The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Kaye Wellings, Kyle G Jones, Catherine H Mercer, Clare Tanton, Soazig Clifton, Jessica Datta, Andrew J Copas, Bob Erens, Lorna J Gibson, Wendy Macdowall, Pam Sonnenberg, Andrew Phelps, Anne M Johnson, Kaye Wellings, Kyle G Jones, Catherine H Mercer, Clare Tanton, Soazig Clifton, Jessica Datta, Andrew J Copas, Bob Erens, Lorna J Gibson, Wendy Macdowall, Pam Sonnenberg, Andrew Phelps, Anne M Johnson

Abstract

Background: Unplanned pregnancy is a key public health indicator. We describe the prevalence of unplanned pregnancy, and associated factors, in a general population sample in Britain (England, Scotland, and Wales).

Method: We did a probability sample survey, the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), of 15,162 men and women aged 16-74 years in Britain, including 5686 women of child-bearing age (16-44 years) who were included in the pregnancy analysis, between Sept 6, 2010, and Aug 31, 2012. We describe the planning status of pregnancies with known outcomes in the past year, and report the annual population prevalence of unplanned pregnancy, using a validated, multicriteria, multi-outcome measure (the London Measure of Unplanned Pregnancy). We set the findings in the context of secular trends in reproductive health-related events, and patterns across the life course.

Findings: 9·7% of women aged 16-44 years had pregnancies with known outcome in the year before interview, of which 16·2% (95% CI 13·1-19·9) scored as unplanned, 29·0% (25·2-33·2) as ambivalent, and 54·8% (50·3-59·2) as planned, giving an annual prevalence estimate for unplanned pregnancy of 1·5% (1·2-1·9). Pregnancies in women aged 16-19 years were most commonly unplanned (45·2% [30·8-60·5]). However, most unplanned pregnancies were in women aged 20-34 years (62·4% [50·2-73·2]). Factors strongly associated with unplanned pregnancy were first sexual intercourse before 16 years of age (age-adjusted odds ratio 2·85 [95% CI 1·77-4·57], current smoking (2·47 [1·46-4·18]), recent use of drugs other than cannabis (3·41 [1·64-7·11]), and lower educational attainment. Unplanned pregnancy was also associated with lack of sexual competence at first sexual intercourse (1·90 [1·14-3·08]), reporting higher frequency of sex (2·11 [1·25-3·57] for five or more times in the past 4 weeks), receiving sex education mainly from a non-school-based source (1·84 [1·12-3·00]), and current depression (1·96 [1·10-3·47]).

Interpretation: The increasing intervals between first sexual intercourse, cohabitation, and childbearing means that, on average, women in Britain spend about 30 years of their life needing to avert an unplanned pregnancy. Our data offer scope for primary prevention aimed at reducing the rate of unplanned conceptions, and secondary prevention aimed at modification of health behaviours and health disorders in unplanned pregnancy that might be harmful for mother and child.

Funding: Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.

Copyright © 2013 Wellings et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Distribution of London Measure of Unplanned Pregnancy score for women with pregnancy outcome in the year before interview
Figure 2
Figure 2
Median age at first sexual intercourse, first live-in relationship, and first child by birth cohort
Figure 3
Figure 3
Behaviours relating to pregnancy risk in the year before interview, by age-group

References

    1. United Nations Population Fund State of World Population 1997: The Right to Choose: Reproductive Rights and Reproductive Health. New York: UNFPA.
    1. Mohllajee AP, Curtis KM, Morrow B, Marchbanks PA. Pregnancy intention and its relationship to birth and maternal outcomes. Obstet Gynecol. 2007;109:678–686.
    1. Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008;39:18–38.
    1. Shah PS, Balkhair T, Ohlsson A, Beyene J, Scott F, Frick C. Intention to become pregnant and low birth weight and preterm birth: a systematic review. Matern Child Health J. 2011;15:205–216. doi: 10.1007/s10995-009-0546-2.
    1. Lanzi RG, Bert SC, Jacobs BK, the Centers for the Prevention of Child Neglect Depression among a sample of first-time adolescent and adult mothers. J Child Adolesc Psychiatr Nurs. 2009;22:194–202.
    1. Carson C, Redshaw M, Sacker A, Kelly Y, Kurinczuk JJ, Quigley MA. Effects of pregnancy planning, fertility, and assisted reproductive treatment on child behavioral problems at 5 and 7 years: evidence from the Millennium Cohort Study. Fertil Steril. 2013;99:456–463.
    1. Campbell AA, Mosher AD. A History of the Measurement of Unintended Pregnancies and Births. Matern Child Health J. 2000;4:163–169.
    1. Krause EL. “They just happened”: the curious case of the unplanned baby, Italian low fertility, and the “end” of rationality. Med Anthropol Q. 2012;26:361–382.
    1. Luker KC. A reminder that human behavior frequently refuses to conform to models created by researchers. Fam Plann Perspect. 1999;31:248–249.
    1. MMWR Prepregnancy Contraceptive Use Among Teens With Unintended Pregnancies Resulting in Live Births—Pregnancy Risk Assessment Monitoring System (PRAMS), 2004–2008. MMWR. 2012;61:25–29.
    1. Santelli J, Rochat R, Hatfield-Timajchy K, the Unintended Pregnancy Working Group The measurement and meaning of unintended pregnancy. Perspect Sex Reprod Health. 2003;35:94–101.
    1. Schwartz A, Peacock N, McRae K, Seymour R, Gilliam M. Defining new categories of pregnancy intention in African-American women. Womens Health Issues. 2010;20:371–379.
    1. Speizer IS, Santelli JS, Afable-Munsuz A, Kendall C. Measuring factors underlying intendedness of women's first and later pregnancies. Perspect Sex Reprod Health. 2004;36:198–205.
    1. Bachrach CA, Newcomer S. Intended pregnancies and unintended pregnancies: distinct categories or opposite ends of a continuum? Fam Plann Perspect. 1999;31:251–252.
    1. Santelli JS, Lindberg LD, Orr MG, Finer LB, Speizer I. Toward a multidimensional measure of pregnancy intentions: evidence from the United States. Stud Fam Plann. 2009;40:87–100.
    1. Kavanaugh ML, Schwarz EB. Prospective assessment of pregnancy intentions using a single- versus a multi-item measure. Perspect Sex Reprod Health. 2009;41:238–243.
    1. Mercer CH, Tanton C, Prah P. Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal) Lancet. 2013 doi: 10.1016/S0140-6736(13)62035-8. published online Nov 26.
    1. Erens B, Phelps A, Clifton S. Methodology of the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) Sex Transm Infect. 2013 doi: 10.1136/sextrans-2013-051359. published online Nov 26.
    1. Wellings K, Nanchahal K, Macdowall W. Sexual behaviour in Britain: early heterosexual experience. Lancet. 2001;358:1843–1850.
    1. Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. 2003;327:1144–1146.
    1. Office for National Statistics . Volumes 1–3. Palgrave Macmillan; Basingstoke: 2010. (Standard Occupational Classification 2010).
    1. Payne RA, Abel GA. UK indices of multiple deprivation—a way to make comparisons across constituent countries easier. Health Stat Q. 2012;53:22–37.
    1. Hale GE, Burger HG. Hormonal changes and biomarkers in late reproductive age, menopausal transition and menopause. Best Pract Res Clin Obstet Gynaecol. 2009;23:7–23.
    1. Barrett G, Wellings K. What is a ‘planned’ pregnancy? Empirical data from a British study. Soc Sci Med. 2002;55:545–557.
    1. Barrett G, Smith SC, Wellings K. Conceptualisation, development, and evaluation of a measure of unplanned pregnancy. J Epidemiol Community Health. 2004;58:426–433.
    1. Morof D, Steinauer J, Haider S, Liu S, Darney P, Barrett G. Evaluation of the London Measure of Unplanned Pregnancy in a United States population of women. PLoS One. 2012;7:e35381.
    1. Rocca CH, Krishnan S, Barrett G, Wilson M. Measuring pregnancy planning: An assessment of the London Measure of Unplanned Pregnancy among urban, south Indian women. Demogr Res. 2010;23:293–334.
    1. Joyce T, Kaestner R, Korenman S. The stability of pregnancy intentions and pregnancy-related maternal behaviors. Matern Child Health J. 2000;4:171–178.
    1. WHO European Health for All Database (HFA-DB) (accessed June 7, 2013).
    1. Schünmann C, Glasier A. Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion. Contraception. 2006;73:520–524. published online February 17, 2006.
    1. Lakha F, Glasier A. Unintended pregnancy and use of emergency contraception among a large cohort of women attending for antenatal care or abortion in Scotland. Lancet. 2006;368:1782–1787.
    1. Cameron ST, Glasier A. Identifying women in need of further discussion about the decision to have an abortion and eventual outcome. Contraception. 2013;88:128–132. doi: 10.1016/j.contraception.2012.10.032. published online December 4, 2012.
    1. Bajos N, Leridon H, Goulard H, Oustry P, Job-Spira N, the COCON Group Contraception: from accessibility to efficiency. Hum Reprod. 2003;18:994–999.
    1. Font-Ribera L, Pérez G, Salvador J, Borrell C. Socioeconomic inequalities in unintended pregnancy and abortion decision. J Urban Health. 2008;85:125–135.
    1. Goto A, Yasumura S, Reich MR, Fukao A. Factors associated with unintended pregnancy in Yamagata, Japan. Soc Sci Med. 2002;54:1065–1079.
    1. Mosher WD, Jones J, Abma JC, Intended and Unintended Births in the United States: 1982–2010 National Health Statistics Report, 2012; 55, July 24, 2012.
    1. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38:90–96.
    1. Finer LB, Sonfield A. The evidence mounts on the benefits of preventing unintended pregnancy. Contraception. 2013;87:126–127.
    1. Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol. 2012;120:1291–1297.
    1. Roehr B. Free birth control cuts rates of unwanted pregnancies and abortions in US. BMJ. 2012;345:e6763.
    1. Kuroki LM, Allsworth JE, Redding CA, Blume JD, Peipert JF. Is a previous unplanned pregnancy a risk factor for a subsequent unplanned pregnancy? Am J Obstet Gynecol. 2008;199:517.
    1. Oringanje C, Meremikwu MM, Eko H, Esu E, Meremikwu A, Ehiri JE. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database Syst Rev. 2009;4 CD005215.
    1. Gipson JD, Santelli JS. Unplanned and assisted conception pregnancies. BMJ. 2011;343:d4996.
    1. Miller WB, Barber JS, Gatny HH. The effects of ambivalent fertility desires on pregnancy risk in young women in the USA. Popul Stud (Camb) 2013;67:25–38.
    1. Moos MK, Bartholomew NE, Lohr KN. Counseling in the clinical setting to prevent unintended pregnancy: an evidence-based research agenda. Contraception. 2003;67:115–132.
    1. Fleissig A. Unintended pregnancies and the use of contraception: changes from 1984 to 1989. BMJ. 1991;302:147.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever