likely to expose the fetus to harmful substances (such as tobacco or alcohol). The child of an unwanted conception especially (as distinct from a mistimed one) is at greater risk of being born at low birthweight, of dying in its first year of life, of being abused, and of not receiving sufficient resources for healthy development. The mother may be at greater risk of depression and of physical abuse herself, and her relationship with her partner is at greater risk of dissolution. Both mother and father may suffer economic hardship and may fail to achieve their educational and career goals. Such consequences undoubtedly impede the formation and maintenance of strong families.

In addition, an unintended pregnancy is associated with a higher probability that the child will be born to a mother who is adolescent, unmarried, or over age 40—demographic attributes that themselves have important socioeconomic and medical consequences for both children and adults. Pregnancy begun without planning and intent also means that individual women and couples are 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 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; in 1992, for example, less than one-fourth of all abortions were obtained by teenagers (Centers for Disease Control and Prevention, 1994). Although abortion has few long-term negative consequences for women's health, resolving an unintended pregnancy by abortion can often be a sobering and emotionally difficult experience that no woman welcomes. In addition, the political and social tensions surrounding abortion in the United States continue to be a divisive force at the national, state, and local levels. Recently, these tensions have taken a violent turn, as exemplified by the murder of several individuals associated with clinics that perform abortions.

A New Social Norm

The committee has found that the extent and consequences of unintended pregnancy are poorly appreciated throughout the United States. Although considerable attention is now focused on teenage pregnancy and nonmarital childbearing, and controversy over abortion continues, the common link among all these issues—pregnancy that is unintended at the time of conception—is essentially invisible. As a consequence, most proposed remedies ignore the common



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