UNINTENDED PREGNANCY IN THE UNITED-STATES

Context: Current debates on how to reduce the high U.S. abortion rate often fail to take into account the role of unintended pregnancy, an i mportant determinant of abortion. Methods: Data from the 1982, 1988 an d 1995 cycles of the National Survey of Family Growth, supplemented by data from other sources, are used to estimate 1994 rates and percenta ges of unintended birth and pregnancy and the proportion of women who have experienced an unintended birth, an abortion or both. In addition , estimates are made of the proportion of women who will have had an a bortion by age 45. Results: Excluding miscarriages, 49% of the pregnan cies concluding in 1994 were unintended; 54% of these ended in abortio n. Forty-eight percent of women aged 15-44 in 1994 had had at least on e unplanned pregnancy sometime in their lives; 28% had had one or more unplanned births, 30% had had one or more abortions and 11% had had b oth. At 1994 rates, women can expect to have 1.42 unintended pregnanci es by the time they are 45, and af 1992 rates, 43% of women will have had an abortion. Between 1987 and 1994. the unintended pregnancy rate declined by 16%, from 54 to 45 per 1,000 women of reproductive age. Th e proportion of unplanned pregnancies that ended in abortion increased among women aged 20 and older, but decreased among teenagers, who are now more likely than older women to continue their unplanned pregnanc ies. The unintended pregnancy rate was highest among women who were ag ed 18-24, unmarried, low-income, black or Hispanic, Conclusion: Rates of unintended pregnancy have declined, probably as a result of higher contraceptive prevalence and use of more effective methods. Efforts to achieve further decreases should focus on reducing risky behavior, pr omoting the use of effective contraceptive methods and improving the e ffectiveness with which all methods are used.