About 50% of pregnancies among all age groups in the United States are unintended. This does not just include teenage girls or unmarried women. This statistic includes women with children, women who are married, college educated women. Every demographic. People like you and I (Yes, even men. Men report unintended pregnancy in their partner at the same rate as women). An unintended pregnancy can have many negative effects on the physical and mental health of both mother and child. The rates of unintended pregnancy are higher in the United States than any other developed country. States with the highest rates of unintended pregnancies are located in the southern portion of the United States (Unintended Pregnancy, 2016). These states also happen to be the ones with greatly reduced funding for women’s healthcare and reproductive choice.
Although unintended pregnancies happen across every demographic, women in low income households, women who are between the ages of 18 and 24, minority women and women who cohabitate with their partner are among the highest risk groups. When looking at only females under the age of 19 who are sexually active, risks are especially high (Unintended Pregnancy, 2016).
When speaking about unintended pregnancies, there are two categories that these pregnancies fall under: mistimed and unwanted. About 27% of unintended pregnancies are mistimed and about 18% are unwanted. About 42% of unintended pregnancies end in abortion and 58% end with birth. Higher income women are more likely to terminate their unwanted pregnancy where lower income women are more likely to give birth. This results in lower income women having a significantly higher unintended birth rate (Unintended Pregnancy, 2016). This is significant because lower income women are less likely to have the resources to care for the children that result from an unintended birth. This can lead to higher use of government assistance among that demographic.
Over two thirds of unplanned births in 2010 were funded by government medical programs such as Medicaid with some states reporting as high as 85% of unplanned births being funded by Medicaid. Government expenditures on unplanned pregnancies were estimated at 21 billion dollars in 2010 (Unintended Pregnancy, 2016).
The government, historically has continued to defund programs like Planned Parenthood and other community services that provide birth control to women. During the 2008-2009 fiscal year Planned Parenthood received 363.2 million dollars in government grants and contracts (Planned Parenthood, 2011). To drive this point home: The government is reducing the 363.2 million dollars they spend on Planned Parenthood and turning around and paying 21 BILLION dollars to provide healthcare for unintended pregnancies (Unintended Pregnancy, 2016), (Planned Parenthood, 2011). That does not include assistance such as WIC, TANF, and SNAP (“food stamps” and “welfare”) received by women who experienced unintended pregnancies.
Politics aside, unintended pregnancy can cause women to lose income and job opportunities. Women who experience unintended pregnancy may have to halt their education or job training. Unintended pregnancy also puts an immense financial and emotional strain on the family unit as a whole. These factors can be true regardless of age, race or financial situation. There are countless possible interventions that can be used to prevent unwanted pregnancy however access to birth control and treatment compliance is consistently a barrier. Some women do not have access to birth control either because there is a lack of resources in the area they live or because they do not have the financial means to obtain birth control. Monthly prescriptions can create compliance issues where either the individual does not have the means to pay for the birth control on a monthly basis or pills are skipped or forgotten.
The Choice Project
One Missouri organization called The Contraceptive Choice Project has dedicated their time to finding the most effective way to reduce unintended pregnancies. In a research study which contained over 9,000 participants (women) which spanned from 2007 to 2011, researchers found that long acting reversible contraceptive methods (LARC) reduced the number of unintended pregnancies significantly. Women were counseled about birth control choices with a focus on the benefits of LARC products. LARC products include two types of IUDs and implantable devices. About 75% of participants chose LARC as opposed to non-long acting methods (pills, patch, ring etc.). Interestingly about 86% of women who chose a LARC option were still using birth control after one year of treatment as opposed to 55% of those who chose non long acting methods. As a result, the study also found that women using LARC were more satisfied with their method of birth control. Women who did not use LARC were at a 20 times higher risk of unintended pregnancy than those who chose LARC (Choiceproject, 2017).
This study also focused on an important aspect of birth control for the adolescent demographic. Focus groups were conducted for participants under the age of 19. Researchers found that convenience, effectiveness and duration of use were among the most cited reasons for choice of and continuation of use for LARC methods (Choiceproject, 2017). This information can be used to council young women on the risks and benefits of these methods to help them better understand their contraceptive choices.
A Family Planning Miracle in Colorado
Although many southern states are resistant to providing women’s healthcare services, Colorado has taken note of the success of The Choice Project. The Colorado Family Planning Initiative was implemented in 2009, teen births and abortions have been nearly halved. Even more significantly, the number of teens who gave birth to a second unintended pregnancy fell by almost 60%. This provides significant evidence that contraceptive education and access to contraceptive choices works to reduce unintended teen pregnancies. In the past, may teen pregnancy prevention programs consisted of abstinence only education, or experiential interventions (taking a fake baby home, taking care of an egg etc.). This type of social intervention also benefits the government, the state of Colorado saved about $70 million dollars in public assistance. The state of Colorado’s Family Planning Initiative had four main strategies (Tarico, 2017):
- Increase access to quality services.
- Increase availability of IUD’s and implants
- Promote healthy decisions and planning
- Improve public policy and practices
Washington and Oregon
Other states such as Oregon are beginning to follow in the footsteps of Colorado. One of the main focuses of the planned interventions in Oregon includes the “One Key Question” which asks women if they are intending to become pregnant in the next year. If they do not intend to become pregnant, all contraceptive options are presented. Oregon is also focusing on identifying how many women are in need of services and assessing what types of services are most beneficial. Currently women can obtain contraceptives after only speaking with a pharmacist and insurance companies are required cover a 12 month supply of contraceptives in a single prescription fill (Tarico, 2017). This strategy will hopefully increase compliance among those who do not chose LARC methods. Oregon is expected to publish new guidelines for Family planning by the summer of 2017.
Washington is also making significant strides in this arena. Schools clinics now provide the full range of birth control options and contraceptive education. Physicians are being trained to properly explain and offer even the newest contraception methods. In 2008 King County home of Seattle received a grant to offer school clinic based contraceptive services including IUDs, this has resulted in a 55% drop in teen pregnancy (Tarico, 2017).
This type of research overall provides valuable information for those who intend to implement interventions related to preventing unplanned pregnancies. The creators of The Choice Project provided a valuable and needed resource for their community (they also provide STI screening, pregnancy testing, well woman exams and emergency contraception) and have provided valuable information for others who wish to do the same thing. It is unfortunate that funding for these types of programs is consistently being cut, it would do so much for so many people to have these services available. Participatory action research such as that conducted by The Choice Project serves to make society a better place for everyone.
The social change research and interventions mentioned above have made great progress in ensuring that women do not experience unintended pregnancies. Women in areas with these services are able to be in control of their own future and the future of their family. One can only hope that other states, including the south where teen and unintended pregnancy is highest, will take note of the success and benefits of these programs.
Planned Parenthood. (2011, April 18). Retrieved April 15, 2017, from http://www.factcheck.org/2011/04/planned-parenthood/
The Contraception Choice Project. (n.d.). Retrieved April 15, 2017, from http://www.choiceproject.wustl.edu/#STUDIES
Unintended Pregnancy in the United States. (2016, October 05). Retrieved April 15, 2017, from https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states
Valerie Tarico / AlterNet. (2017, April 07). A Family Planning Miracle in Colorado: Program Has Teen Births and Abortions Drop by Half, and It’s Heading to Other States. Retrieved April 16, 2017, from http://www.alternet.org/personal-health/family-planning-miracle-colorado-program-has-teen-births-and-abortions-drop-half-and