were unintended, and births to women with three or more previous births were more likely to be unintended than were first births. The evidence demonstrates that making contraception and abortion safe and widely available and ensuring that women have high levels of education do not, by themselves, reduce the proportions of unintended pregnancies and births.
Thus, despite the increased use of effective contraception, the proportion of births that are unwanted or mistimed may rise in the early stages of the fertility transition before leveling off or falling. Changes in fertility preferences that accompany the fertility transition make the goal of eliminating unintended births a moving target. There is good evidence that fertility intentions change during the course of the transition to low fertility. Desired family size has fallen in almost every country where trend data are available from DHS and the World Fertility Survey, and the decline has sometimes been dramatic: in Kenya, the average fell by more than three children per woman in 20 years (Rutstein, 1995). Desired family size has fallen quite consistently for almost all birth cohorts of women, and for both educated and uneducated women, in 28 countries for which two or three comparable surveys are available (Rutstein, 1995).
Lloyd (1994:191) argues that "the emergence of 'unwanted fertility' is symptomatic of parents' rising aspirations and their increasing awareness of alternatives to their own and their children's current condition." This gap between intentions and experience appears to grow in the early stages of the demographic transition, when declining mortality, particularly for infants and children, results in larger numbers of children growing up for given numbers of live births. As actual fertility declines, wanted fertility may decline even faster, so that the proportion of births that are unintended may actually grow even while fertility control is becoming more prevalent.
The evidence about the prevalence of unintended pregnancy discussed so far is based on women's reports about their intentions and contraceptive behavior. Further evidence that large proportions of pregnancies are unintended comes from the limited available data on the prevalence of induced abortion. The most authoritative estimates are that in 1987, worldwide, there were between 26 and 31 million legal abortions and 10 to 22 million illegal abortions (Henshaw and Morrow, 1990).
By combining direct reports with incomplete data on treatment of abortion complications, Henshaw estimated that in 1990, there were total of 20 million "unsafe abortions," that is, those "not provided through approved facilities and/or persons" (World Health Organization, 1994:2).