With no budge in more than 20 years, are US unintended pregnancy rates finally on the decline?

Expert Commentary The unintended pregnancy rate has hovered around 50% for at least 20 years despite vigorous efforts to educate both the public and health care providers on the importance of using effective contraceptive methods. During that time, new contraceptives were developed and older methods were improved to reduce risk and adverse effects. Despite these efforts, however, an estimated 48% of all unintended pregnancies in the United States occurred among contraceptive users.¹ Results of the study by Finer and Zolna on the recent decline in unintended pregnancies suggest there may be some light at the end of the tunnel.

Details of the studyThe study authors used data from the National Survey of Family Growth (NSFG) and other sources to calculate rates of pregnancy in the United States for 2008 and 2011, including rates based on pregnancy intentions and outcome. About 45% of pregnancies in 2011 were unintended, compared with 51% in 2008. The rate in 2011 represents the lowest rate of unintended pregnancy in more than 3 decades.

Rates reduced in many population subgroupsThe percentage of unintended pregnancies ending in abortion remained stable at 40% in 2008 and 42% in 2011. The largest changes in rate of unintended pregnancy from 2008 to 2011 occurred in women aged 15 to 17 years (−44%), women cohabiting (−29%), those with incomes at 100% to 199% of the federal poverty level (−32%), women who were not high school graduates (−28%), and Hispanic women (−26%). Other population subgroups also showed improvement but to a lesser extent than those described here.

The study authors concede that some of the reduction in unintended pregnancies can be attributed to the economic recession that occurred during the study time frame, when many women intentionally reduced or delayed childbearing. The more likely explanation, they point out, is the increased use of long-acting reversible contraception (LARC), particularly the intrauterine device (IUD). Notably, among US women using contraception, the rates of IUD use increased from 4% in 2007 to 12% in 2012.²

Nevertheless, while the unintended pregnancy rate has shown improvement, the rate in the United States still lags considerably behind that of other industrialized nations. In Western Europe, for example, the unintended pregnancy rate was 34% in 2012.³

What this evidence means for practiceAs the study data suggest, use of contraceptive methods that do not rely on a frequent activity by the user, such as LARC methods, is associated with improved adherence. Consequently, all LARC methods, including the IUD, are associated with a pregnancy rate of about 1% or less; this rate is equal to or better than the rates seen with many forms of tubal sterilization, and it is superior to that seen with other methods, such as oral contraceptives, which have a contraceptive failure rate of about 9%.⁴

Finally, to correct disparities noted in this study that may be related particularly to access to contraceptive methods, the Affordable Care Act contains provisions that should lead to greater availability of contraceptive services in the United States.

—Ronald T. Burkman, MD

Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

Expert Commentary The unintended pregnancy rate has hovered around 50% for at least 20 years despite vigorous efforts to educate both the public and health care providers on the importance of using effective contraceptive methods. During that time, new contraceptives were developed and older methods were improved to reduce risk and adverse effects. Despite these efforts, however, an estimated 48% of all unintended pregnancies in the United States occurred among contraceptive users.¹ Results of the study by Finer and Zolna on the recent decline in unintended pregnancies suggest there may be some light at the end of the tunnel.

Details of the studyThe study authors used data from the National Survey of Family Growth (NSFG) and other sources to calculate rates of pregnancy in the United States for 2008 and 2011, including rates based on pregnancy intentions and outcome. About 45% of pregnancies in 2011 were unintended, compared with 51% in 2008. The rate in 2011 represents the lowest rate of unintended pregnancy in more than 3 decades.

Rates reduced in many population subgroupsThe percentage of unintended pregnancies ending in abortion remained stable at 40% in 2008 and 42% in 2011. The largest changes in rate of unintended pregnancy from 2008 to 2011 occurred in women aged 15 to 17 years (−44%), women cohabiting (−29%), those with incomes at 100% to 199% of the federal poverty level (−32%), women who were not high school graduates (−28%), and Hispanic women (−26%). Other population subgroups also showed improvement but to a lesser extent than those described here.

The study authors concede that some of the reduction in unintended pregnancies can be attributed to the economic recession that occurred during the study time frame, when many women intentionally reduced or delayed childbearing. The more likely explanation, they point out, is the increased use of long-acting reversible contraception (LARC), particularly the intrauterine device (IUD). Notably, among US women using contraception, the rates of IUD use increased from 4% in 2007 to 12% in 2012.²

Nevertheless, while the unintended pregnancy rate has shown improvement, the rate in the United States still lags considerably behind that of other industrialized nations. In Western Europe, for example, the unintended pregnancy rate was 34% in 2012.³

What this evidence means for practiceAs the study data suggest, use of contraceptive methods that do not rely on a frequent activity by the user, such as LARC methods, is associated with improved adherence. Consequently, all LARC methods, including the IUD, are associated with a pregnancy rate of about 1% or less; this rate is equal to or better than the rates seen with many forms of tubal sterilization, and it is superior to that seen with other methods, such as oral contraceptives, which have a contraceptive failure rate of about 9%.⁴

Finally, to correct disparities noted in this study that may be related particularly to access to contraceptive methods, the Affordable Care Act contains provisions that should lead to greater availability of contraceptive services in the United States.

—Ronald T. Burkman, MD

Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

Expert Commentary The unintended pregnancy rate has hovered around 50% for at least 20 years despite vigorous efforts to educate both the public and health care providers on the importance of using effective contraceptive methods. During that time, new contraceptives were developed and older methods were improved to reduce risk and adverse effects. Despite these efforts, however, an estimated 48% of all unintended pregnancies in the United States occurred among contraceptive users.¹ Results of the study by Finer and Zolna on the recent decline in unintended pregnancies suggest there may be some light at the end of the tunnel.

Details of the studyThe study authors used data from the National Survey of Family Growth (NSFG) and other sources to calculate rates of pregnancy in the United States for 2008 and 2011, including rates based on pregnancy intentions and outcome. About 45% of pregnancies in 2011 were unintended, compared with 51% in 2008. The rate in 2011 represents the lowest rate of unintended pregnancy in more than 3 decades.

Rates reduced in many population subgroupsThe percentage of unintended pregnancies ending in abortion remained stable at 40% in 2008 and 42% in 2011. The largest changes in rate of unintended pregnancy from 2008 to 2011 occurred in women aged 15 to 17 years (−44%), women cohabiting (−29%), those with incomes at 100% to 199% of the federal poverty level (−32%), women who were not high school graduates (−28%), and Hispanic women (−26%). Other population subgroups also showed improvement but to a lesser extent than those described here.

The study authors concede that some of the reduction in unintended pregnancies can be attributed to the economic recession that occurred during the study time frame, when many women intentionally reduced or delayed childbearing. The more likely explanation, they point out, is the increased use of long-acting reversible contraception (LARC), particularly the intrauterine device (IUD). Notably, among US women using contraception, the rates of IUD use increased from 4% in 2007 to 12% in 2012.²

Nevertheless, while the unintended pregnancy rate has shown improvement, the rate in the United States still lags considerably behind that of other industrialized nations. In Western Europe, for example, the unintended pregnancy rate was 34% in 2012.³

What this evidence means for practiceAs the study data suggest, use of contraceptive methods that do not rely on a frequent activity by the user, such as LARC methods, is associated with improved adherence. Consequently, all LARC methods, including the IUD, are associated with a pregnancy rate of about 1% or less; this rate is equal to or better than the rates seen with many forms of tubal sterilization, and it is superior to that seen with other methods, such as oral contraceptives, which have a contraceptive failure rate of about 9%.⁴

Finally, to correct disparities noted in this study that may be related particularly to access to contraceptive methods, the Affordable Care Act contains provisions that should lead to greater availability of contraceptive services in the United States.

—Ronald T. Burkman, MD

Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.