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Am J Obstet Gynecol. 1994 May;170(5 Pt 2):1485-9.

Epidemiology of unintended pregnancy and contraceptive use.

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Alan Guttmacher Institute, New York, NY 10005.


Almost all women are at risk for unintended pregnancy throughout their reproductive years. However, adolescents, formerly married women, and women of low socioeconomic status are at greater risk for contraceptive nonuse and for contraceptive failure; thus they are also at greater risk for unintended conceptions. Of the 6.4 million pregnancies occurring in the United States in 1988, more than half (56%) were unintended. An equal proportion of unintended pregnancies end in abortion (44%) as with birth (43%), and both options have great personal and social consequences. The level of unintended pregnancy appears to have increased during the last decade after consistent decreases since the early 1960s. Decreasing both the periods of contraceptive nonuse and contraceptive misuse will help lower the rate of unintended pregnancy in this country.


Adolescents comprise only 10% of all women aged 15-44 years who are sexually active, yet they account for 26% of all abortions, a reflection of their high levels of unintended pregnancy. Overall, between 47% and 51% of unintended pregnancies to women aged 15-34 years end in abortion; in women aged 40-44 years the rate is nearly 60%. 43% of unintended pregnancies are aborted by women at or above 200% of poverty compared with about 50% by women less than 100% of poverty. Periods of nonuse of contraception are times of high risk for unintended pregnancy. Women at risk for nonuse of contraception demonstrate a pattern similar to that of women at risk of unintended conceptions with regard to age, marital status, and income level. About 19% of never-married women at risk of unintended pregnancy are nonusers compared with 12% of formerly married women and 6% of those who are currently married. The level of nonuse is greatest among younger women (21% of women under 20 years old are not using contraception) and poor women (19%). Most of the 2% of women who have never used contraception are never-married young women in an early relationship. The remaining 8% of current nonusers tend to be either between methods or between relationships. Separated, divorced, or widowed women have the highest contraceptive failure rates (26%) across all age groups, and married women have the lowest rates of unintended pregnancies (15%) while using reversible contraception. Adolescent women who are unmarried have lower contraceptive failure rates than do older never-married with relatively low coital frequency. 21% of women under 200% of poverty have contraceptive failures compared with 10% of higher income women. Only 13% of OC users also use condoms to prevent STDs. The somewhat higher rate of STD testing reported among OC users has been associated with an annual pelvic examination and Papanicolaou smear required for prescription renewal, which detect asymptomatic diseases.

[Indexed for MEDLINE]

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