A new study finds that the unintended pregnancy rate in the United States declined by 18 percent between 2008 and 2011, falling to the lowest rate in more than three decades. The study, published in the New England Journal of Medicine, attributes the dramatic decline in unintended pregnancies to the increasing use of long-acting reversible contraceptive methods, especially intrauterine devices (IUDs).
Reducing the unintended pregnancy rate has long been a public health priority in the United States, where approximately half of all pregnancies each year are unintended. While unintended pregnancy rates are declining around the world, the United States notoriously falls behind countries that have similar levels of wealth and industrialization, resulting in profound public health consequences
. Research shows that unintended pregnancies are associated with a variety of adverse economic, psychosocial, and maternal health outcomes, as well as poor infant and child health outcomes, including preterm birth, low birthweight, and impaired child development.
In this latest study, researchers from the Guttmacher Institute analyzed previously collected data from several sources to assess the rate of unintended pregnancy among women and girls ages 15 to 44. The results showed that there were 45 unintended pregnancies for every 1,000 women and girls in 2011, compared to 54 for every 1,000 in 2008. That’s the lowest rate observed since the Guttmacher Institute began keeping records 35 years ago. Rates went down “across nearly all age, income, education and race and ethnic groups,” the researchers reported, though stark disparities remain among poor women and women of color.
“After a long period of minimal change, the unintended pregnancy rate has declined to the lowest rate observed in the United States since we first began tracking these numbers in 1981, and by 18 percent in just three years,” Dr. Lawrence Finer, the study’s lead author, said in a statement.
The study links the drop in unintended pregnancy to a corresponding increase in the use of intrauterine devices and other long-acting reversible contraceptives (LARCs) such as birth control implants. From 2007 to 2012, the use of IUDs and other LARCs more than tripled among U.S. women. According to the American College of Obstetrics and Gynecologists, LARCs are the most reliable and effective form of reversible birth control available. Over the long term, LARC methods are 20 times more effective than birth control pills, the patch, or the ring, with an efficacy rate of more than 99 percent — about the same as sterilization, except these methods are reversible if and when a woman decides to become pregnant.
“When women have access to a broad method mix that includes highly effective [contraceptive] methods, they can choose the method that is best suited for them,” Dr. Finer said. “This reduces their risk of unintended pregnancy and leads to better health outcomes for women and their families.”
The researchers are hopeful that the introduction of the Affordable Care Act could drive the unintended pregnancy rate down even further by expanding access to LARCs and other forms of birth control with no co-pay. Previous studies have found that when women aren’t prohibited by cost, they choose more effective, long-lasting forms of birth control and experience significantly fewer unintended pregnancies as a result.
“Given that we researched a period that was before the Affordable Care Act, we’re interested to see what is going to happen going forward,” Finer said. “We may see a continued downward trend.”
Breaking down the barriers to contraceptive access
Despite these promising results, nearly half (45 percent) of the 6.1 million pregnancies that occurred in the U.S. in 2011 were unintended. That’s down down from 51 percent in 2008, but it’s still far higher than the mark set by the U.S. Department of Health and Human Services’ Healthy People 2020 campaign.
Moreover, poor women and women of color are still disproportionately affected by unintended pregnancy, most likely because LARCs are more difficult to obtain in these communities. According to the study, poor women had more than five times as many unintended pregnancies as higher-income women, while women of color were roughly twice as likely to experience an unintended pregnancy as white women.
IUDs are very effective, but they can be costly—according to Planned Parenthood, many women pay up to $1,000 upfront for an IUD that lasts 12 years. We know from previous research that cost is one of the major barriers to consistent use of reliable contraceptive methods. Just last month, another study published in the New England Journal of Medicine found that when Republican lawmakers in Texas eliminated Planned Parenthood from its Medicaid public family planning program for low-income women, fewer claims were filed for contraception, and more low-income women in Texas ultimately gave birth. Thanks to these funding cuts, health officials in the state were anticipating nearly 24,000 additional unplanned births between 2014 and 2015, costing state and federal taxpayers approximately $273 million in Medicaid spending alone.
Taken together, these findings really underscore what we all stand to lose as Republicans in Congress and Statehouses across the country continue their partisan push to defund Planned Parenthood, one of the largest providers of low-cost contraception and family planning services in the country. When Planned Parenthood clinics close, women don’t just lose access to Planned Parenthood; many of them lose access to effective contraception and family planning services entirely (not to mention STI tests, cancer screenings, fertility testing, sex education, and a host of other preventive health care services). Without access to affordable birth control, women lose their ability to control their own reproductive health outcomes, with potentially profound implications for the trajectory of a woman’s life.
On the other hand, increasing the availability of affordable contraceptive methods “empower[s] women to choose when they start their family,” said Dr. Adam Jacobs, director of family planning for Mount Sinai Hospital in New York City. “By doing that, you let them stay in education, which leads to a better income. They’re better able to plan their families and plan their lives.”
In fact, being able to access birth control before age 21 has been found to be the most influential factor in enabling women to stay in college, and to pursue advanced degrees. Today, the number of women who complete four or more years of college is six times what it was before birth control became legal. Researchers estimate that birth control accounted for more than 30 percent of the increase in the proportion of women in skilled careers from 1970 to 1990, and it’s also been touted as a major driver of the number of women pursuing medicine, dentistry, and law careers. Moreover, at least one-third of the wage gains women have made since the 1960s are attributed to increased use of oral contraceptives.