Addressing Unintended Pregnancies: You’re Doing it Wrong


surprisepregnancyThe Guttmacher Institute recently announced a study saying that as of 2012, 40% of pregnancies worldwide are unintended, and that this is not much different from 2008.

Predictably, they also say that these “findings highlight [the]need for increased investment in contraceptive services.”

Let’s break this down point by point:

1) What is “unintended,” exactly?

The paper helpfully provides the following tautology by way of a definition:

“Unintended pregnancies consist of unplanned births, induced abortions, and miscarriages resulting from unintended pregnancies.”

(Amazing what academic journals will accept these days.)  Fortunately, the Guttmacher Institute published a more comprehensive guide to the taxonomy of pregnancy by intendedness.

Conventional measures of unintended pregnancy are designed to reflect a woman’s intentions before she became pregnant. Unintended pregnancies are pregnancies that are reported to have been either unwanted (i.e., they occurred when no children, or no more children, were desired) or mistimed (i.e., they occurred earlier than desired). In contrast, pregnancies are described as intended if they are reported to have happened at the “right time” or later than desired (because of infertility or difficulties in conceiving). A concept related to unintended pregnancy is unplanned pregnancy—one that occurred when the woman used a contraceptive method or when she did not desire to become pregnant but did not use a method. Intentions are often measured or reported only for pregnancies ending in live births; pregnancies ending in abortion are generally assumed to have been unintended. All of these definitions assume that pregnancy is a conscious decision.”

I included the entire paragraph in order to demonstrate the incongruity of that last sentence.  The Guttmacher Institute apparently thinks that 40% of the world’s conscious decision-making is unintentional.  If this is the case, medication may indeed be called for, but not necessarily of the contraceptive variety.

2) Regions with high “unmet need” for contraceptives do not necessarily have high rates of unintended pregnancy.

The new report says that Africa has the lowest rate of unintended pregnancy in the world (35%), compared with 45% in Europe and 51% in North America.  This is despite the fact that Africa is repeatedly touted as the region with the highest “unmet need” for contraception.  The “unmet need” concept is highly flawed, and as I explain here, even in Africa, less than 2% of married women claim they don’t use contraceptives because of lack of access.

The article says:

“The proportion of pregnancies that were unintended can be low in traditional societies, where many couples want large families”

So, conscious decision-making is at work here.  However, the constant pushing of contraceptives on these traditional societies does have an effect – it can actually drive up the percentage of unintended pregnancies.  Explaining why the rates of unintended pregnancy haven’t changed much since 2008 despite expanded access to contraceptives globally, the authors write:

“This finding is not surprising because, whereas increases in contraceptive use might cause a decrease in the proportion of births that were unplanned, the growing desire to have smaller families can easily offset the effects of contraceptive use on this proportion.”

Let’s think about that for a moment: increased contraceptive use is linked to a desire to have fewer children.  So why would this drive up the rate of unintended pregnancy, unless this contraceptive use were highly prone to failure?

3) Contraceptives are prone to failure

As I noted above, both Europe and North America have rates of unintended pregnancy that are above the global average, despite being industrialized, developed, low-fertility regions.  Now, particularly in light of the recent Supreme Court rulings, some will say that in the United States, contraceptive access remains an issue, but if we turn instead to England, we see this:

“Amongst developed countries, England has the highest rate of unintended pregnancy after the United States (US). Compared to the US, where contraceptive coverage is limited by insurance and reimbursement difficulties, contraception in England is provided free of charge by the National Health Service (NHS) and is used by 88% of women at risk of pregnancy.”

That’s right, contraception available for free, with the government footing the bill, and lots of women are using it.  They’re also getting pregnant, and many are seeking abortions.  The British Pregnancy Advisory Service published new data earlier this year, saying that two thirds of women who came to them for an abortion were using a contraceptive when they became pregnant.  (I discuss it here.)

4) Scratch a contraception advocate, find an abortion advocate

Continuing with the British Pregnancy Advisory Service, the most telling quote is this, from the organization’s chief executive:

Ultimately women cannot control their fertility through contraception alone, and need accessible abortion services as a back-up for when their contraception lets them down.”

The new Guttmacher report doesn’t explicitly call for increased abortion access, although their organization unambiguously promotes this in many of its publications.  But given the human and technical failures of even the most modern forms of contraception mean that pregnancies will still occur, and while many contraception advocates will plead for support from the pro-life community, saying their products will reduce abortions, it’s very rare to find one who will explicitly say that in the event of a pregnancy, the woman should not be offered an abortion.

5) Unintended (and even unwanted) pregnancies often result in beloved children

Not only are parents of “surprise” children highly likely to accept and love them, they also have a tendency to “reclassify” them as having been intended all along – much to the chagrin of the architects of complex taxonomies of pregnancy wantedness.  Some snippets from the new article:

“the results are likely influenced by changes in women’s attitudes toward these births over time.”

“some women who say they do not want to become pregnant but then do become pregnant and have a child will later report that the pregnancy was intended”

“some pregnancies that are unwanted at conception may be reported some months or years later as mistimed or wanted”

Because this tendency could lead to lower estimates of unintended pregnancy, the authors took steps to gather data in a way that ensured that “women might be less prone to rationalizing the planning status of such births.”

While a certain degree of technicality is to be expected in an academic paper, it’s worth pointing out that this “rationalizing of planning status” could also be described as not only accepting a surprise pregnancy, but becoming so attached to the child that one couldn’t fathom seeing him or her as anything other than wanted from the very beginning.  Of course, some women (and men) find this acceptance comes less easily:

“one can also argue that the births women continue to claim are unintended, even retrospectively, represent those that a woman had a particularly strong or persistent wish to avoid.”

One could argue additionally that if the Guttmacher Institute was really interested in doing something helpful for women with unintended pregnancies, it could study the factors that tend to encourage women’s acceptance of their children and look for ways to foster these things on a global and regional level.


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