Missing the Boat on Pregnancy Prevention: Teenage Pregnancy Grabs the Headlines, but Most Unintended and Unwanted Pregnancies Occur among Adults
Hogue, Carol J. Rowland, Issues in Science and Technology
Teenage pregnancy grabs the headlines, but most unintended and unwanted pregnancies occur among adults.
In the past year, new national efforts have been launched that are aimed at reducing the large numbers of unintended pregnancies among U.S. teenagers. Yet even if these efforts are dramatically successful, they will make only a dent in the problem of unintended pregnancy, because about three-fourths of the 3.1 million unintended pregnancies in the United States each year occur among adults. Indeed, more than half of the 4.5 million pregnancies among women 20 years of age or older are unintended.
The 60 percent unintended pregnancy rate in the United States has remained virtually unchanged since the early 1980s and is by far the highest in the industrialized world. Even if the United States were to achieve the 30 percent target set by the U.S. Public Health Service in its Healthy People 2000 initiative - which is unlikely without major new investments in broad-based pregnancy prevention programs - it would still have higher rates than Canada, the United Kingdom, and various northern European countries.
Unintended pregnancies place enormous burdens on individuals, families, and communities, burdens that Americans are largely unaware of except as they relate to teens. These burdens are unlikely to diminish, however, unless Americans begin to confront a deep cultural bias: the belief that unintended pregnancies among adults are common and inevitable. The attitude in cultures that have much lower rates of unintended pregnancies is that these are unfortunate and rare events that occur despite our best intentions. It is time to adopt and promote a new norm: All pregnancies should be intended - that is, they should be consciously and clearly desired at the time of conception. This is the main conclusion of a report by an Institute of Medicine (IOM) committee on which I served.
Unintended pregnancies are not just unwanted pregnancies. They also include mistimed pregnancies - conceptions that happen too soon - which can interrupt or postpone educational or vocational goals.
Whereas 28 percent of all U.S. births are mistimed and 11 percent are unwanted at conception, the proportion of unwanted pregnancies among adults (among all unintended pregnancies ending in birth) is much higher than it is for teens, most of whom want to have children at some time because they are still at the beginning of their childbearing years. Put another way, fully 90 percent of the children born from unwanted conceptions have mothers older than 19, and 70 percent have married adult parents. Many children born after an unwanted conception are born into poverty. Among ever-married women living below the federal poverty line, more than one in five of their children were not wanted at the time they were conceived. However, unwanted conceptions know no economic barriers: One in 10 of all children born to married women are unwanted at conception.
From a societal perspective, unintended conceptions carry a high cost. About one-half of unintended pregnancies among women 15 to 34 years old are terminated by abortion. For older women, the proportion ending in abortion increases to almost 60 percent. This reflects the higher proportion of unwanted conceptions among the unintended pregnancies of older women. Married women terminate more than one-fourth of their unintended conceptions. When women are grouped by income, those on either extreme choose abortion less often than women living just above the federal poverty line, who resolve 58 percent of their unintended pregnancies with an abortion.
Although abortion has few, if any, long-term negative effects on a woman's physical or psychological well-being, the decision to terminate a pregnancy can pose difficult moral or ethical problems. The high U.S. abortion rate fosters political and social tensions that cast a pall over rational discussions about meeting the needs of couples for pregnancy prevention and family planning. …