Unplanned Pregnancy Alone

Cases of unplanned pregnancies are on the rise. Studies show that most women who are planning to have a child, do not actually intend to get pregnant at this time. The majority of unintended pregnancies result in births which are considered out-of-wedlock and the infants are born to unmarried women. More than 40 percent of unplanned pregnancies result in abortions while the rest end in live birth.

An unintended pregnancy is a birth resulting from ‘non-consensual,’ or unwanted, sexual intercourse. More than 40 percent of births are unplanned in the Philippines. Most of these pregnancies are conceived outside wedlock and result in babies born to unmarried women. This can potentially limit their educational and occupational opportunities throughout their lives.

An unintended pregnancy is a birth resulting from ‘non-consensual,’ or unwanted, sexual intercourse. More than 40 percent of births are unplanned in the Philippines. Most of these pregnancies are conceived outside wedlock and result in babies born to unmarried women. This can potentially limit their educational and occupational opportunities throughout their lives.

What are The Consequences of Unplanned Pregnancy

3Consequences of Unintended Pregnancy

Does it matter whether a pregnancy is unintended at the time of conception—mistimed or unwanted altogether? There is a presumption that it does—that unintended pregnancy has a major impact on numerous social, economic, and cultural aspects of modern life. But it is important to define what these consequences might be. Accordingly, this chapter examines five sets of information that help to answer this important question. The first section addresses elective termination of pregnancy, because about half of all unintended pregnancies in the United States are resolved by abortion. As such, abortion can be seen as one of the primary consequences of unintended pregnancy. The second section considers the fact that unintended pregnancy is more common among unmarried women and women at either end of the reproductive age span (Chapter 2)—demographic attributes which themselves carry increased medical or social risks for children and/or their parents.

The final three sections address additional consequences of unintended pregnancy. The third section analyzes a complex set of studies in which the intendedness of pregnancy itself is related to a variety of outcomes for both the child (such as birthweight and cognitive development) and parents (such as educational achievement). These studies allow one to consider whether pregnancy intention itself affects various child and parental outcomes. The fourth consequence explored is that opportunities for preconception health assessment and care are often missed when pregnancy occurs unintentionally. Preconception care is still a developing field of clinical practice, but its potential impact is important. The fifth section of the chapter analyzes how some dimensions of the childbearing population in the United States would change if unwanted pregnancies were eliminated altogether and mistimed ones were redistributed (typically, postponed). This statistical exercise helps provide an understanding of the consequences of current demographic patterns of unintended pregnancy and subsequent childbearing.

Abortion as a Consequence Of Unintended Pregnancy

As the Chapter 2 discussed, about half of all unintended pregnancies end in abortion. Accordingly, the occurrence of abortion can be seen as one of the primary consequences of unintended pregnancy. Voluntary interruption of pregnancy is an ancient and enduring intervention that occurs globally whether it is legal or not. The legalization of abortion in all of the United States, accomplished through the 1973 Supreme Court ruling Roe v. Wade, served in large part to replace illegal abortion (as well as abortion obtained outside of the United States) with legal abortion in this country. It is estimated that before the legalization of abortion, about 1 million abortions were being performed annually, few of them legally, and somewhere between 1,000 and 10,000 women died annually from complications following these often poorly performed procedures. Before the Supreme Court ruling, abortion was probably the most common criminal activity in this country, surpassed only by gambling and narcotics violations (Luker, 1984; Jaffe et al., 1981).

A 1975 report by the Institute of Medicine documented the benefits to public health by the legalization of abortion. The Supreme Court decision was followed not only by a decline in the number of pregnancy-related deaths in young women (Cates et al., 1978) but also by a decline in hospital emergency room admissions because of incomplete or septic abortions, conditions that are more common with illegally induced abortions (Institute of Medicine, 1975).

Given the long-standing reliance on abortion to resolve many unintended pregnancies, it is important to consider available information about the major medical and psychological risks that this procedure may pose (Centers for Disease Control and Prevention, Reproductive Epidemiology Unit, 1994; Frye et al., 1994; Lawson et al., 1994). From the voluminous data available for review, two important findings stand out that are often overlooked in the controversy over this procedure. First, whatever the risks associated with legal abortion in the United States, it remains a far less risky medical procedure for the woman than childbirth; over the 1979–1985 interval, for example, the mortality associated with childbirth was more than 10 times that of induced abortion (Council on Scientific Affairs, American Medical Association, 1992). Second, abortion in the first trimester of pregnancy carries fewer risks to health than abortion in the second trimester of pregnancy and beyond.

Medical Complications

As with any surgical procedure, abortion carries an inherent risk of medical complications, including death. Complications known to be directly related to the procedure include hemorrhage, uterine perforation, cervical injury, and infection, which is often due to incomplete abortion. Later complications that have been investigated include possible negative effects on subsequent pregnancy outcomes, particularly low birthweight, midtrimester spontaneous abortion, and premature delivery. The vast majority of abortions performed in this country are first-trimester vacuum aspiration procedures. Pregnancy outcomes among women who have had one vacuum aspiration abortion are no different than those among women who have not had an abortion. Results are mixed, however, as regards the influence on subsequent pregnancy outcomes of having had more than one abortion or having second-trimester abortions by vacuum extraction. At present, investigators are studying a possible relationship between abortion and an increased risk of developing premenopausal breast cancer (Daling et al., 1994).

Rates of Complications

To assess the frequency with which the well-documented complications of abortion occur, between 1970 and 1978 the Centers for Disease Control and the Population Council conducted the Joint Program for the Study of Abortion in three waves: 1970–1971, 1971–1974, and 1975–1978. These surveys showed that the risk of developing major complications 1 from legal abortion decreased greatly during the 1970s: from 1.0 percent in the first wave to 0.29 percent in the last (Buehler et al., 1985; Cates and Grimes, 1981; Grimes et al., 1977; Tietze and Lewit, 1972). Although the total complication rate2 increased from 9.0 to 14.8 percent over the three waves, this probably reflected an increased follow-up rate, a change in the distribution of firstand second-trimester abortions among the study populations, and an increase in reports of minor complications. Alternatively, the change may have been due to an actual increase in complications. More recent data show a total complication rate of induced abortion of less than 1 percent (Gold, 1990; Hakim-Elahi et al., 1990).

In all waves, the risk of all complications increased steadily with increasing gestational age, being lowest for women obtaining abortions at ≤ 8 weeks of gestation and increasing 2 to 10 times for procedures after 12 weeks of gestation. Complication rates were lowest among women whose abortions were performed using suction curettage and increased with more invasive procedures (those often used for more advanced pregnancies).

Trend data are also available on mortality. The annual number of legal-abortion-related deaths decreased from 24 deaths in 1972 to 6 in 1987, and the mortality rate decreased from 4.1 per 100,000 abortions in 1972 to 0.4 in 1987. As with overall complication rates, the risk of mortality is lower for abortions performed by suction or sharp curettage during the first trimester and for pregnancies of lower gestational age (Lawson et al., 1994). The risk of mortality is higher, however, for nonwhite women, women 35 years of age and older, and for women of higher parity.

The increased risk of both morbidity and mortality with increasing gestational age underscores the health risks averted by early rather than late abortion. At present, 11 percent of abortions are obtained after 12 weeks of pregnancy; these later abortions are obtained disproportionately by adolescents: for girls under age 15, 22 percent of abortions are done in the second trimester, whereas the comparable figure for women over age 20 is 9 percent (Rosenfield, 1994). Although late abortion may be due to delay in recognizing a pregnancy, in deciding what to do if the pregnancy is unwanted, or may be a consequence of a genetic defect not detected until the second trimester, public policies can also increase the chance that an abortion will be performed in the second rather than the first trimester. Policies that may discourage first-trimester abortions include mandatory waiting periods (now required in 13 states), parental involvement/judicial bypass laws (35 states), and various informed consent laws, many of which require that women be given antiabortion lectures and materials intended to discourage them from having an abortion (31 states) (National Abortion and Reproductive Rights Action League, 1994). Chapter 7 notes the important and related issues of insufficient training of providers in abortion techniques and of declining numbers of abortion providers.

Psychological Issues

Although the medical risks of abortion appear to be very small, the procedure may pose troubling moral and ethical problems to some women and providers as well. In addition, women (and those close to them) may find that confronting an unintended pregnancy and weighing the option of abortion are emotionally difficult experiences, and the procedure itself may involve appreciable pain and expense.

Accordingly, numerous researchers have attempted to determine the extent to which abortion results in psychological problems in the weeks and months following the procedure. Some have investigated what has been called “post-abortion syndrome,” hypothesizing that abortion may lead to a form of posttraumatic stress disorder, even though abortion does not meet the American Psychiatric Association’s definition of trauma (Gold, 1990). Most of the 250 studies dealing with the psychological effects of induced abortion suffer from substantial methodological shortcomings and limitations (Council on Scientific Affairs, 1992; Adler et al., 1990; Gold, 1990; Koop, 1989). In light of these problems, former Surgeon General C. Everett Koop concluded in 1989 that data “were insufficient…to support the premise that abortion does or does not produce a post-abortion syndrome.” He also concluded that emotional problems resulting from abortion are “minuscule from a public health perspective” (Koop, 1989). Similarly, Adler et al. (1990:42) concluded that “studies [of the psychological impact of abortion] are consistent in their findings of relatively rare instances of negative responses after abortion and of decreases in psychological distress after abortion compared to before abortion.”

How to Prevent Unwanted Pregnancy and Abortion

A number of things might affect the decision you make about an unplanned pregnancy. If you are unsure of what to do, you are not alone. While some women know what they want from the outset, others can find the decision-making process difficult.

An unplanned pregnancy can raise different and sometimes confusing feelings and thoughts. This is very normal and most women experience this.

Your feelings can seem confusing as they often conflict with each other. For example, you may feel:

  • anxious as you consider having a baby (or another baby)
  • scared because you don’t know how to be a parent
  • concerned if your current relationship is not stable
  • joy because this is something you have always dreamed about
  • excited as this may be a new opportunity for you

Even though these feelings seem to be in conflict with each other, they are all important to work through.

First steps in making this decision

As well as your feelings, there are many things to consider when making a decision and this can often add to this stressful time. Some things that might help you are:

  • Don’t rush your decision (but remember that some options are influenced by how many weeks pregnant you are).
  • Give yourself permission to explore and think about all your options.
  • Be kind to yourself — you will feel differently about your options and decision day to day.
  • Find as much information about what you need to support your decision (such as what support networks are available to you).
  • Ensure you look after yourself physically and emotionally.

It is important that you take the time you need to make the best decision for you at this point in your life.

What options do you need to think about?

There are three options to consider with an unplanned pregnancy:

  1. Continuing with the pregnancy and raising the child.
  2. Continuing with the pregnancy, adoption or alternative care.
  3. Terminating the pregnancy, otherwise known as an abortion.

At this stage it can be helpful to talk to someone you know and trust. Many people find it is useful to speak to a professional. If you feel you need someone else to talk to, counsellors can help you work through the emotional, financial and practical issues involved with all of the options available to you.

Information for men

It is up to you how you will involve the father in the decision-making process and this will be affected by the current circumstances of the relationship.

You may want to attend counselling together or he may want to talk to someone to discuss his own feelings about the pregnancy. The counsellors at Pregnancy, Birth and Baby are available for all members of your family to talk to.

How Do You Have an Unplanned Pregnancy

Most unintended pregnancies result from not using contraception or from not using it consistently or correctly. To help women, men, and couples prevent or achieve pregnancy, it is essential to understand their pregnancy intentions or reproductive life plan.

Unplanned pregnancies happen for a variety of reasons. Many women, men, and couples want to avoid unintended pregnancy, but don’t know how to prevent it. To help women, men, and couples prevent or achieve pregnancy, it is essential to understand their pregnancy intentions or reproductive life plan.

Unplanned pregnancy occurs when couples or individuals do not want to become pregnant. It is common for people to have various levels of a contraceptive use intention and plan, including prevention (no sex), pregnancy only if they want it, or pregnancy in case they decide that they want it.

The likelihood of an unplanned pregnancy can be reduced by using contraception correctly and consistently. Evidence shows that using contraception can prevent unplanned pregnancies, as well as reduce the number of abortions and maternal deaths around the world.

How Does an Unplanned Pregnancy Happen

Most unintended pregnancies result from not using contraception, or from using contraceptives inconsistently or incorrectly. Accordingly, prevention includes comprehensive sexual education, availability of family planning services, and increased access to a range of effective birth control methods.

Unplanned pregnancy occurs when a couple does not want to have children at the time, or does not intend to have additional children. The most common reason for an unplanned pregnancy is a failure to use contraceptives consistently. In fact, about half of all pregnancies—both wanted and unwanted—are caused by incorrect or inconsistent use of birth control. Prevention includes comprehensive sexual education, availability of family planning services, and increased access to a range of effective birth control methods.

Unplanned pregnancy can happen to anyone. This is why it is important to understand what leads to an unplanned pregnancy, and how to prevent it. Most unintended pregnancies result from not using contraception, or from using contraceptives inconsistently or incorrectly.

Unplanned or unwanted pregnancies occur when birth control is not used, or when it is used inconsistently or incorrectly. In order to prevent these pregnancies, comprehensive sex education programs are needed as well as increased availability of family planning services.

Unplanned pregnancies happen when people don’t use contraception or when they use contraception inconsistently or incorrectly. To prevent unwanted pregnancies, have open conversations with your partner about the types of birth control you both prefer and how often you plan to use it. Then get full medical care (including routine check-ups on all methods), refer to your healthcare provider if necessary, and consider a method that fits your needs.

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