The 37%

by Adrianna McIntyre

A staggering (at least in my view) statistic found its way into my inbox last week. 37%. Nope, not some new riff on economic inequality or a quantification of the under- and uninsured. This is something completely different: 37% 0f U.S. births between 2006-2010 were unintended at the time of conception, according to a recently released CDC report–timely, coming just on the heels of the contraceptive mandate. Overall, this number has not declined since 1982. So. More than 1 in 3 births (births, mind you, not pregnancies) has been unplanned since before I was born.

Yikes.

Whenever the word “overall” is used, nuances are bound to follow. Demographic fine print: this number has significantly declined among married white females in the past two decades, but that trend has been obscured by a simultaneous increase among umarried women. It should come as no statistical surprise that unmarried women, black women, and women with less education and/or income are more likely to have unplanned births, and recent publications have found that  mothers and children of these births are at increased risk of poor health and socioeconomic outcomes.

If you’re reading this, you are surely a busy and responsible 20-something who will never encounter something so scandalous as an unintended pregnancy (alternatively, you are a health policy wonk who saw this on twitter). Either way, why should you care?

20-somethings: This issue disproportionately affects younger women: 37 jumps to a nice round 50% when you start talking  about 20 to 24-year olds. Related, remember how you can stick around on your parents’ insurance until you’re 26? It turns out young women shouldn’t assume that maternity coverage is included in benefits as a child-dependent–regardless of how intended a pregnancy is. Also of note in this study, among women who were not using contraception when they got pregnant, 36% claimed that they did not think they could get pregnant. There’s much that could be said here about  the role of comprehensive sex ed, but I’m not going to say it today. And this didn’t vary across age groups, so I’m not going to ascribe it to the “invincible” mindset commonly noted in discussions of Millennials and health care.  But seriously, if you’re on the “it could never happen to me” train, kindly get off. Immediately.

For the wonks: it’s been estimated that unintended births cost just over $11 billion annually, accounting only for prenatal care, pregnancy, labor/delivery, and infant care in the year after birth. Long-term costs (both medical and nonmedical) after that first year of life weren’t factored in, because of estimation difficulty. Using Medicaid data and looking at just those same short-term costs, another study estimated that for every dollar invested in family planning, $4 can be saved in government health expenditures.

The argument that contraceptives are cost-saving by virtue of preventing pregnancies is a contentious one, without much consensus (h/t Austin Frakt over at TIE). I haven’t had a chance to look over everything,  but I think there are a few things to bear in mind when looking at the data. The CDC report notes that “among women who had unintended births in the United States in 2002, about 40% were using contraception, which means that 60% were not.” Unfortunately, there is no substantive discussion of what role barriers to access might have played in this discrepancy (#wonkproblems). It seems that the increased risk of unintended births to women of lower incomes, lower education levels, and nonwhite ethnicities (the report looks at black women and non-white Hispanics) would be associated with insurance/coverage, but I haven’t tried to locate a study to back this up (yet… watch this space). More importantly, don’t know whether coverage disparities could explain the decline in unintended births among white married women and concurrent increase among nonmarried women.

I’m actually interested in the 40% of women who were on contraception, too–I couldn’t find a breakdown of which kinds of birth control were being used. The kinds of contraception covered under the ACA–the pill, injectables, IUDs–are significantly more effective than just using condoms. At 2-3%, injectables and implants (IUDs) have the lowest failure rate. The pill has a failure rate of about 9% when you account for improper use (like skipping days). Condoms have a failure rate of 15% with normal use. Nine and fifteen might not seem so different when you see them next to each other, but it’s a 50% difference; IUDs/the shot are 5x more effective than condoms. So I suppose my musing has expanded beyond “will the improved contraceptive access lead to more women using birth control” to include “will improved contraceptive access lead to more women using more effective birth control?” Maybe those variations in effectiveness are negligible considerations in the grand scheme. Still, it’s something to chew on.

Thoughts?

photo credit: knowyourmeme.org

_____________________________
Adrianna works in clinical research and will begin graduate studies at the University of Michigan this fall.
Follow her on Twitter @onceuponA.

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2 thoughts on “The 37%

  1. JZ says:

    It was interesting to note that 23% were mistimed births and unwanted births were 13.8 % totaling to the 37 %. Also sex education of proper use of a condom could bring that 15% down to 2-3% of pregnancy after ‘perfect use’. Women potentially using IUDs or injectables may have to overcome psychological barriers such as fear of sides effects, needles, foreign objects in body even if access is increased.

    • To clarify for other readers, the “unwanted” births (13.8%) were to mothers who never intended to have children. “Mistimed” was a category for women who eventually wanted children, and the authors broke it into two subcategories: women who wanted children sometime in the next 2 years (9.2%) or in 2 or more years (14%).

      You make a good point about the contraceptives–and it holds true for the pill too; there may be women uncomfortable taking hormone medications.

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