Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
55031726
label
Family Planning [Folder 1]
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
55031726
sourceUrl
contentType
document
title
Family Planning [Folder 1]
citationUrl
collections
Records of the First Lady's Office (Clinton Administration)
Melanne Verveer's Subject Files
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
55031726
levelOfDescription
fileUnit
otherTitles
2068127-20130534S-093-003-2022
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
d490ad4c65fce7a4
ocrText
the
Vital Voices
Sin
free family
planny
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
The Rockefeller Foundation
Our Common Future
Global Population and
The United States,
7
file Intern'l
templanning
Remarks of
J. Brian Atwood
International Family Planning
Columbia University
N.Y.,N.Y.
February 6, 1997
I want to thank Dean Allan Rosenfield of Columbia and Steve Sinding of the
Rockefeller Foundation for sponsoring this event. Both of these individuals have spent
an adult lifetime helping people understand the importance of family planning. I thank
them for their leadership.
We gather here today because we care deeply about the lives of millions of
poor people around the world who have grown to depend upon the American family
planning program. Possibly next week Congress will vote on what should be a rather
technical issue: will USAID be able to start spending "metered" family planning
funds on March 1 or will we have to wait until July 1.
Does that sound straightforward? Well, I wish it were that straightforward. It
would appear today that we will once again find ourselves entangled in the so-called
Mexico City policy. This Reagan Administration policy, adopted by Executive Order,
instructed USAID not to provide family planning resources to any organization that
uses its own private resources to provide abortion-related services. The practical
effect of this was to deny us the right to work with some of the most effective family
planning organizations in the world -- organizations that have worldwide affiliates who
would never accept American-dictated rules and who, I should note, are committed to
obeying the laws of the countries in which they operate.
Did Mexico City have the effect of changing the policies of these organizations?
Absolutely not. Our government cannot extend its control over what organizations do
with private funds. In my view, many of these groups would rather collapse than give
in on these very private matters.
This vote goes back to a deal made last year during the appropriations process
over our funding. The House and Senate leadership and the Administration -- who
had reached an impasse over family planning funds -- agreed to a provision that would
delay the release of our family planning funds until July of this year. Built into this
provision was an agreement that if the President found the delay in funding was
adversely affecting our programs, he could send such a finding to Congress and they
would vote on whether funds could be released March 1.
Well, for anyone with common sense, it is no surprise that withholding funding
adversely affects our family planning programs. The President was unequivocal in
asking Congress to release USAID's full funding. He said, "it is my determination
that a delay will cause serious, irreversible and avoidable harm. In the balance are the
lives and well-being of many thousands of women and children and America's
credibility as the leader in family planning programs around the world." The
President's finding determined that delaying funding would result in unintended
pregnancies, the deaths of mothers and children, and more abortions around the globe
-- not less.
So how did delaying our funding -- which will trigger such grave consequences
-- become the pet project of every pro-life group in Washington? Certainly, it is not
because America's family planning programs somehow cause abortions. Again, let me
be unequivocal: family planning prevents abortions.
We know this intuitively -- after all, it is unintended pregnancies, not desired
ones, that drive desperate women to take desperate actions. And we know it
empirically -- data from countries as socially and religiously diverse as Hungary,
Russia, Mexico, and even our own United States show clearly that increases in
contraception cause decreases in abortions.
For two decades U.S. population assistance programs have strictly adhered to
our law forbidding the use of U.S. funds to support or promote abortions overseas.
At USAID we reaffirmed that policy early in the Clinton Administration, maintaining
that our programs and resources should be used to help the needy rather than to
promote a pro or an anti-abortion view on the sovereign governments of the
developing world.
Not one penny of our funding goes to any organization that breaks the laws of
the country in which it operates. And our system of audits has documented that no
funds have been diverted to illegal ends.
So why then an abortion debate? Maybe the real reason is that the opponents
of our funding want to talk about abortion, because they know they can't win a fair
discussion on the merits of family planning. Maybe these groups would rather raise
the false issue of abortion than to admit that family planning works, is voluntary, and
is making the world a better place.
In their report released just last week, the Rockefeller Foundation noted that
family planning programs have been one of the greatest success stories of U.S.
development assistance. The Rockefeller report noted that these programs have helped
2
bring family size down from six children to three children. Smaller family size has
meant, healthier, better cared for and more economically productive families.
This report points out how we have all benefitted from a world population
which is 500 million less than it would have been without this assistance. The
Rockefeller report went on to note that by demonstrating our concern for the health
and well being of families in the developing world, the United States is advancing its
most human and compassionate values.
And yet, as the Rockefeller report also highlights, our 30 year history of non-
partisan, constructive engagement in family planning, that has bettered the lives of
millions around the world, is under attack as never before. As a result, during the
last two years there has been a one-third reduction in the funds appropriated by
Congress for international family planning assistance. The administrative restrictions
that have been imposed -- the metering of monthly dispersals -- has begun to make our
programs less efficient, less responsive to need, less results oriented. And already this
has cost us at least one million dollars in red tape and administrative costs.
Is this what our opponents want? To give us taxpayers' dollars and then tie us
in knots so our program fails? It is becoming obvious that that is exactly their
intention.
But this is not just about the efficient operations of a government agency and its
cooperating agencies. This is about human life. This is about the world our children
will live in. This is about the global environment. This may even be about war and
peace.
The fact is that in the one short hour that we will be here together, the
population of the world will increase by nearly another 10,000 people. And those are
10,000 people who will need food, an education, economic opportunities and a chance
to help change the world around them. Most of these 10,000 people will be born in
the developing world, where competition for scarce resources is already fierce and
where hopelessness is a common currency.
It is incumbent upon all of us to look to the world of the twenty first century
and to make the small strategic investments today that will prevent crises and make the
world more hopeful in the future. A brighter future will not be possible unless we are
able to carry forward our commitment to honor a fundamental human right -- the
right of all couples and individuals to responsibly decide for themselves the number
and timing of their children, free of coercion or constraint.
3
Without this basic right, how can we expect that fifty percent of humanity who
are women will be able to exercise their other rights? In a world where the poorest
women struggle under the burden of multiple, closely spaced pregnancies, in a world
where women are denied the right to decide whether they want to have more children
or not and when they want to have them -- promises of education, employment
opportunities, and a secure old age are hollow without family planning.
Global population is not the only cause of environmental degradation, famine,
economic stagnation, high infant mortality rates and ethnic conflict. But we must
recognize the important amplifying effect of rapid population growth on all of these
threats to the world today. If we fail to see that smaller, better cared for families are
in everyone's best interest, our legacy could well be one of growing disorder, social
degradation, and conflict.
Experts on food security tell us that achieving the goal of the recent World
Food Summit -- reducing the number of malnourished by half by the year 2015 -- will
require coordinated interventions in improving agricultural productivity through
research; building vibrant economies through market reforms; meeting basic human
needs; and, stabilizing population so that we are not in a continual, and unwinnable,
circular race between the numbers of mouths to feeds and the food available to feed
them.
Today, there are over 100 million couples in the world who would use family
planning if they had access to high quality contraceptive services, but they do not.
Compare that to the 290 million couples currently using family planning, and it is
obvious that simply filling this unmet need would go a very long way toward
improving health and stabilizing world population.
Voluntarism is the essence of USAID's population assistance programs.
Let me be clear, we reject with equal firmness the extremists on both sides:
those who would involuntarily impose population control and those who would deny
women access to family planning services. The former is the reason we cannot and
will not condone the coercive population control policies of the People's Republic of
China. The latter is the reason we cannot accept the reimposition of the Mexico City
policy.
Avoiding these extremes and focusing instead on meeting basic human needs
and supporting informed decision-making is why we have over the past several years
built an integrated strategic approach at USAID that stresses five key principles:
4
No woman should be forced to become pregnant unless she wishes to bear a
child;
No woman should be put at risk of death as a consequence of pregnancy;
No family should be forced to face the needless death of a young child;
No person should have her or his life placed at risk as a consequence of
responsible sexual activity; and,
No person, and particularly no woman, should enter adulthood without the
basic educational skills that will enable them to become a part of our global
society.
I believe these principles reflect American values. Pursued as a group, they
will ensure the reproductive health of women around the world. This is what more
than 180 nations at the Cairo International Conference on Population and Development
agreed to as the central tenets of reproductive health, and it is what we at USAID
have committed ourselves to applying in real life.
Our family planning programs work to ensure that women and men have the
information to make informed decisions about the size of their families, and the
contraceptives and services to prevent unintended pregnancies.
It is estimated that over 30 million couples around the world are practicing
family planning today because of U.S. assistance.
Our maternal health programs work to provide prenatal care and nutrition, to
develop effective and low cost ways to identify high risk pregnancies, and to establish
low-tech -- but lifesaving -- referrals for women whose lives are in danger from
complications of their pregnancies.
Our child survival programs have pioneered the use of oral rehydration, case
management for pneumonia, immunization outreach, and micronutrient
supplementation, and have demonstrated the most dramatic decreases in child mortality
over the shortest time span ever seen.
Our programs to prevent AIDS and other sexually transmitted infections have
demonstrated the value of a strategy which aims both at changing high risk sexual
behavior and at early detection and treatment of infections, and we are seeing the first
evidence of a slowing of the AIDS epidemic in countries from Thailand to Uganda.
5
And our new commitment to education for girls and women is reflected in the
bright smiles of girls at school in the highlands of Guatemala and the eager intensity
of young women in the hills of Nepal who are reading their very first words.
Who would oppose these programs? Why would we not act to improve
millions of lives when we have the tools right at our fingertips? Because of U.S.
leadership in these fields other donor nations have taken on new responsibilities in all
of the areas I have discussed to a scale never before seen. Japan, Germany, the
European Union, and others have launched significant new initiatives. And many
countries that have benefited from the fruits of U.S. population assistance -- from
Colombia, to Tunisia, to Thailand -- have moved to self-sufficiency in their family
planning and health efforts. Yet allowing our commitment to falter now would be like
declaring the relay race won before the baton has been passed.
The world stands poised at the brink of the largest generation in human history.
By the year 2000, demographers estimate the generation having children will
not only be the largest there has ever been in the long march of human population
growth, it will be the largest there will ever be. We are nearly at the crest of the hill.
This means that our challenge, while daunting, is not permanent, and certainly not
beyond our reach. But the twenty one million additional young women joining those
already of childbearing age in the developing world each year, desperately need our
help to assure that they are not condemned to the cycle of unwanted pregnancy,
malnutrition, illness and death which had been the lot of too many of their mothers
and grandmothers. And after this generation, our work may truly be done.
If we accept our responsibility to complete the job we have started, in the year
2050 we will be able to look on a world in which problems will be progressively more
manageable, not less. The actions we take today will decide if the world in 2050 has
9 billion inhabitants or 11 billion.
By slowing population growth, we will give ourselves the opportunity to feed,
educate, clothe and house the children of the world. We will help shape a world
where democracy and opportunity replace desperation and fear. We will have
contributed to a world where every child is a wanted child.
I urge the Congress to release USAID family planning funds. I urge the
American people to brush aside the emotional rhetoric about abortion and support a
program that is working to make the world a better place for millions of people. And
I urge all of you to continue your enlightened work -- to continue caring deeply about
people.
6
The
Alan
Guttmacher
MEMORANDUM
Institute
TO:
Friends of Family Planning
New York and Washington
FROM:
Susan Cohen
DATE:
January 22, 1998
A Not-for-Profit Corporation
RE:
Promoting Prevention of Unintended Pregnancy
for Reproductive Health
Research, Policy Analysis
and Public Education
1120 Connecticut Avenue
Suite 460
Washington, DC 20036
Telephone: 202 296-4012
Fax: 202 223-5756
e-mail: [email protected]
In light of the discussion on January 20th with the First Lady and the Vice President about
the Administration's priority on making abortion less necessary by promoting family planning, I
thought you would find the attached materials useful.
It is self-evident to most Americans that increased access to effective family planning
services and information is the most effective and responsible way to reduce abortion. It is not only
a winning message - - it is also supported by the data and experiences of women both in the United
States and in other countries. The recent AGI study that provoked interest during the meeting
reveals the dramatic decline in the unintended pregnancy rate in this country and finds that much of
that success is attributable directly to improved contraceptive use. The fact that the abortion rate
also dropped steeply during this same time period, then, is not surprising. The data make clear that
a large factor in explaining the reduction in the abortion rate is, indeed, the success of family
planning.
In addition, "The Role of Contraception in Reducing Abortion" highlights some of the
major evidence - - from the United States and abroad - that contraception works.
Please feel free to contact me with any questions or to further discuss these issues. I could
not agree more with the First Lady and the Vice President that we must work together to promote
this unified front to take back the moral and political high ground.
A Not-for-Profit Corporation
News
for Reproductive Health
The
Research, Policy Analysis
and Public Education
Alan
120 Wall Street
New York, NY 10005
Guttmacher
Institute
New York and Washington
Contact: Susan Tew
EMBARGOED FOR RELEASE:
212/248-1111 (x2208)
SATURDAY. JAN. 17, 1998-6 PM
[email protected]
U.S. UNINTENDED PREGNANCY RATE FALLS 16% SINCE 1987
Improved Contraceptive Use a Major Factor
The rate of unintended pregnancy among women of reproductive age (15-44) in the United
States dropped 16%-from 54 to 45 pregnancies per 1,000 women annually-between 1987 and
1994, according to a new study "Unintended Pregnancy in the United States," by The Alan
Guttmacher Institute (AGI). As reflected in the overall drop in the unintended pregnancy rate during
this period, the abortion rate declined 11% from 27 to 24 abortions per 1,000 women annually
(continuing its downward trend since 1980), as did the unintended birth rate, which declined 22%
from 27 to 21 births per 1,000 women. (Unintended pregnancies are estimated as the sum of
abortions and of births resulting from pregnancies reported as having been unplanned.)
Another measure of unplanned pregnancy-the proportion of all pregnancies that are
unintended-dropped 14% between 1987 and 1994. In 1987, 57% of all pregnancies were
unplanned; in 1994, 49% of 5.4 million pregnancies in the United States were unplanned.
Unintended pregnancy is highest among women aged 18-24, and those who are unmarried, low-
income, black or Hispanic.
The dramatic decline in unplanned pregnancy has occurred to a large extent as a result of
higher contraceptive prevalence and use of more effective methods. For example, condom use has
increased significantly and the proportion of women at risk of an unplanned pregnancy using no
contraceptive method has gone down. The decline may also begin to explain why all measures of
abortion in the United States (rates, ratios and numbers) are falling. It is important, however, to note
that unplanned pregnancy in this country continues to be much higher than in most comparable
developed countries.
The new study shows how widespread unplanned pregnancy is among U.S. women: 48% of
women (15-44) have had at least one unplanned pregnancy in their lives. Twenty-eight percent have
had at least one unplanned birth, 30% have had one or more abortions and 11% have had both. At
1992 abortion rates, 43% of women will have had an abortion by age 45.
"The drop in unintended pregnancy in this country is good news, but half of pregnancies is
still half. Whether they end in abortion or unplanned birth, unintended pregnancies come at a cost
1
both to the people involved and to society. The key to reducing unplanned pregnancy further will be
to decrease risky behavior, promote the use of effective contraceptive methods, including emergency
contraceptive pills, and improve the effectiveness with which all methods are used," comments study
author Stanley K. Henshaw, deputy director of research at AGI.
The study, published in the forthcoming January/February 1998 issue of Family Planning
Perspectives, presents 1994 estimates of the percentage of births and pregnancies that were
unintended, the intended and unintended pregnancy rates, and the proportion of women who have
had an unintended birth, an abortion or both. It also provides estimates of the proportion of women
who will have had an abortion by age 45 (cumulative first-abortion rate).
The analysis is based on several sources of the most current available data on reproductive
behavior, including AGI's 1992 survey of all known abortion providers in the country, AGI's 1994
survey of nearly 10,000 women having abortions and the 1995 National Survey of Family Growth (a
periodic nationally representative survey of U.S. women of reproductive age conducted by the
National Center for Health Statistics).
The full study presents detailed demographic characteristics of women who have unintended
pregnancies, distributed by age, marital status, poverty status, race and ethnicity (see attached tables
1-4). Among key findings:
1 in 11 (9%) U.S. women have a pregnancy each year
51% of all pregnancies to U.S. women end in planned births, 23% end in unplanned
births (either mistimed or unwanted conceptions) and 27% end in abortion
nearly 5% of women have an unplanned pregnancy each year
54% of unintended pregnancies end in abortion and 46% end in birth
nearly one-third of all births (31%) are unplanned (21% are mistimed and 10%
unwanted)
60% of women in their 30s have had an unplanned birth or an abortion
two-thirds of pregnancies to 30-34-year-old women end in planned births
15% of 30-39-year-old women have had an unplanned birth and an abortion
6 in 10 unintended pregnancies to both women under 15 and over 40 end in abortion
never-married women have more than twice the unintended pregnancy rate of married
women
low-income women have nearly three times the rate of unintended pregnancy as higher-
income women, but are less likely to end their unplanned pregnancies in abortion
black and Hispanic women have considerably higher rates of unplanned pregnancy than
other women but are only somewhat more likely to end these pregnancies in abortion
58% of women who had an abortion had been using a contraceptive during the month
they became pregnant, as had 48% of those who had an unplanned birth
###
The Alan Guttmacher Institute is a not-for-profit organization for reproductive health research,
policy analysis and public education with offices in New York City and Washington, D.C.
2
Unintended Pregnancy in the United States
by Stanley K. Henshaw
changes from 1987 to 1994 and the effect
Context: Current debates on how to reduce the high U.S. abortion rate often fail to take into ac-
of changes in unintended pregnancy rates
count the role of unintended pregnancy, an important determinant of abortion.
on rates of abortion and unplanned birth.
Methods: Data from the 1982, 1988 and 1995 cycles of the National Survey of Family Growth,
supplemented by data from other sources, are used to estimate 1994 rates and percentages of
Data and Methodology
unintended birth and pregnancy and the proportion of women who have experienced an unin-
Data from the 1995 NFSG and from other
tended birth, an abortion or both. In addition, estimates are made of the proportion of women
sources are used to present estimates, for
who will have had an abortion by age 45.
1994, of the percentage of births and preg-
nancies that were unintended, the in-
Results: Excluding miscarriages, 49% of the pregnancies concluding in 1994 were unintend-
ed; 54% of these ended in abortion. Forty-eight percent of women aged 15-44 in 1994 had had
tended and unintended pregnancy rates,
at least one unplanned pregnancy sometime in their lives; 28% had had one or more unplanned
and the proportion of women who have
births, 30% had had one or more abortions and 11% had had both. At 1994 rates, women can
ever had an unintended birth, an abortion
expect to have 1.42 unintended pregnancies by the time they are 45, and at 1992 rates, 43% of
or both. In addition, we have calculated
women will have had an abortion. Between 1987 and 1994, the unintended pregnancy rate de-
the proportion of women who, at 1992
clined by 16%, from 54 to 45 per 1,000 women of reproductive age. The proportion of unplanned
rates, will have had an abortion by age 45.
pregnancies that ended in abortion increased among women aged 20 and older, but decreased
For this analysis, unintended pregnancies
among teenagers, who are now more likely than older women to continue their unplanned preg-
were estimated as the sum of abortions
nancies. The unintended pregnancy rate was highest among women who were aged 18-24,
and of births resulting from pregnancies
unmarried, low-income, black or Hispanic.
reported as having been unintended.
Conclusion: Rates of unintended pregnancy have declined, probably as a result of higher con-
Births
traceptive prevalence and use of more effective methods. Efforts to achieve further decreases
should focus on reducing risky behavior, promoting the use of effective contraceptive methods
The most recent national data on the plan-
and improving the effectiveness with which all methods are used.
ning status of births come from the NSFG,
a periodic fertility survey. In addition to
Family Planning Perspectives, 1998, 30(1):24-29 & 46
the 1995 survey, we also use data from
NSFGs conducted in 1982 and 1988.
The 1995 NSFG interviewed a nation-
T
lhe relatively high rate of unintended
more children ever.³ A study of births to
ally representative probability sample of
pregnancy in the United States¹ has
ever-married women found that the pro-
10,847 civilian women aged 15-44.8 Inter-
received increasing attention as the
portion of births that were unplanned de-
views were conducted between January
immediate cause of both abortion and un-
creased from 38% in 1969-1973 to 32% in
and October 1995 and included questions
planned birth. For example, the Institute of
1978-1982, then increased again to 35% in
on the planning status of each pregnancy
Medicine recently published a report that
1984-1988.⁴ Another study comparing the
experienced by a respondent. Following
summarized the consequences of unin-
1982 and 1988 NSFG survey results found
the NSFG definition, births were catego-
tended pregnancies that are carried to term
that there had been no change in the un-
rized as unplanned if the woman had been
and urged the adoption of a new national
intended pregnancy rate between 1982
practicing contraception when she became
goal that all pregnancies be planned.² Im-
and 1987, but that the unintended birth
pregnant, if she had not wanted to become
proved fertility control would allow women
rate had increased from 25 per 1,000
pregnant until a later time or if she had
and couples to have children when they feel
women aged 15-44 to 27 per 1,000, while
wanted no more children ever. The preg-
best prepared socially and financially to as-
the abortion rate fell by a similar amount.⁵
nancy was considered intended if the
sume the responsibilities of parenting.
An earlier study based on the 1982 NSFG
woman had not been practicing contra-
The most accurate national estimates of
concluded that 46% of women aged 15-44
ception and reported that she had not
unplanned birth have been based on the
at the time of the survey had experienced
cared whether she became pregnant. The
National Surveys of Family Growth
one or more unintended pregnancies and
small number of births for which intention
(NSFG), a series of nationally representa-
that at 1982 rates, 46% would have at least
status was undetermined (0.3%) were dis-
tive surveys that collect detailed repro-
one abortion by age 45.6
tributed proportionally.
ductive and contraceptive histories and
The publication of data from the 1995
related information from women of re-
NSFG⁷ provides information on the in-
Stanley K. Henshaw is deputy director of research with
productive age. A study based on the 1988
tendedness of births during the five years
The Alan Guttmacher Institute, New York (AGI). The re-
search on which this article is based was funded by the
NSFG estimated that 57% of pregnancies
preceding the 1995 survey interviews, and
Andrew W. Mellon Foundation and The Rockefeller
in 1987 (excluding miscarriages) were un-
can be used as the basis of an updated re-
Foundation. The author thanks his colleagues in the re-
intended; that is, they ended in induced
port on unintended pregnancy. In this ar-
search department of AGI: Haishan Fu, for calculations
abortion, the woman had wanted no chil-
ticle, we assess the prevalence of unin-
of contraceptive use; Suzette Audam, for programming;
and Yvette Cuca, Taylor Haas and Shelby Pasarell, for
dren at that time or she had wanted no
tended pregnancy during this period, the
research assistance.
24
Family Planning Perspectives
This information was used to determine
formed nationally is compiled through pe-
states. We used tabulations of these abor-
the proportion of unplanned births among
riodic surveys of abortion providers con-
tions by single year of age to break down
NFSG respondents in the five years pre-
ducted by The Alan Guttmacher Institute.¹³
national five-year age-groups into single-
ceding the interview. We chose the five-year
However, this provided abortion estimates
year categories. For years lacking an NCHS
period to ensure that the sample size would
only through 1992, the most recent year
tape, we interpolated or projected figures.
be large enough to yield a stable proportion.
covered by the surveys. For 1993 and 1994,
We also used the tape tabulations to cal-
We estimated the number of unplanned
we projected totals from trends in the num-
culate for each year during 1973-1994 the
births in the United States by multiplying
ber of abortions in published and unpub-
proportion of first-time abortions within
the resulting proportion with the number
lished reports from state health statistics
each single-year age-group. First, we mul-
of births reported in 1994 by the National
agencies. We used information only from
tiplied the number of abortions by the pro-
Center for Health Statistics (NCHS).9
states with consistent data collection pro-
portions we had derived from the tapes
We also estimated unplanned births for
cedures in the two adjacent years (42 states
in order to arrive at an initial estimate for
1994 according to the mothers' age, mar-
and the District of Columbia to project 1993
each year of first abortions for each single
ital status, poverty status, race, ethnicity
totals from the 1992 data, and 43 states and
year of age. We then adjusted the numbers
and contraceptive use during the month
the District of Columbia to project 1994 to-
of first abortions in each single-year age
of conception. Since the number of births
tals from the 1993 data).
category so that the sum for each year was
by poverty status is not published by the
The age, marital status, race and eth-
equal to the total number of first abortions
NCHS, we used the poverty distribution
nicity of women who had had abortions
previously estimated for that year from
of births, as tabulated from the NSFG.
were based on percentage distributions
CDC data. To estimate the cumulative
Births to unmarried women are reported
compiled from state health department re-
number of first abortions that took place
by the NCHS, but we used NSFG tabula-
ports by the Centers for Disease Control
during 1973-1994 for each age cohort, we
tions to further categorize these women
and Prevention (CDC), 14 with adjustments
added together the number of first abor-
as formerly married or never-married.
for year-to-year changes in the reporting
tions that each age-group would have ex-
For 1981 and 1987, the proportions of un-
states. For 1994, we separated unmarried
perienced for each year during this peri-
planned births were taken from published
women who had had abortions into sub-
od. We then divided this total by the
1982 and 1988 NSFG results¹⁰ and applied
categories of never-married and former-
number of women in that age-group in the
to the numbers of births in 1981 and 1987.¹¹
ly married women and derived the dis-
population in 1994 to arrive at the pro-
While the NSFG coded the woman as mar-
tribution of abortions by women's poverty
portion of U.S. women in each age-group
ried or unmarried for each birth, it did not
status according to data from a 1994-1995
who had ever had an abortion.
include a category for formerly married
national survey of 9,985 abortion pa-
Our estimates of the number of first
women. For this reason, we were unable
tients. 15 For 1987, we took the distribution
abortions are subject to several possible
to calculate marital status for 1981.
of abortions by marital status from a sim-
sources of error: The states included in the
Finally, using the 1995 NSFG data, we
ilar survey of 9,480 abortion patients in
NCHS tapes may not have been completely
estimated the proportion of U.S. women
that year. 16
representative of all women having abor-
in 1994 who had ever had an unplanned
Because abortions are underreported in
tions; some women may not have report-
birth. In the interests of simplicity and
population surveys,¹⁷ we decided not to
ed their prior abortions to the abortion
comparability with other published data,
use NFSG data on the number of women
provider; some of the women who had first
the results for all analyses are presented
in each age-group who had ever had an
abortions died before 1994 and should not
according to the age and marital status of
abortion, a procedure that would have re-
have been counted; and some immigrants
the woman at the time of the birth or abor-
sulted in a serious underestimate. Instead,
may have had abortions before coming to
tion, rather than her age and marital sta-
we made estimates from national abortion
the United States.⁸ Nevertheless, the results
tus at the time of conception. Similarly, the
statistics, a complicated task since a
provide an approximate picture of the past
year shown is the year of pregnancy out-
woman aged 35 in 1994 could have had an
abortion experience of U.S. women since
come, not the year of conception.
abortion in any year since 1973, placing her
the 1973 Roe V. Wade decision.
in a number of possible age-groups. In ad-
Abortions
dition, we wished to avoid counting more
Unintended Pregnancy
In calculating the number of unintended*
than once the many women who have had
We estimated the proportion of women
pregnancies, it was assumed that all preg-
more than one abortion.
who have ever had an unintended preg-
nancies ending in abortion were unwant-
The first step in estimating the number
ed, although a small proportion of abortions
of women in each age-group who have had
"Unintended" and "unplanned" are used interchange-
may have occurred among initially want-
an abortion was to estimate the number of
ably in this article.
ed pregnancies. This may have happened
abortions that occurred in each year ac-
+For a detailed description of the methods for estimat-
for any number of reasons, including health
cording to single year of age. We started
ing the number of abortions according to women's char-
acteristics, see Henshaw SK and Van Vort J, Abortion Fact-
problems experienced by the woman or the
with the number of abortions by five-year
book, 1992 Edition: Readings, Trends, and State and Local Data
fetus or changes in the woman's circum-
age-groups (with single-year groupings for
to 1988, New York: The Alan Guttmacher Institute, 1992,
stances, sometimes resulting from the loss
teenagers) for each year during 1973-1994,
P. 164.
of her partner or lack of support.¹²
derived from CDC reports with adjust-
#For a description of the 1988 data file, see Kochanek KD,
To calculate the number of unintended
ments as described above. To distribute the
Induced terminations of pregnancy: reporting states, 1988,
pregnancies in 1994, we needed an estimate
five-year groups to single years of age, we
Monthly Vital Statistics Report, 1991, Vol. 39, No. 12, Sup-
of the total number of abortions that oc-
plement. The NCHS used the same procedures to com-
used microdata tapes compiled by the
pile each data file.
curred during the year and data on the
NCHS for 1980, 1983, 1985, 1986 and
characteristics of women who had abor-
The number of immigrants exceeded the number of
1988-1992. Each tape contains data on
deaths, resulting in an increase by 3-4% of the number
tions. The total number of abortions per-
more than 280,000 abortions in 12 or more
of women in each age cohort between 1980 and 1990.
Volume 30, Number 1, January/February 1998
25
Unintended Pregnancy in the United States
Table 1. Estimated number of pregnancies (excluding miscarriages), percentage distribution of pregnancies, by outcome and intention, and
selected measures of unintended pregnancy, all by characteristic, 1994
Characteristic
No. of
% distribution of pregnancies
% of births
% of
% of
Pregnancy rate*
preg-
that were
pregnancies
unintended
nancies
Intended
Unin-
Abortions
Total
unintended
that were
pregnancies
Total
Intended
Unintended
births
tended
unintended
that ended in
births
abortion
Total
5,383,800
50.8
23.0
26.6
100.0
30.8
49.2
54.0
90.8
46.1
44.7
Age at outcome
<15t
25,100
18.3
33.2
48.5
100.0
64.5
81.7
59.4
13.7
2.5
11.2
15-19
781,900
22.0
42.7
35.3
100.0
66.0
78.0
45.3
91.1
20.0
71.1
15-17
306,100
17.3
46.5
36.2
100.0
72.9
82.7
43.8
59.0
10.2
48.8
18-19
475,800
25.0
40.2
34.8
100.0
61.7
75.0
46.4
140.3
35.1
105.2
20-24
1,479,500
41.5
26.2
32.3
100.0
38.7
58.5
55.2
164.1
68.1
96.0
25-29
1,405,200
60.3
17.2
22.5
100.0
22.2
39.7
56.7
147.0
88.7
58.4
30-34
1,111,400
66.9
14.6
18.4
100.0
18.0
33.1
55.7
100.0
66.9
33.1
35-39
482,400
59.2
17.9
23.0
100.0
23.2
40.8
56.3
43.7
25.9
17.8
>40#
98,300
49.3
17.9
32.8
100.0
26.7
50.7
64.7
9.9
4.9
5.0
Marital status at outcome
Currently married$
3,003,900
69.3
19.3
11.3
100.0
21.8
30.7
37.0
95.2
66.0
29.2
Formerly married
356,700
37.5
21.8
40.7
100.0
36.8
62.5
65.1
64.7
24.3
40.4
Never-married
2,023,100
22.3
31.0
46.7
100.0
58.2
77.7
60.1
91.0
20.3
70.8
Poverty status**
<100%
1,358,000
38.6
31.3
30.1
100.0
44.8
61.4
49.0
143.7
55.4
88.3
100-199%
1,292,500
46.8
27.7
25.4
100.0
37.2
53.2
47.9
115.2
53.9
61.2
>200%
2,733,200
58.8
15.9
25.4
100.0
21.3
41.2
61.5
70.8
41.6
29.2
Race
White
3,981,700
57.1
21.2
21.6
100.0
27.1
42.9
50.4
82.7
47.3
35.5
Black
1,130,700
27.7
28.6
43.7
100.0
50.8
72.3
60.4
136.7
37.8
98.9
Other
271,400
50.0
22.0
28.0
100.0
30.5
50.0
56.0
93.9
46.9
46.9
Ethnicity
Hispanic
900,200
51.4
22.4
26.1
100.0
30.4
48.6
53.8
143.0
73.5
69.4
Non-Hispanic
4,483,600
50.7
22.6
26.7
100.0
30.9
49.3
54.1
84.6
42.9
41.7
*Pregnancy rates for this category are expressed as per 1,000 women aged 15-44, except for rates for age-groups. Denominator for rates is women aged 14. #Numerator for rates is women aged 40 and
older; denominator is women aged 40-44. §Includes separated women. **Percentage of federal poverty level at time of interview. In 1994, the federal poverty level was $17,020 for a family of four. Note:
Intention status of births is based on births in the five years before the 1995 interview.
nancy by first adding the number of women
the proportion of unintended pregnancies
currently married women, among those
who had had an unplanned birth to the
that ended in abortion reflects actual de-
with an income 200% or more of the feder-
number who had had an abortion, and then
cisions to terminate or continue pregnan-
al poverty level, and among white and non-
subtracting those who were counted twice
cies. In addition, it assures that all tables
Hispanic women (Table 1).
because they had had both an unplanned
in this article are consistent, since it would
During the five years preceding the 1995
birth and an abortion. Tabulations of the
be difficult to calculate the proportion of
NSFG interview, 31% of births were re-
NSFG indicate that the proportion of
women who have ever had an unintend-
ported as unintended-that is, the woman
women who have had an unintended birth
ed pregnancy while at the same time tak-
did not want to have children when she did
and also reported having had an abortion
ing into account the overlap between
(21%) or wanted no more births ever (10%).
ranged from 9% among women aged 15-19
women who have had unintended preg-
Applying the same proportions to 1994
to 28% among women aged 30-34. Since
nancies that ended in miscarriage, birth
births, we estimated that 1.22 million births
comparisons with national data indicate
and abortion. (However, the number of
resulted from unintended pregnancies.
that the actual number of abortions expe-
miscarriages after 6-7 weeks of pregnan-
Adding abortions, there were 2.65 million
rienced is about 56% higher than the num-
cy-the point at which miscarriages are
unintended pregnancies, or 49% of all preg-
ber reported in the NSFG for the period
likely to be noted by the woman-can be
nancies for that year. (If we include an es-
1976-1994,¹⁸ we used this figure as a cor-
estimated by adding 20% of births to 10%
timated 390,000 miscarriages that would
rection factor and adjusted the proportion
of abortions. 20 Miscarriages may also be
have otherwise ended in abortion or un-
experiencing both unintended birth and
estimated using NSFG data.²¹)
intended birth, we find that a total of 3.04
abortion upward for each age-group. Since
million unintended pregnancies occurred
the rate of abortion underreporting was the
Results
during 1994.) Of all pregnancies in 1994 (ex-
same for women younger than 35 and those
Rates and Outcomes
cluding miscarriages), 23% ended in un-
aged 35-44, we used the same correction
Approximately 3.95 million births and 1.43
intended births and 27% in abortions. Thus,
factor in all age-groups. 19
million abortions occurred in 1994, for a total
among women who experienced an unin-
of 5.38 million pregnancies, not including
tended pregnancy in 1994 (excluding mis-
Miscarriages
miscarriages. (Use of the estimation proce-
carriages), 54% had an abortion and 46%
Except where otherwise specified, we ex-
dure mentioned above produces an esti-
carried the pregnancy to term.
cluded miscarriages from all calculations
mated 930,000 miscarriages during the year
Forty-eight percent of the women who
of the number of pregnancies and of preg-
as well.) The largest number of pregnancies
had an unplanned birth had been using a
nancy rates. With miscarriages omitted,
occurred among women aged 20-29, among
contraceptive method during the month
26
Family Planning Perspectives
Table 2. Estimated rates of unintended pregnancies, unintended births and abortions per 1,000 women, age and marital status, and percent-
age of unintended pregnancies ended by abortion, by characteristic, 1981, 1987 and 1994
Characteristic
Unintended pregnancy
Unintended birth
Abortion
% ended by abortion
1981
1987
1994
1981
1987
1994
1981
1987
1994
1981
1987
1994
Total
54.2
53.5
44.7
25.0
26.6
20.9
29.2
26.9
24.1
53.9
50.3
54.0
Age at outcome
15-19
78.1
79.3
71.1
35.2
37.1
38.9
42.9
42.2
32.2
54.9
53.2
45.3
20-24
93.6
102.7
96.0
42.3
50.2
43.0
51.4
52.5
53.0
54.8
51.1
55.2
25-29
60.6
66.1
58.4
29.3
35.4
25.3
31.3
30.8
33.1
51.6
46.5
56.7
30-34
37.0
37.3
33.1
19.3
19.3
14.6
17.7
17.9
18.4
47.8
48.2
55.7
35-39
15.0
18.8
17.8
5.5
9.0
7.8
9.5
9.8
10.0
63.5
52.2
56.3
>40*
4.3
5.3
5.0
0.9
2.4
1.8
3.4
2.9
3.2
78.2
54.3
64.7
Marital status at outcome
Currently marriedt
u
41.5
29.2
u
29.8
18.4
u
11.7
10.8
u
28.2
37.0
Formerly married
u
54.6
40.4
u
19.0
14.1
u
35.7
26.3
u
65.3
65.1
Never married
u
71.5
70.8
u
23.2
28.2
u
48.2
42.5
u
67.5
60.1
*Numerator for rates is women aged 40 and older; denominator is women aged 40-44. tincludes separated women. Notes: All measures exclude miscarriages. The intention status of births is based on
births in the five years before the interviews in 1988 and 1995 and in the four years before the 1982 interview. u=unavailable.
they became pregnant,* as had 58% of those
about 45 had an accidental pregnancy dur-
of intended pregnancy. Among women in
who had abortions (not shown). For all un-
ing 1994 (or nearly 5%). Among women
poverty, pregnancies were more likely
intended pregnancies combined, slightly
aged 15-17, the rate was similar to that for
than among higher income women to be
more than half (53%) of the women had
all women. It peaked at 105 per 1,000
unintended and to end in unplanned
been using a method. Of the contraceptive
among women aged 18-19, then dropped
births, and were slightly more likely to
users, 58% ended their pregnancies by
sharply with age. At these rates, a cohort
end in abortions. The overall pregnancy
abortion, compared with 49% of nonusers
of 100 women will have experienced 142
rate declined with increasing income, and
who had accidental pregnancies. (When
unintended pregnancies, or about 1.42 per
this trend resulted mainly from the high-
the estimated number of unintended preg-
woman, by the time they are 45 (not
er rate of unintended pregnancy among
nancies that ended in miscarriage is in-
shown).
poor women. The proportion of poor
cluded, the percentage of women who
The intended pregnancy rate was about
women's unintended pregnancies that
were using a method remains at 53%, but
the same as the unintended rate (46 per
ended in abortion was similar to the pro-
among contraceptive users, we estimate
1,000), having increased from 40 per 1,000
portion among women living at 100-199%
that 51% had abortions, 37% had births and
in 1987 and 43 per 1,000 in 1981 (not shown).
of the poverty level, and was less than that
12% had miscarriages; among nonusers, we
The age pattern of intended pregnancy,
among women whose income was 200%
estimate that 43% had abortions, 44% had
however, was very different from that of un-
or more of the poverty level.
births and 13% had miscarriages.) Thus,
intended pregnancy: Intended pregnancy
The differences between white and
contraceptive users appear to have been
was much higher than unintended preg-
black women generally paralleled those
more motivated to prevent births than were
nancy among women aged 25-39 and much
between high- and low-income women:
nonusers, although many nonusers did
lower than unintended pregnancy among
Compared with white women, black
have abortions.
teenagers. Each year, 1% of all women aged
women had a higher pregnancy rate. The
The proportion of all pregnancies that
15-17 had an intended pregnancy.
higher pregnancy rate for black women
were unintended varied sharply by age,
Among married women, 31% of preg-
resulted from an unintended pregnancy
with teenagers younger than 18 having
nancies were unintended, compared with
rate that was almost three times that of
the highest percentage (82-83%). The pro-
63% among formerly married women and
white women. Because black women's un-
portion decreased with rising age, drop-
78% among never-married women. Only
intended pregnancy rate was so high, the
ping to 33% among women aged 30-34,
37% of married women who had unin-
proportion of these women's pregnancies
and then increased again, reaching 51%
tended pregnancies ended them by abor-
that ended in abortion (44%) was much
among women aged 40 and older. Some
tion, compared with 60-65% of unmarried
higher than that of white women (22%).
44% of teenagers aged 15-17 ended their
women. The pregnancy rate among never-
On all measures, women of other races
unintended pregnancies by abortion, the
married women (91 per 1,000) was about
fell between white and black women, usu-
lowest proportion in any age-group. (The
the same as that of married women (95 per
ally closer to white women. Hispanic
relatively high proportion among women
1,000). The outcomes of these pregnancies
women had a much higher rate of both in-
younger than 15 is misleading because it
reflect differences in intention status for
tended and unintended pregnancy than
excludes the pregnancies of 14-year-olds
these groups, however: Almost half of
that ended in births at age 15. It also ex-
pregnancies among formerly and never-
*Based on NFSG tabulations of births that were conceived
cludes pregnancies to 14-year-olds that
married women ended in abortion (47%
after January 1, 1991, and that took place before the in-
ended in abortion at age 15, but there are
and 41%, respectively), compared with
terview. For abortion data, see reference 15.
relatively few of these.) The proportion
only 11% of those among married women.
tThese figures are based on the age of the woman when
was also relatively low for women aged
Women's poverty status (defined as the
the pregnancy ended, not her age at conception. Ad-
18-19 (46%), and was highest among
justment to age at conception would lower the propor-
ratio of family income to the federal def-
tions for women younger than 20 and raise them for
women older than 40 (65%).+
inition of poverty) was strongly associ-
women older than 30.
The unintended pregnancy rate shows
ated with the unintended pregnancy rate
In 1994, the federal poverty level was $17,020 for a fam-
that for every 1,000 women aged 15-44,
but only weakly associated with the rate
ily of four.
Volume 30, Number 1, January/February 1998
27
Unintended Pregnancy in the United States
Table 3. Percentage of women who have ever had at least one un-
age-groups, the abortion
were 40-44, 38% of the women surveyed
planned birth, abortion or unintended pregnancy, by age-group, 1994
rate increased slightly or
had had this experience.
stayed the same, while
Similarly, the probability of having had
Age
≥1 unplanned
21 abortions*
Both birth
≥1 unintended
the rate of unintended
births
and abortion
pregnanciest
an abortion also increased with age, ris-
births fell significantly as
ing from 7% among women aged 15-19 to
Total
28.4
29.9
10.6
47.7
a consequence of the re-
40% among women aged 30-34. The pro-
15-19
6.1
7.0
0.9
12.2
duced rate of unintend-
portion was lower among women older
20-24
22.5
26.3
7.4
41.4
ed pregnancy. In 1994,
than 34 because this research did not at-
25-29
28.5
37.3
10.8
55.1
30-34
33.7
40.2
14.8
59.2
teenage women were
tempt to include abortions before 1973,
35-39
36.6
38.3
14.9
60.0
less likely than women
when these women experienced their
40-44
38.1
25.0
12.7
50.4
in any other age-group
highest-risk years (ages 15-24). Overall,
*Since 1973. tExcludes miscarriages.
to end an unintended
11% of all women had had both at least one
pregnancy by abortion,
unplanned birth and at least one abortion.
whereas in earlier peri-
Among women in their 30s, this propor-
did non-Hispanic women, but the per-
ods teenagers have been similar to other
tion was 15%.
centage of unintended pregnancies and
women in this respect.
About 48% of all women aged 15-44
births and the distribution of outcomes
Between 1987 and 1994, currently and
had ever had an unintended pregnancy
were almost identical for Hispanic and
formerly married women experienced re-
(either an unplanned birth or an abortion,
non-Hispanic women.
ductions in unintended pregnancy that
or both). The percentage increased with
were reflected in decreases both in the rate
age, to a high of 60% among women
Trends
of unintended birth and in that of abor-
35-39. Although the percentage was lower
There have been significant changes over
tion. Among married women, the pro-
among women aged 40-44, this figure
time in the frequency of unintended preg-
portion of unintended pregnancies that
may be understated, again because neither
nancy and in the resolution of such preg-
ended in abortion increased from 28% to
legal nor illegal abortions that occurred be-
nancies, especially since 1987. Between
37%. Never-married women, on the other
fore 1973 were counted in this estimate.
1981 and 1987, the unintended pregnancy
hand, reported an increase in unintend-
Although we know how many women
rate changed little, but from 1987 to 1994,
ed births that was approximately equal to
in each age-group had already had an un-
the rate dropped 16%, from 54 per 1,000 to
the decrease in abortions in this group,
intended pregnancy, we cannot say ex-
45 per 1,000 (Table 2, page 27). As a result,
and the proportion of unintended preg-
actly how many will have one by age 45,
the rates of both unintended births and
nancies that ended in abortion declined.
because of the difficulties of estimating the
abortions fell between 1987 and 1994, but
All three income groups experienced a
proportion of women having a first abor-
the drop was greater for unintended births
decrease in the proportion of pregnancies
tion who have previously had an un-
(6 per 1,000) than for abortions (3 per
that were unintended (not shown). The
planned birth and, of those having an un-
1,000). Consequently, the proportion of un-
proportion of unintended pregnancies that
planned birth, the proportion who have
intended pregnancies ended by abortion
ended in abortion remained about the same
had an abortion. However, we were able
increased from 50% to 54%.
among women in the lowest income group,
to make lifetime abortion estimates at 1992
The changes differed markedly by age-
decreased among those in the middle in-
rates, the most recent year for which data
group, especially when teenagers were
come group and increased sharply among
were available (Table 4).*
compared with women aged 20 and older.
women in the highest income category.
We estimated the first-abortion rate by
Between 1981 and 1987, the unintended
applying the 1992 proportion of first abor-
pregnancy rate and birthrate changed lit-
Lifetime Experiences
tions for each age-group to the abortion
tle among teenagers but increased among
Over their lifetime, the proportion of
rate for that age-group. The cumulative
all women aged 20 and older, except
women experiencing an unintended preg-
first-abortion rate indicates the number of
among women aged 30-34. Changes in
nancy is substantial, even when the pro-
women per 1,000, at 1992 rates, who will
abortion rates were very small during this
portion in any one year
period. From 1987 to 1994, the rate of un-
is small. Of the women
Table 4. Abortion rate per 1,000 women and percentage of abor-
intended pregnancy fell among all age-
aged 15-44 who were
tions that were first abortions, and first-abortion and cumulative
groups, although the change was small
surveyed in the 1995
first-abortion rates, by year, all according to age-group
among women aged 35 and older. Among
NFSG, 28% indicated
Age
Abortion % that
First-abortion rate
Cumulative first-
teenagers, the drop in unintended preg-
that they had had one or
rate in
were first
abortion rate*
nancy affected only the abortion rate,
1992
abortions
more unplanned births,
in 1992
1982
1992
1982
1992
which fell by 24% (from 42 per 1,000 to 32
and based on national
Total
per 1,000), while the rate of unintended
25.9
.530
abortion statistics, 30%
17.8
13.7
na
na
births actually increased slightly (from 37
of women had had one
<15t
7.6
.942
7.8
7.2
7.8
7.2
per 1,000 to 39 per 1,000). Among all other
15-17
23.1
or more abortions (Table
.855
26.0
19.7
85.8
66.4
18-19
53.8
.722
45.4
38.9
176.6
144.1
3). The probability of
15-19
35.5
.760
34.1
27.0
176.6
144.1
*Information on the proportion of first abortions by age
having experienced an
20-24
56.3
.541
30.3
30.5
328.1
296.5
25-29
33.9
.419
is unavailable for years since 1992. For calculating the
15.7
14.2
406.6
367.5
unplanned birth in-
30-34
19.0
.393
7.1
7.5
442.1
404.8
lifetime experience of abortion for Table 3, we assumed
creased with age, large-
35-39
10.4
405
2.8
4.2
456.1
425.9
that the 1993 and 1994 proportions of first abortion were
40-44
3.2
.453
0.7
1.4
459.6
433.1
similar to those for 1992, since small errors would have
ly because of the in-
little effect on the results. The cumulative first abortion
creased years of
"Number having an abortion by end of specific age-period, per 1,000 women, at current rates.
+Denominator for rates is women aged 14. Numerator for rates is women aged 40 and older;
rate, however, depends entirely on these proportions,
exposure to pregnancy
denominator is women aged 40-44. Note: na=not applicable. Sources: 1982 DATA-See ref-
erence 6.
which are only accurate for 1992.
risk. By the time they
28
Family Planning Perspectives
have had a first abortion by the time they
among women at risk of unintended preg-
bearing, leaving unplanned pregnancies
reach the end of the age range. At these
nancy has gone down.24 Another possible
more concentrated among those less mo-
rates, 14% of women can expect to have
factor is the availability of two new high-
tivated to avoid childbearing.
had an abortion before age 20, 37% by age
ly effective contraceptives, the implant and
Whether they end in abortion or un-
30 and 43% by age 45.*
the injectable. In part because Medicaid
planned birth, unintended pregnancies
The 1992 cumulative lifetime first-abor-
pays for these methods, many of the
come at a cost both to the individuals in-
tion rate was slightly lower than the 1982
women who adopted them were at espe-
volved and to the larger society. Reduc-
cumulative rate (46%), and the rate may
cially high risk of unintended pregnancy-
tion of unplanned pregnancy can only be
be still lower today, since abortion rates
even when they were using other re-
achieved by decreasing risky behavior,
fell somewhat between 1992 and 1994. The
versible methods. Therefore, use of the
promoting the use of effective contracep-
drop between 1982 and 1992 was almost
new methods may have prevented a dis-
tive methods and improving the effec-
entirely the result of the lower first-abor-
proportionate number of pregnancies.
tiveness with which all methods are used.
tion rate among teenagers, which fell by
Overall, the drop in unintended preg-
More research is needed on the best ways
seven percentage points; the first-abortion
nancy between 1987 and 1994 is reflected
to accomplish these goals, but we know
rate among other age-groups changed by
in decreases in the rates of both unplanned
that sensible strategies are to improve the
no more than two percentage points.
birth and abortion. Further progress is
accessibility of contraceptive services, to
needed, however. In view of the lower
dispel misconceptions about the health
Discussion
rates of unintended pregnancy in other
risks of contraception and to make emer-
Although it is well known that unintend-
developed countries,²⁵ such progress
gency contraception easily available and
ed pregnancy is common in the United
should be possible.
widely known.
States, the statistics presented in this arti-
Among women aged 20 and older, the
cle show just how widespread the expe-
reduction in unintended pregnancy re-
References
rience is: Half of all pregnancies are un-
sulted in lower rates of unplanned birth.
1. Jones EJ et al., Pregnancy, Contraception and Family Plan-
intended; 28% of women aged 15-44 have
Abortion rates in this group changed lit-
ning Services in Industrialized Countries, New Haven: Yale
had an unplanned birth and 30% have had
tle or increased slightly. Thus, the per-
University Press, 1989.
an abortion; 60% of women in their 30s
centage of unintended pregnancies ended
2. Brown SS and Eisenberg L, The Best Intentions: Unin-
have had an unplanned birth or an abor-
by abortion increased, indicating that
tended Pregnancy and the Well-Being of Children and Fami-
tion; and, at 1992 rates, 43% of women will
lies, Washington, DC: National Academy Press, 1995.
women and couples had become less will-
have had an abortion by age 45. Some of
ing to accept unplanned births. One rea-
3. Forrest JD, Epidemiology of unintended pregnancy
the women who are most prone to unin-
and contraceptive use, American Journal of Obstetrics and
son for the change is that a higher pro-
Gynecology, 1994, 170(5):1485-1489, Table I.
tended pregnancy, especially unmarried
portion of women in each age-group were
and low-income women, are those who
4. Williams LB and Pratt WF, Wanted and unwanted
not currently married. Among unmarried
childbearing in the United States: 1973-88, Advance Data
may have the greatest difficulty caring for
women, 60-65% resolved unintended
from Vital and Health Statistics, 1990, No. 189.
an unanticipated child.
pregnancies by abortion, compared with
In spite of the disruption that can be
5. Forrest JD and Singh S, The sexual and reproductive
37% among married women. Of women
behavior of American women, 1982-1988, Family Plan-
caused by an unplanned birth, only about
aged 25-29, the proportion who were cur-
ning Perspectives, 1990, 22(5):206-214
half of unintended pregnancies are termi-
rently married and living with their hus-
6. Forrest JD, Unintended pregnancy among American
nated by abortion. A majority of married
band fell from 59% in 1987 to 53% in
women, Family Planning Perspectives, 1987, 19(2):76-77.
women (63%) continue their unintended
1994 26 Even within the married group,
7. Abma JC et al., Fertility, family planning, and women's
pregnancies, possibly because they find it
however, more women ended their unin-
health: new data from the 1995 National Survey of Fam-
easier to accommodate an additional child
tended pregnancies by abortion in 1994
ily Growth, Vital and Health Statistics, 1997, Series 23, No.
than do unmarried women. However, 35%
than did so in 1987. One possible reason
19.
of formerly married women and 40% of
may be married couples' increased re-
8. Ibid.
never-married women also continue their
liance on the woman's earnings.
9. Ventura SJ et al., Advance report of final natality sta-
unplanned pregnancies.
The pattern among teenagers is re-
tistics, 1994, Monthly Vital Statistics Report, 1996, Vol. 44,
Between 1987 and 1994, the rate of un-
markably different. Among women aged
No. 11, Supplement.
intended pregnancy fell from 54 preg-
15-19 who had an unwanted pregnancy,
10. Forrest JD and Singh 1990, op. cit. (see reference 5),
nancies per 1,000 women of reproductive
the proportion who ended these preg-
P. 212, Table 8; and Forrest JD, 1994, op. cit. (see refer-
age to 45 per 1,000, a decrease of 16%. A
nancies by abortion fell from 53% to 45%.
ence 3).
likely explanation for the decline in unin-
The abortion rate declined 24%, while the
11. National Center for Vital and Health Statistics
tended pregnancy is an increase in wide-
rate of unplanned birth did not decline at
(NCHS), Advance report of final natality statistics, 1981,
spread and effective contraceptive use. The
all-and may have increased slightly. In
Monthly Vital Statistics Report, 1983, Vol. 32, No. 9, Sup-
1995 NSFG data show that condom use
the absence of data, any explanation of the
plement; and NCHS, Advance report of final natality sta-
has increased significantly, and that the
tistics, 1987, Monthly Vital Statistics Report, 1989, Vol. 38,
differences between teenagers and other
No. 3, Supplement.
proportion of contraceptive nonusers
age-groups is speculative. One hypothe-
sis is that teenagers may have been influ-
12. Torres A and Forrest JD, Why do women have abor-
*In the future, one can expect that for women having
tions? Family Planning Perspectives, 1988, 20(4):169-176.
enced by antiabortion messages. Other
abortions at age 35 or older, a lower proportion will be
having a first abortion, since a greater proportion of their
possible reasons are decreased access to
13. Henshaw SK and Van Vort J. Abortion services in the
United States, 1991 and 1992, Family Planning Perspectives,
reproductive lives will have occurred while legal abor-
abortion services, barriers posed by
1994, 26(3):100-106 & 112.
tion has been available. If we assume that the proportion
parental involvement statutes, and use of
of first abortions was .35 for women aged 35-39 and .30
14. Koonin L et al., Abortion surveillance-United States,
for women aged 40-44, the cumulative abortion rate for
better contraceptive methods (such as the
1993 and 1994, Morbidity and Mortality Weekly Report, 1997,
women aged 45 will be 428 per 1,000, similar to the rate
injectable and implant) by those teenagers
46(SS-4):37-98, and earlier volumes.
of 433 per 1,000, shown in Table 4.
who are strongly motivated to avoid child-
(continued on page 46)
Volume 30, Number 1, January/February 1998
29
Unintended Pregnancy in the United States
Unintended Pregnancy
18. Fu H et al., Measuring the extent of abortion under-
23. Forrest JD, 1987, op. cit. (see reference 6).
(continued from page 29)
reporting in the 1995 National Survey of Family Growth,
unpublished paper, New York: The Alan Guttmacher In-
24. Finer L and Zabin LS, Does the timing of the first fam-
15. Henshaw SK and Kost K, Abortion patients in
stitute, 1997.
ily planning visit still matter? Family Planning Perspec-
1994-1995: characteristics and contraceptive use, Family
19. Ibid.
tives, 1998, 30(1):30-33 & 42.
Planning Perspectives, 1996, 28(4):140-147 & 158, Table 1.
16. Henshaw SK and Silverman J, Characteristics and
20. Leridon H, Human Fertility: The Basic Components,
25. Jones EJ et al., 1989, op. cit. (see reference 1).
prior contraceptive use of abortion patients, Family Plan-
Chicago: University of Chicago Press, 1977, Table 4.20.
26. U.S. Bureau of the Census, Marital status and living
ning Perspectives, 1988, 20(4):158-168, Table 2.
21. Ventura SJ et al., Trends in pregnancies and pregnancy
arrangements: March 1987, Current Population Reports,
17. Jones EF and Forrest JD, Underreporting of abortion
rates: estimates for the United States, 1980-92, Monthly
1988, Series P-20, No. 423, Table 1; and Saluter AF, Mar-
in surveys of U.S. women: 1976 to 1988, Demography,
Vital Statistics Report, 1995, Vol. 43, No. 11, Supplement.
ital status and living arrangements: March 1994, Current
1992, 29(1):113-126.
22. Forrest JD, 1994, op. cit. (see reference 3).
Population Reports, 1996, Series P-20, No. 484, Table 1.
46
Family Planning Perspectives
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
The Role of Contraception
In Reducing Abortion
Issues in Brief
F
ollowing the 1994 election,
that better access to and more
contraceptive programs in
which gave social conserva-
effective use of contraceptives
reducing abortion rates come
tives a majority in the U.S.
are necessary to reduce the
from the experiences of many
House of Representatives for
incidence of abortion.
countries, including the
the first time in 40 years,
United States.
Common sense still leads most
emboldened leaders of the
antiabortion movement began
people to the conclusion that
more effective contraception
Contraception Works
to campaign openly against
means fewer abortions-and
government-subsidized family
For Individuals
planning programs. In a pre-
research results point to that
conclusion as well. Individual
As more and more couples feel
view of the legislative assaults
women who use an effective
strongly about limiting the num-
to come against both the inter-
national and domestic pro-
method of contraception simply
ber of children they have, and
grams, House Pro-Life Caucus
are much less likely to face an
about having those children
unintended pregnancy and the
when they want them, the
Chairman Christopher Smith
(R-NJ) declared in January
decision of whether to have an
demand for contraception will
abortion than women who do
be great; in its absence or in the
1995 that he opposed U.S.-sup-
event of its failure, so will the
ported family planning efforts
not. Similarly, the advent of
demand for abortion. The choice
abroad because they lead to
high-quality contraceptive ser-
for societies is whether to facili-
"abortion activism" and, by
vices, both in the United States
tate access to contraception or to
implication, result in more
and elsewhere, has been shown
leave women and their families
rather than fewer abortions.
over time to be associated with
with abortion, legal or not, as
lower levels of abortion.
The "evidence" for his claim
the only means of achieving
derives in part from a misun-
Fundamentally, the relation-
their childbearing goals.
derstanding of the data.
ship between contraceptive use
American women typically
Following the introduction of
and abortion is explained by a
want two children, as do
family planning programs, con-
single phenomenon: the inex-
women in European countries
traceptive use and abortion
orable and universal trend
and many parts of Asia. In
rates in some countries have
toward couples' wanting, and
Latin America, the average
initially risen simultaneously;
having, smaller families and
preference is for two or three
in other countries-including
trying to time the birth of their
children. Women in Sub-
the United States-contracep-
children to best advantage.
Saharan Africa still want large
tive use is nearly universal, but
Acknowledgment of this reality
families, five or six children on
abortion rates have only recent-
is important, since an individ-
average, but indications are
ly begun to decline significant-
ual's decision to practice con-
that, as in more developed
ly. These data have been used
traception or to have an abor-
countries, their desired family
to legitimate the assertion that
tion stems from this same goal.
size is beginning to decline,
the availability of contraception
This Issues in Brief seeks to
too. These numbers represent
itself causes more abortions.
explain the statistical trends in
women's goals, but not neces-
In the two and a half years
the context of women's lives,
sarily their experience. In most
since Smith's comment, the pro-
their reproductive goals and
countries of the world, a signifi-
ponents of this view have sowed
the choices available to them.
cant proportion of women
sufficient doubt among enough
A great deal of information
reveal that they have actually
policymakers about the role of
exists, largely from research in
had more children than they
family planning programs
the United States, on the likeli-
had intended.
domestically and internationally
hood that an individual can
To succeed in having the num-
The
to disrupt a decades-long politi-
avoid an unintended pregnan-
ber of children she wants when
Alan
cal consensus. Previously, all
cy, and abortion, by practicing
she wants them, a woman must
Guttmacher
but a very small minority con-
effective contraception.
use contraceptive methods
sidered self-evident the view
Institute
Analyses of the effectiveness of
properly for a long time. The
New York and Washington