no contraception is used, two studies show that it also happens when it is claimed that contraception is being used.1,2

In fact, over 30% of unintended pregnancies happened when women were using highly effective contraceptive methods like the Pill or IUD.1

2.Web  unintended can pregnancy happen

It can be calculated that ‘contraceptive interruption’ is inevitable in a woman’s life, where she is trying to prevent pregnancy from the time she is about 17 years old (mean age of first sexual intercourse) until she is about 50. If she is on the Pill she will need to take about 8000 tablets correctly. It is unsurprising that she sometimes forgets tablets or makes mistakes.

References

1.Bajos N et al. Hum Reprod.2003; 18(5) 994 – 9.

2.Wynn LL and Trussell J. Contraception 2008; 77: 1-5.
3.Nappi et al. Eu J  Contracep and Repr Health Care 19.2 (2014): 93-101.

Compared with intended pregnancy, unintended pregnancies have a potential public health impact.

Potential health impact, compared with intended pregnancy

Women

• More likely to behave in a way that could increase the risks to their baby e.g. smoking and alcohol use during pregnancy1
• Later pre-natal care2
• Increased risk of antenatal and postnatal depression1
• Greater mood disturbance e.g. greater anxiety at 12 months post partum1
• Disruption of the life of a woman, education missed, careers missed, stress and consequences for her life2

Children

• Increased risk of poor school performance or neglect1
• Where the mother is <17 years their children start school with deficits in cognition, knowledge and language development (even where background characteristics are accounted for)3
• More likely to require psychiatric treatment (including in-patient) at any time in life (this study followed children for up to 35 years)4

Relationships

•In couples, lower levels of positive interaction at 3, 12 and 24 months after birth1

 

On the macro level, the public health, health systems, and economic impact of unintended pregnancy are also considerable.5

A US study shows the positive effect, on health and welfare costs, of reducing unintended pregnancy:

“Through the provision of effective methods of contraception to low-income individuals who have limited access to these services elsewhere, California’s family planning program averted an estimated 205,000 unintended pregnancies, averting nearly 94,000 live births and 79,000 abortions. The program saved federal, state, and local governments over $1.1 billion within 2 years after a pregnancy and $2.2 billion up to 5 years after.”6          

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References
1.Grussu P et al. Birth 2005; 32(2): 107-114.
2.Committee on Unintended Pregnancy, Institute of Medicine and the National Academy of Science. Brown S and L Einsenberg, editors. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. ISBN 13 978-0309052306.
3.Terry-Humen E et al. Playing catch-up: How children born to teenage mothers fare. Available at: http://www.thenationalcampaign.org/resources/pdf/pubs/PlayingCatchUp.pdf. Accessed October 2013.
4.David HP. Health Matters 2006; 14(27): 181-190.
5.UNFPA State of world population 2012. Accessed at: http://www.unfpa.org/public/home/publications/pid/12511. October 2013.
6.Amaral G et al. Health Serv Res 2007; 42(5): 1960-80.

Unintended pregnancy results from unprotected sexual intercourse (UPSI). UPSI is common.1

In a large European survey of over 7000 sexually active women, 30% reported having unprotected sex, at least once, in the last 12 months1

These frequent acts of unprotected sexual intercourse are not happening in a distinct sub-population, but happen irrespective of age, income, education level and marital status.1

Unprotected sexual intercourse can happen, even when a couple consciously tries to prevent it.

Unprotected sexual intercourse can result from a couple not using any contraception,1 including ‘withdrawal’.2 It can also happen when they consciously try to prevent it. For example UPSI can happen as a result of :

– Accidental condom problem1 (breakage, slippage, not on in time)

– Oral contraceptive (OC) problems1 e.g. forgotten pill

– A temporary break from the usual contraceptive1

– Forgetting to apply a patch or insert a vaginal ring1

UPSI can also happen as a result of violence (rape).

The majority of women say that there are no particular circumstances that could explain their lack of contraception or contraception failure.1 Only a minority recognised that some factors may have influenced their behaviour, making contraceptive failure more likely.1

These factors included a new partner or relationship breakdown, travel, influence of alcohol or using a new contraceptive method.1

References
1. Nappi et al. Eu J  Contracep and Repr Health Care 19.2 (2014): 93-101.
2.Trussell J. Contraception 2011; 83: 397-404.

Unintended pregnancies result from unprotected sex where no children, or no more children are desired.

It has been estimated that 44% of pregnancies in Europe are unintended.1

This figure may seem surprising. However, during most of a woman’s reproductive life she is likely to be trying to avoid pregnancy. Therefore the period during which a pregnancy would be considered unintended is much longer than the period during which she would be actively trying to become pregnant.

Two thirds of unintended pregnancies end via abortion, a quarter end in birth and about 11% in miscarriage.1

References
1.Singh S et al. Stud Fam Plann 2010; 41: 241-50.