World Contraception Day: Unintended Pregnancy in America

The unintended pregnancy rate in America is astoundingly high (nearly 50%) and minority women, particularly Black and Hispanic women are at almost twice the risk of unintended pregnancies as Caucasian. The negative implications of an unintended pregnancy can affect a woman’s social, emotional and financial stability. On a national and worldwide level, unintended pregnancies have a significant societal impact, contributing to national debt and poverty. With major advances in Family Planning in the forms of sexual health education and access to contraception, we have seen a slow decline in unintended pregnancies although the racial gap persists.

Limitations in access to contraception

Multiple financial barriers impede access to contraception. Some states in the US have enacted laws that aim to prevent access to legal abortion and family planning services. Further, sexual health education is largely influenced by individual state regulations. Nationally, proposed revisions to Title X, a Federal grant program prioritizing family planning services to low income and minority women, will restrict access to the women who are most vulnerable.

Birth control pills are a popular form of contraceptive use.
A packet of contraceptive pills

Historical and cultural considerations

Limited access to culturally competent services is a large barrier to medical care. In one study that reviewed knowledge and attitudes surrounding contraception among 602 women ages 18-29 most at risk of unintended pregnancies, the authors found that Black and Latino women were more likely to associate contraception with negative views of the government limiting family sizes of minority women (Rocca & Harper, 2012). We must acknowledge that some of the mistrust these women demonstrate in the healthcare system is steeped in historical medical misconduct such as that displayed in the infamous Tuskegee experiment.

Long-acting reversible contraception (LARC) is the most effective type of contraception. The CHOICE project, a study that had a goal of increasing LARC uptake and decreasing unintended pregnancy, found that many women, particularly minority women held misconceptions that limited their willingness to utilize LARC. When deep-rooted cultural beliefs were addressed, a significant increase in the utilization of highly efficacious contraception methods was observed. These are important to address given low-income minority women are more likely to choose less efficacious contraceptive options such as condoms (Access to Contraception, 2015).

Worldwide limitations to contraception

Unintended pregnancy has a negative impact globally. Although different countries have specific access issues, some themes are common throughout the developing world including a lack of adequately trained providers, reliance on less effective contraception, limited knowledge of the correct way to use contraception, policies or laws that restrict the access of unmarried women and social taboos (i.e. partners refusing to use condoms).

Unintended pregnancy directly impacts a woman’s ability to shape her family, pursue an education, gain financial stability and fulfill her dreams. Given the high morbidity and mortality rates seen among pregnant women worldwide, unintended pregnancies can endanger women’s lives. Our global community must work to ensure all women have reliable access to safe and efficacious forms of contraception. Only when access to contraception is readily available, will we begin to see a significant shift in unintended pregnancy rates.

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