medical consequences for both children and parents. Pregnancy begun without planning and intent also means that individual women and couples are often not able to take full advantage of the growing field of preconception risk identification and management, nor of the rapidly expanding knowledge base regarding human genetics. Moreover, unintended pregnancy currently leads to approximately 1.5 million abortions in the United States annually, a ratio of about one abortion to every three live births. This ratio is two to four times higher than that in other Western democracies, in spite of the fact that access to abortion in those countries is often easier than in the United States. Reflecting the widespread occurrence of unintended pregnancy, abortions are obtained by women of all reproductive ages, by both married and unmarried women, and by women in all income categories.
Of the 5.4 million pregnancies that were estimated to have occurred in 1987, about 3.1 million were unintended at the time of conception. Within this pool of unintended pregnancies, some 1.6 million ended in abortion and 1.5 million resulted in a live birth. Only 2.3 million pregnancies in that year were intended at the time of conception and resulted in a live birth.
During the 1970s and early 1980s, the proportion of births that were unintended at the time of conception decreased. Between 1982 and 1988, however, this trend reversed and the proportion of births that were unintended at conception began increasing. This unfortunate trend appears to be continuing into the 1990s. In 1990, about 44 percent of all births were the result of unintended pregnancy;2 the proportion is close to 60 percent among women in poverty, 62 percent among black women, 73 percent among never-married women, and 86 percent among unmarried teenagers.
Many factors help to explain the nation's high level of unintended pregnancy. Most obvious is the failure to use contraceptive methods carefully and consistently—or sometimes even at all—as well as actual technical failures of the methods themselves. Women and their partners relying on reversible means of contraception (about 21 million women) and those using no contraception at all, despite having no clear intent to become pregnant (about 4 million women), contribute roughly equally to the pool of unintended pregnancies. Many women and couples who are not seeking pregnancy move between these two groups, sometimes using contraception, sometimes not.
Contraceptive use and unintended pregnancy are influenced by numerous factors: knowledge about contraceptive methods and reproductive health generally, individual skill in using contraception properly, a wide range of personal feelings and attitudes, varying patterns of sexual behavior, access to