USA: Contraception and unintended pregnancy

An editorial by James Trussell and Lisa Wynn in the journal Contraception examines the reasons for the high incidence of unintended pregnancy in the USA.

Trussell and Wynn begin by noting:

‘Almost half (49%) of all pregnancies in the United States are unintended: There were 3.1 million in 2001 alone, the last year for which data are available. There has been no change in the recent past; these statistics were the same in 1994. One of every two women aged 15–44 in the United States has experienced at least one unintended pregnancy.’

In examining the reasons for this, they note that ‘A]lmost 90% of the women at risk for an unintended pregnancy were using a contraceptive method.’ The most popular contraceptive methods are oral contraceptive pills (11.6 million users), female sterilization (10.3 million users), male condoms (6.8 million users) and male sterilization (3.5 million users). However, ‘even with the majority of women at risk for unintended pregnancy using some form of contraception, 10.7% of all women at risk were not using any contraceptive method.’

Of the 3.1 million unintended pregnancies in 2001, Trussell and Wynn found that less than half (48%) result from contraceptive failure, and 52% were contributed by the 10.7% of women who use no method at all.

In their conclusion, the authors write:

‘Reducing unintended pregnancy is a formidable challenge. There is no magic bullet, and there will always be a group of women and men who have unprotected sex or whose contraceptive methods fail.

‘Yet, a quick look at the rate of unintended pregnancy in other countries suggests that the problem is not simply one of ‘human nature’ or a matter of the limitations of existing contraceptive technologies. While 49% of pregnancies in the United States are unintended, the corresponding percentage in France is only 33%, and in Edinburgh, Scotland, it is only 28%. Compared with the United States, these countries have much lower proportions of women at risk for unintended pregnancy who use no contraception at all; while this figure is 11% in the United States, it is only 3% in France and 3% in the United Kingdom. Moreover, IUD use is much more common; while only 2% of women at risk use IUDs in the United States, 6% use IUDs in the United Kingdom and 20% use IUDs in France.

‘No matter how dedicated they are, family planning providers cannot fix such structural problems. Instead, policy interventions are needed on a broader scale.’

Reducing unintended pregnancy in the United States. James Trussell and Lisa Wynn. Contraception, V77, N1, January 2008