||This article or section may contain misleading parts. (August 2012)|
Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception. Unintended pregnancy mainly results from engaging in vaginal sexual activity without the use of contraception, or due to incorrect use of a contraceptive method, but may also arise from the failure of the contraception method when used correctly to prevent pregnancy.
Available contraception methods include use of birth control pills, a condom, intrauterine device (IUD, IUC, IUS), contraceptive implant (implanon/nexplanon), hormonal patch, hormonal ring, cervical caps, diaphragms, spermicides, or sterilization. Women choose to use a contraceptive method based on method efficacy, medical considerations, side effects, convenience, availability, friends' or family members' experience, religious views, and many other factors. Some cultures limit or discourage access to birth control because they consider it to be morally or politically undesirable. Unintended pregnancies may also result from rape, incest or various other forms of forced or unwanted sex.
Unintended pregnancies may be unwanted pregnancies or mistimed pregnancies. Worldwide, 38% of pregnancies (about 80 million pregnancies) were unintended in 1999. Unintended pregnancies are the main reason for induced abortions, resulting in about 42 million induced abortions; not all unintended pregnancies result in abortions or unwanted children. Unintended pregnancy has been linked to numerous maternal and child health problems.
- 1 Intention
- 2 Causes
- 3 Facts
- 4 Prevention
- 5 Epidemiology
- 6 By country/region
- 7 History
- 8 See also
- 9 References
- 10 Further reading
- 11 External links
An intended pregnancy is one that is consciously desired at the time of conception. A pregnancy is intended if either partner intended or desired a pregnancy to occur, though the other partner may not want a pregnancy either at all or at that time, or he/she may be ambivalent to a pregnancy.
Feelings towards a pregnancy can change during the course of a pregnancy. For instance, a change of circumstances might lead to the continued pregnancy being unwanted and perhaps a desire to terminate an initially intended pregnancy. On the other hand, an initially unintended pregnancy might later be welcomed.
- Not using contraception or family planning services.
- Using contraception inconsistently or incorrectly.
- Contraceptive failure (the method was used correctly, but did not work.) Contraceptive failure accounts for a relatively small fraction of unintended pregnancies when modern highly effective contraceptives are used. A condom breaking during intercourse or using a condom with a hole in it can lead to malfunctioning contraceptives.
Reasons contraceptives might not have been used or been used incorrectly include:
- Coercion. Rape, or even forced pregnancy, which sometimes happens in the context of domestic violence. Unintended pregnancies are more likely to be associated with abuse than intended pregnancies. This may also include birth control sabotage, which is the manipulation of someone's use of birth control to undermine efforts to prevent pregnancy.
- Lack of knowledge about sex and reproduction, including erroneous beliefs.
- Lack of knowledge or experience with the contraceptive or lack of motivation to use it correctly.
- Lack of planning or ambivalence about whether to have a child.
- Lack of over-the-counter availability of contraceptives.
- Inability or unwillingness to attend healthcare appointments to obtain contraceptives.
- A mistaken belief that the woman is infertile, e.g. post-menopausal, previous diagnosis of infertility
Live births: Unless the fetus dies in utero, the result of an unintended pregnancy is an unintended birth. According to one study, over one third of living people in the US under 31 years of age (born since 1982) were the result of unintended pregnancies, a rate that has remained largely unchanged to date.
Pregnancy has risks and potential complications. On average, unintended pregnancies result in poorer outcomes for the mother and for the child, if birth occurs. Unintended pregnancy usually precludes pre-conception counseling and pre-conception care, and sometimes delays initiation of prenatal care. The great majority of abortions result from unintended pregnancies.
Results of unintended pregnancy include:
- Prenatal care initiated later, and less adequate. Adversely affects health of woman and of child and less preparation for parenthood. Delay from unintended pregnancy is in addition to that from other risk factors for delay. Unwanted pregnancies have more delay than mistimed.
- Unintended pregnancies preclude chance to resolve sexually transmitted diseases (STD) before pregnancy. Untreated STD in pregnant woman can result in premature delivery, infection in newborn or infant death.
- Preclude use of genetic testing to help make decisions about whether to become pregnant.
- Women with an unintended pregnancy are more likely to suffer depression during or after pregnancy.
- Poorer maternal mental health
- Increased risk of physical violence during pregnancy.
- Reduced likelihood of breastfeeding, resulting in less healthy children.
- Lower mother-child relationship quality. (see also Maternal bond)
- More likely that mother smokes tobacco (about 30% more likely in the US) or drinks during pregnancy, which results in poorer health outcomes and additional costs for welfare system. (see also Fetal alcohol syndrome, Fetal alcohol spectrum disorder)
- Greater relationship and stability
- More likely to delay initiation of prenatal care
Children whose births were unintended are:
- Greater likelihood of low birth weight, particularly for unwanted pregnancies. This may be through increased risk of preterm delivery. In the US, eliminating all unwanted pregnancies would reduce rate of low birth weight by 7% for blacks, and 4% for whites, helping to decrease the large disparity in rates for whites vs. blacks.
- Greater infant mortality. If all sexually active couples in the US had routinely used effective contraception in 1980, there would have been 1 million fewer abortions, 340,000 fewer live births that were unintended at conception, 5,000 fewer infant deaths, and the infant mortality rate would have been 10% lower.
- Likely to be less mentally and physically healthy during childhood.
- At higher risk of child abuse and neglect.
- Less likely to succeed in school,
- More likely to live in poverty and need public assistance.
- More likely to have delinquent and criminal behavior. (see also Legalized abortion and crime effect)
- Significantly lower test scores
- Less likely to have a close relationship with their mother.
Unintended pregnancies lead to higher rates of maternal morbidity, and threaten the economic viability of families.
Women with unintended pregnancies have less education and participate less in the workforce than women whose pregnancies are intended.
Abortion, the voluntary termination of pregnancy, is one of the primary consequences of unintended pregnancy. A large proportion of induced abortions worldwide are due to unwanted or mistimed pregnancy. Unintended pregnancies result in about 42 million induced abortions per year worldwide. In the United States, over 92% of abortions are the result of unintended pregnancy.
Abortion carries few health risks when performed in accordance with modern medical technique. It is safer for the pregnant woman than childbirth. However where safe abortions are not available, abortion can contribute significantly to maternal mortality and morbidity.
While decisions about abortion may cause some individuals psychological distress, some find a reduction in distress after abortion. There is no evidence of widespread psychological harm from abortion. Unwanted pregnancy and births resulting from these pregnancies are also psychologically distressing, so considerations of psychological impact of abortion should be in comparison to potential harm from these stressors.
Some find abortion morally objectionable. This could be due to religious beliefs, one's own personal beliefs or the context of the situation.
Over the six years between 1995 and 2000 there were an estimated 338 million pregnancies that were unintended and unwanted worldwide (28% of the total 1.2 billion pregnancies during that period). These unwanted pregnancies resulted in nearly 700,000 maternal deaths (approximately one-fifth of maternal deaths during that period). More than one-third of the deaths were from problems associated with pregnancy or childbirth, but the majority (64%) were from complications from unsafe or unsanitary abortion. Most of the deaths occurred in less developed parts of the world, where family planning and reproductive health services were less available.
Prevention includes comprehensive sexual education, availability of family planning services, abstinence and increased access to a range of effective birth control methods. Most unintended pregnancies result from not using contraception, and many result from using contraceptives inconsistently or incorrectly. Though, increased rates of sexual activity are also a factor.
Increasing use of long-acting reversible contraceptives (such as IUD and contraceptive implants) decreases the chance of unintended pregnancy by decreasing the chance of incorrect use. Method failure is relatively rare with modern, highly effective contraceptives, and is much more of an issue when such methods are unavailable or not used. (See comparison of contraceptive methods).
In the United States, women who have an unintended pregnancy are more likely to have subsequent unplanned pregnancies. Providing family planning and contraceptive services as part of prenatal, postpartum and post abortion care can help reduce recurrence of unintended pregnancy.
Providing contraceptives and family planning services at low or no cost to the user helps prevent unintended pregnancies. Many of those at risk of unintended pregnancy have little income, so even though contraceptives are highly cost-effective, up front cost can be a barrier. Subsidized family planning services improve the health of the population and saves money for governments and health insurers by reducing medical, education and other costs to society.
Providing modern contraceptives to the 201 million women at risk of unintended pregnancy in developing countries who do not have access to contraception would cost an estimated US$3.9 billion per year. This expenditure would prevent an estimated 52 million unintended pregnancies annually, preventing 1.5 million maternal and child deaths annually, and reduce induced abortions by 64% (25 million per year). Reduced illness related to pregnancy would preserve 27 million healthy life years, at a cost of $144 per year of healthy life.
Note: Numbers and rates are for detected pregnancies. A large proportion of pregnancies miscarry before the woman is aware of the pregnancy.
The global rate of unintended pregnancy was 55 per 1,000 women aged 15–44 in 2008, of which 26 per 1,000 ended in abortion. The rate of intended pregnancy was 79 per 1,000. The estimated 208 million pregnancies in 2008 resulted in 102 million intended births, 41 million induced abortions, 33 million unintended births, and 31 million miscarriages.
Globally, the proportion of married women practicing contraception increased from 54% in 1990 to 63% in 2003. The global rate of unintended pregnancy declined from 69 per 1,000 women in 1995. The decline was greatest in the more developed world.
Worldwide, 38% of pregnancies were unintended in 1999 (some 80 million unintended pregnancies in 1999). In developed world an estimated 49% of pregnancies were unintended, 36% in the developing world.
According to a 2004 study, current pregnancies were termed "desired and timely" by 58% of respondents, while 23% described them as "desired, but untimely", and 19% said they were "undesired".
United States of America
The United States rate of unintended pregnancies is higher than the world average, and much higher than that in other industrialized nations. Almost half (49%) of U.S. pregnancies are unintended, more than 3 million unintended pregnancies per year.
A 2011 study by the Guttmacher Institute based on data from the Centers for Disease Control and Prevention and other sources determined that the average U.S. rate of unintended pregnancies was 51 per 1,000 women ages 15 to 44 in 2006. Most states' rates were between 40 and 65 unintended pregnancies per 1,000 women. The state with the highest rate of unintended pregnancies was Mississippi, 69 per 1,000 women, followed by California, Delaware, the District of Columbia, Hawaii and Nevada (66 to 67 per 1,000). New Hampshire had the lowest rate, 36 per 1,000 women, followed by Maine, North Dakota, Vermont and West Virginia (37 to 39 per 1,000 women).
Over 92% of abortions are the result of unintended pregnancy, unintended pregnancies result in about .8 million abortions/year. In 2001, 44% of unintended pregnancies resulted in births, and 42% resulted in induced abortion and the rest in miscarriage. It is estimated that more than half of US women have had an unintended pregnancy by age 45. The U.S. states with the highest levels of abortions performed were Delaware, New York and New Jersey, with rates of 40, 38 and 31 per 1,000 women, respectively. High rates were also seen in the states of Maryland, California, Florida, Nevada and Connecticut (25 to 29 per 1,000 women). The state with the lowest abortion rate was Wyoming, which had less than 1 per 1,000 women, followed by Mississippi, Kentucky, South Dakota, Idaho and Missouri (5 to 6 abortions per 1,000 women).
US birth rates declined in the 1970s. Factors that are likely to have led to this decline include: The introduction of the birth control pill in 1960, and its subsequent rapid increase in popularity; the completion of legalization of contraceptives in the 1960s and early 1970s; the introduction of federal funding for family planning in the 1960s and Title X in 1970; increased career and educational gains for women and its consequence of increased opportunity costs; and the legalization of abortion, which was completed in 1973. The decline in birth rate was associated with reductions in the number of children put up for adoption and reduction in the rate of neonaticide.
- It is unclear to what extent legalization of abortion may have increased the availability of the procedure. It is estimated that before legalization about 1 million abortions were performed annually. Before legalization, abortion was probably one of the most common criminal activities. Before legalization, an estimated 1,000 to 10,000 women died each year from complications of poorly performed abortions. Legalization was followed by a decrease in pregnancy related deaths in young women, as well as decrease in hospital admissions for incomplete or septic abortions, conditions more common than induced abortion.
- The infanticide rate during the first hour of life dropped from 1.41 per 100,000 during 1963 to 1972 to 0.44 per 100,000 for 1974 to 1983; the rate during the first month of life also declined, whereas the rate for older infants rose during this time.
|Year||Unintended pregnancies||Unintended births|
The proportion of births that were unintended at time of conception decreased during the 1970s and early 1980s. Between 1982 and 1988 the proportion of births that were unintended began increasing. In 1990 about 44% of births were unintended at time of conception. The fraction of births that were unintended at time of conception was even higher among lower class women (almost 60%), never-married women (73%) and unmarried teens (86%).
Among lower class women, the rate of unintended pregnancy and unintended birth rose from 1994 to 2001, while it declined for the more affluent women (those >200% of federal poverty level). (Unintended pregnancy rose almost 30% and unintended births rose 50% for those below federal poverty level.) Contraceptive use had been increasing for years, but stopped in the 1990s, and began to decline among lower class women. Cuts in federal and state family planning programs may account for the decreased use of contraceptives and increase in unintended pregnancies.
Costs and potential savings
The public cost of unintended pregnancy is estimated to be about 11 billion dollars per year in short term medical costs. This includes costs of births, one year of infant medical care and costs of fetal loss. Preventing unintended pregnancy would save the public over 5 billion dollars per year in short term medical costs. Savings in long term costs and in other areas would be much larger. By another estimate, the direct medical costs of unintended pregnancies, not including infant medical care, was $5 billion in 2002. The Brookings Institution conducted a research and their results show that taxpayers spend more than $12 billion each year on unintended pregnancies. They also find that, if all unintended pregnancies were prevented, the resulting savings on medical spending alone would equal more than three quarters of the federal FY 2010 appropriation for the Head Start and Early Head Start programs and would be roughly equivalent to the amount that the federal government spends each year on the Child Care and Development Fund (CCDF).
Of the 800,000 teen pregnancies per year, over 80% were unintended in 2001. One-third of teen pregnancies result in abortion. In 2002, about 9% of women at risk for unintended pregnancy were teenagers, but about 20% of the unintended pregnancies in the United States are to teenagers. A somewhat larger proportion of unintended births are reported as mistimed, rather than unwanted, for teens compared to women in general (79% mistimed for teens vs. 69% among all women in 1998).
In 2011, a total of 329,797 babies were born to women aged 15–19 years, for a live birth rate of 31.3 per 1,000 women in this age group.1 This is a record low for U.S. teens in this age group, and a drop of 8% from 2010. Birth rates fell 11% for women aged 15–17 years, and 7% for women aged 18–19 years. While reasons for the declines are not clear, teens seem to be less sexually active, and more of those who are sexually active seem to be using birth control than in previous years.
In the US it is estimated that 52% of unintended pregnancies result from couples not using contraception in the month the woman got pregnant, and 43% result from inconsistent or incorrect contraceptive use; only 5% result from contraceptive failure, according to a report from the Guttmacher Institute. Contraceptive use saved an estimated $19 billion in direct medical costs from unintended pregnancies in 2002.
In 2006, publicly funded family planning services (Title X, medicaid, and state funds) helped women avoid 1.94 million unintended pregnancies, thus preventing about 860,000 unintended births and 810,000 abortions. Without publicly funded family planning services, the number of unintended pregnancies and abortions in the United States would be nearly two-thirds higher among women overall and among teens; the number of unintended pregnancies among lower class women would nearly double The services provided at publicly funded clinics saved the federal and state governments an estimated $5.1 billion in 2008 in short term medical costs. Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed.
Reducing unintended pregnancy in the United States would be particularly desirable since abortion is such a politically divisive issue.
Rape is defined as sexual intercourse that is forced on a person without his or her permission. It may involve physical force, the threat of force, or it may be done against someone who is unable to give consent. Sexual intercourse may be vaginal, anal, or oral, and may involve the use of a body part or an object.
A longitudinal study in 1996 of over 4000 women in the United States followed for 3 years found that the rape-related pregnancy rate was 5.0% among victims aged 12–45 years. Applying that rate to rapes committed in the United States would indicate that there are over 32,000 pregnancies in the United States as a result of rape each year.
Early ways of preventing unwanted pregnancy included withdrawal and various alternatives to intercourse; they are difficult to use correctly and, while much better than no method, have high failure rates compared to modern methods. Various devices and medications thought to have spermicidal, contraceptive, abortifacient or similar properties were also used.
Abortions have been induced to prevent unwanted births since antiquity, abortion methods are described in some of the earliest medical texts. The degree of safety of early methods relative to the risks of child birth is unclear.
Infanticide (‘customary neonaticide’) or abandonment (sometimes in the form of exposure) are other traditional ways of dealing with babies that were not wanted or that a family could not support. Opinions on the morality or desirability of the practices have changed through history.
Where modern contraceptives are not available, abortion has sometimes been used as a major way of preventing birth. For instance in much of Eastern Europe and the former Soviet republics in the 1980s, desired family size was small, but modern contraceptive methods were not readily available, so many couples relied on abortion, which was legal, safe, and readily accessible, to regulate births. In many cases, as contraceptives became more available the rate of unintended pregnancy and abortion dropped rapidly during the 1990s.
In the 19th and 20th centuries, the desired number of pregnancies has declined as reductions in infant and childhood mortality have increased the probability that children will reach adulthood. Other factors, such as level of education and economic opportunities for women, have also led to reductions in the desired number of children. As the desired number of children decreases, couples spend more of their reproductive lives trying to avoid unintended pregnancies.
- Contraceptive mandate
- Demographic dividend
- Prevalence of teenage pregnancy
- Feminization of poverty
- Healthy People program
- International Conference on Population and Development
- Legalized abortion and crime effect
- Millennium Development Goals
- Nutrition and pregnancy
- Religious views on birth control
- Take Charge
- "Unintended Pregnancy Prevention". Centers for Disease Control and Prevention. Retrieved November 13, 2013.
- Dawn Stacey: Contraception. About.com. Retrieved 11 October 2009.
- Wyatt, Kirk D; Anderson, Ryan T; Creedon, Douglas; Montori, Victor M; Bachman, John; Erwin, Patricia; LeBlanc, Annie (2014). "Women’s values in contraceptive choice: a systematic review of relevant attributes included in decision aids". BMC Women's Health 14 (1): 28. doi:10.1186/1472-6874-14-28. PMID 3932035.
- Hanson, S.J.; Burke, Anne E. (21 December 2010). "Fertility control: contraception, sterilization, and abortion". In Hurt, K. Joseph; Guile, Matthew W.; Bienstock, Jessica L.; Fox, Harold E.; Wallach, Edward E. The Johns Hopkins manual of gynecology and obstetrics (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. 382–395. ISBN 978-1-60547-433-5.
- Eisenberg, Leon; Brown, Sarah Hart (1995). The best intentions: unintended pregnancy and the well-being of children and families. Washington, D.C: National Academy Press. ISBN 0-309-05230-0. Retrieved 2011-09-03.
- J. Joseph Speidel; Cynthia C. Harper; Wayne C. Shields (September 2008). "The Potential of Long-acting Reversible Contraception to Decrease Unintended Pregnancy". Contraception 78 (3): 197–200. doi:10.1016/j.contraception.2008.06.001. PMID 18692608.
- Sharing Responsibility:Women, Society and Abortion Worldwide (PDF) (Report). 1999.
- "Abortion in Context: United States and Worldwide". Alan Guttmacher Institute. May 1999. Retrieved 2011-08-28.
- "Healthy Timing and Spacing of Pregnancy: HTSP Messages". USAID. Retrieved 2008-05-13.
- Hatcher, Robert D. (2011). Contraceptive Technology (20th ed.). Ardent Media, Inc. ISBN 978-1-59708-004-0.
- Hathaway J.E.; Mucci L.A.; Silverman J.G.; et al. (2000). ", Health status and health care use of Massachusetts women reporting partner abuse". Am J Prev Med 19 (4): 302–307. doi:10.1016/s0749-3797(00)00236-1.
- <name=Oopsie babies>"Oopsie babies? A third of U.S. births unintended, study finds". July 2012.
- "Family Planning - Healthy People 2020". Retrieved 2011-08-18.
Which cites: * Logan C, Holcombe E, Manlove J, et al. (May 2007). "The consequences of unintended childbearing: A white paper" (PDF). Washington: Child Trends, Inc. * Cheng D, Schwarz E, Douglas E, et al. (March 2009). "Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors". Contraception 79 (3): 194–8. doi:10.1016/j.contraception.2008.09.009. PMID 19185672. * Kost K, Landry D, Darroch J (Mar–Apr 1998). "Predicting maternal behaviors during pregnancy: Does intention status matter?". Fam Plann Perspectives 30 (2): 79–88. doi:10.2307/2991664. PMID 9561873. * D’Angelo, D, Colley Gilbert B, Rochat R; et al. (Sep–Oct 2004). "Differences between mistimed and unwanted pregnancies among women who have live births". Perspect Sex Reprod Health 36 (5): 192–7. doi:10.1363/3619204. PMID 15519961.
- "Providers miss opportunities to prevent depression in and discuss birth control with women with unplanned pregnancies". Research Activities (Agency for Healthcare Research and Quality) (372): 15. August 2011.
- "Unplanned Pregnancy" (PDF). The National Campaign. Retrieved 2013-11-21.
- "Religious Views on Contraception". Religious Coalition for Reproductive Choice. 2006. Retrieved 2007-05-16.
- Logan C, Holcombe E, Manlove J, et al. (2007 May [cited 2009 Mar 3]). "The consequences of unintended childbearing: A white paper" (PDF). Washington: Child Trends, Inc. Check date values in:
- Lesa Bethea (1999). "Primary Prevention of Child Abuse". American Family Physician.
- Monea J, Thomas A (June 2011). "Unintended pregnancy and taxpayer spending". Perspectives on Sexual and Reproductive Health 43 (2): 88–93. doi:10.1363/4308811. PMID 21651707.
- Bankole; et al. (1998). "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries". International Family Planning Perspectives.
- Lawrence B. Finer; Lori F. Frohwirth; Lindsay A. Dauphinee; Susheela Singh; Ann M. Moore (September 2005). "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives" (PDF). Perspectives on Sexual and Reproductive Health 37 (3): 110–118. doi:10.1111/j.1931-2393.2005.tb00045.x. PMID 16150658.
- Grimes, D. A.; Benson, J.; Singh, S.; Romero, M.; Ganatra, B.; Okonofua, F. E.; Shah, I. H. (2006). "Unsafe abortion: The preventable pandemic" (PDF). The Lancet 368 (9550): 1908–1919. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724.
- Grimes, DA; Creinin, MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. doi:10.7326/0003-4819-140-8-200404200-00009. PMID 15096333.
- Raymond, E. G.; Grimes, D. A. (2012). "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". Obstetrics & Gynecology 119 (2, Part 1): 215–219. doi:10.1097/AOG.0b013e31823fe923. PMID 22270271.
- Grimes DA (January 2006). "Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999". Am. J. Obstet. Gynecol. 194 (1): 92–4. doi:10.1016/j.ajog.2005.06.070. PMID 16389015.
- Haddad, LB.; Nour, NM. (2009). "Unsafe abortion: unnecessary maternal mortality". Rev Obstet Gynecol 2 (2): 122–6. PMC 2709326. PMID 19609407.
- Adler, NE; David, HP; Major, BN; Roth, SH; Russo, NF; Wyatt, GE (1990). "Psychological responses after abortion". Science 248 (4951): 41–4. doi:10.1126/science.2181664. PMID 2181664.
- Templeton, A.; Grimes, D. A. (2011). "A Request for Abortion". New England Journal of Medicine 365 (23): 2198–2204. doi:10.1056/NEJMcp1103639.
- "More on Koop's study of abortion". Fam Plann Perspect 22 (1): 36–9. 1990. doi:10.2307/2135437. JSTOR 2135437. PMID 2323405.
- Cockburn, Jayne; Pawson, Michael E. (2007). Psychological Challenges to Obstetrics and Gynecology: The Clinical Management. Springer. p. 243. ISBN 978-1-84628-807-4.
- "APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health" (Press release). American Psychological Association. 12 August 2008. Retrieved 7 September 2011.
- "Report of the APA Task Force on Mental Health and Abortion" (PDF). Washington, DC: American Psychological Association. 13 August 2008.
- "Promises to Keep: The Toll of Unintended Pregnancies on Women's Lives in the Developing World". Retrieved 2009-01-22.
- New, Michael (May 6, 2013). "Unintended Pregnancy Rates Rise Despite Increased Contraception Use". LifeNews.
- James Trussell; Anjana Lalla; Quan Doan; Eileen Reyes; Lionel Pinto; Joseph Gricar (2009). "Cost effectiveness of contraceptives in the United States". Contraception 79 (1): 5–14. doi:10.1016/j.contraception.2008.08.003. PMC 3638200. PMID 19041435.
- Susheela Singh; Jacqueline E. Darroch; Michael Vlassoff; Jennifer Nadeau (2003). Adding it Up: The Benefits of Investing In Sexual and Reproductive Health Care (Report). The Alan Guttmacher Institute and UNFPA. ISBN 0-939253-62-3.
- Harris, Irving B. Children in jeopardy can we break the cycle of poverty? New Haven: Yale Child Study Center, Distributed by Yale UP, 1996.
- Susheela Singh; Deirdre Wulf; Rubina Hussain; Akinrinola Bankole; Gilda Sedgh. Abortion Worldwide: A Decade of Uneven Progress (PDF) (Report). Alan Guttmacher Institute.
- Wellings, K.; Jones, K. G.; Mercer, C. H.; Tanton, C.; Clifton, S.; Datta, J.; Copas, A. J.; Erens, B.; Gibson, L. J.; MacDowall, W.; Sonnenberg, P.; Phelps, A.; Johnson, A. M. (2013). "The prevalence of unplanned pregnancy and associated factors in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)". The Lancet 382 (9907): 1807. doi:10.1016/S0140-6736(13)62071-1.
- Trussell J, Wynn LL (January 2008). "Reducing unintended pregnancy in the United States". Contraception 77 (1): 1–5. doi:10.1016/j.contraception.2007.09.001. PMID 18082659.
- National Human Development Report Russian Federation 2008, UNDP,pages 47–49, Retrieved on 10 October 2009
- "Emergency Contraception: Unintended Pregnancy in the United States". Retrieved 2009-01-25.
- "Unintended Pregnancy Rates at the State Level". JournalistsResource.org, retrieved 20 March 2012
- Finer, Lawrence B.; Kost, Kathryn (May 2011). "Unintended Pregnancy Rates at the State Level". Perspectives on Sexual and Reproductive Health 43 (2).
- Rameet Singh; Jennifer Frost; Beth Jordan; Elisa Wells (January 2009). "Beyond A Prescription: Strategies for Improving Contraceptive Care". Contraception 79 (1): 1–4. doi:10.1016/j.contraception.2008.09.015.
- "Abortion Incidence and Access to Services in the United States". JournalistsResource.org, retrieved 20 March 2012
- Jones, Rachel K.; Kooistra, Kathryn (March 2011). "Abortion Incidence and Access to Services in the United States". Perspectives on Sexual and Reproductive Health 43 (1).
- Maureen Paul. Management of unintended and abnormal pregnancy: comprehensive abortion care. Wiley-Blackwell. p. 34. ISBN 978-1-4051-7696-5.
- Stanley K. Henshaw (1998). "Unintended Pregnancy in the United States". Family Planning Perspectives 30 (1): 24–29 & 46. doi:10.2307/2991522.
- Finer L, Henshaw S (June 2006). "Disparities in rates of unintended pregnancy in the United States, 1994 and 2001". Perspect Sex Reprod Health 38 (2): 90–6. doi:10.1363/3809006. PMID 16772190.
- Marc Kaufman (May 5, 2006). "Unplanned Pregnancy Increases among Poor". San Francisco Chronicle. Retrieved 2011-08-23.
- Trussell J (March 2007). "The cost of unintended pregnancy in the United States". Contraception 75 (3): 168–70. doi:10.1016/j.contraception.2006.11.009. PMID 17303484.
- "The High Cost of Unintended Pregnancy". The Brookings Institution.
- Dragoman M, Davis A (June 2008). "Abortion care for adolescents". Clin Obstet Gynecol 51 (2): 281–9. doi:10.1097/GRF.0b013e31816d72ee. PMID 18463459.
- "Teenage pregnancy. Fact sheet". SIECUS Rep 26 (3): 21–2. 1998. PMID 12293248.
- Trussell J, Koenig J, Stewart F, Darroch JE (1997). "Medical care cost savings from adolescent contraceptive use". Fam Plann Perspect 29 (6): 248–55, 295. doi:10.2307/2953412. JSTOR 2953412. PMID 9429869.
- "Teen Pregnancy". Centers for Disease Control and Prevention. Retrieved 2013-11-21.
- "Facts on Publicly Funded Contraceptive Services in the United States". Guttmacher Institute. February 2011. Retrieved August 12, 2011.
- Centers for Disease Control and Prevention. (2006). "Recommendations to improve preconception health and health care — United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care.". MMWR 55 (RR-6).
- "Rape (sexual assault) - overview". U.S. Department of Health and Human Services. Retrieved 2013-11-21.
- Holmes, MM; Resnick, HS; Kilpatrick, DG; Best, CL (1996). "Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women". American Journal of Obstetrics and Gynecology 175 (2): 320–324. doi:10.1016/S0002-9378(96)70141-2. PMID 8765248.
- Potts, M, Campbell, M (2009). "History of contraception". Glob. libr. women's med. doi:10.3843/GLOWM.10376. ISSN 1756-2228.
- Eisenberg, Leon; Brown, Sarah Hart (1995). The best intentions: unintended pregnancy and the well-being of children and families. Washington, D.C: National Academy Press. ISBN 0-309-05230-0.
- Mosher, William D., Jo Jones, and Joyce C. Abma. (2012). Intended and unintended births in the United States, 1982-2010. Hyattsville, Md.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.