Nearly half of all pregnancies that occur each year in the United States are unplanned, and many unintended pregnancies result from incorrect use of contraception, say three recent studies.
The 3.1 million unplanned pregnancies lead to 1.3 million abortions, 1.4 million unplanned births, and about 400 000 miscarriages each year, said Sharon Camp, president and chief executive officer of the non-profit Guttmacher Institute, which promotes sexual and reproductive health worldwide and which conducted the three studies, funded by the National Institutes of Health (Perspectives on Sexual and Reproductive Health 2007;39:90-9, 2007;39:48-55, and in press).
Of the unplanned pregnancies, about 52% occur in women who were not using contraception, the institute reported, while 43% occur in women who used contraception inconsistently or incorrectly and 5% were in women whose contraceptive method was used correctly but failed.
The institute said that the number of unplanned pregnancies could be reduced through better counselling to help women choose the right method and more support to help them continue contraceptive use when they experience side effects, have sex infrequently, or are ambivalent about avoiding pregnancy.
The institute conducted a retrospective survey of contraceptive use in a nationally representative sample of 1978 women aged 18 to 44 who were neither pregnant nor seeking to become pregnant but were fertile and sexually active. Of these women 1207 were married, 277 were cohabiting, 109 were formerly married, and 383 were unmarried.
The survey results showed that 38% of women who used oral contraceptives missed one or more pills during a three month period and that 61% of women who relied on their partner using a condom said that it was not used at each act of intercourse or was put on late at least once during a three month period. Many women stopped and started different methods during the year, with an average gap of five months before they started another method.
The reasons for inconsistent use or non-use included changes in women’s lives, such as stopping or starting a relationship, a move, a new job or school, or a personal crisis. Other reasons included social disadvantage; problems with access to care; low motivation or ambivalence about avoiding pregnancy; and attitudes and experiences with the contraceptive method and with the healthcare provider. Inconsistent use was higher among women who were not satisfied with their current method.
The institute also surveyed 805 publicly funded family planning clinics and 451 private obstetricians and gynaecologists and family doctors. Clinics were better than obstetricians and gynaecologists in providing counselling about side effects and teaching how to be consistent in daily pill use. Family doctors were least likely to provide such advice.
Women who were dissatisfied with their healthcare providers or considered that it was difficult to ask their provider questions were more likely to be inconsistent in using contraceptives.
The institute recommended that healthcare providers develop ways to share “best practices” about counselling on contraceptive use, improve training in communication, and implement ways for clients to contact them with questions or concerns.
It recommended that women choose a method that was appropriate at present (recognising that this may change in future), talk to their provider about changes in their lives that affect their contraceptive use, and ask the provider about back-up methods or emergency contraception.