Getting the Facts Straight • 1
The Benets
of Birth Control
in America
━
Getting the Facts Straight
By Kelleen Kaye, Jennifer Appleton Gootman, Alison Stewart Ng, and Cara Finley
Forrest Alton
Chief Executive Ocer
South Carolina Campaign to Prevent Teen Pregnancy
Robert Wm. Blum, M.D., M.P.H, Ph.D.
William H. Gates, Sr. Professor and Chair
Department of Population, Family & Reproductive Health
Johns Hopkins Bloomberg School of Public Health
Linda Chavez
Chairman
The Center for Equal Opportunity
Vanessa Cullins, M.D., M.P.H., M.B.A.
Vice President for Medical Aairs
Planned Parenthood Federation of America
Susanne Daniels
President, Programming
MTV
Amanda Deaver
Partner
Prism Public Aairs
Mark Edwards
Executive Director
Opportunity Nation
Ira Fishman
Managing Director
NFL Players Association
William Galston, Ph.D.
Senior Fellow, Governance Studies
The Brookings Institution
Ron Haskins, Ph.D.
Senior Fellow, Economic Studies
Co-Director, Center for Children and Families
The Brookings Institution
Nancy L. Johnson
Senior Public Policy Advisor, Federal Public Policy
and Healthcare Group
Baker, Donelson, Bearman, Caldwell & Berkowitz, PC
Ivan Juzang
Founder and President
MEE Productions
Thomas H. Kean
Chairman
The Carnegie Corporation of New York
Chief Executive Ocer
THK Consulting
Jody Greenstone Miller
President and CEO
The Business Talent Group
Bruce Rosenblum
President
Television and Digital Media of Legendary
Entertainment Chairmen
Chief Executive Ocer
Academy of Television Arts & Sciences
Victoria P. Sant
President
The Summit Foundation
Isabel V. Sawhill, Ph.D.
Senior Fellow, Economic Studies
The Brookings Institution
Matthew Stagner, Ph.D.
Senior Fellow
Director of Human Services
Mathematica Policy Research
Mary C. Tydings
Managing Director
Russell Reynolds Associates
Stephen A. Weiswasser
Partner
Covington & Burling
Gail R. Wilensky, Ph.D.
Senior Fellow
Project HOPE
Kimberlydawn Wisdom, MD, MS
Senior Vice President
Community Health & Equity
Chief Wellness Ocer
Henry Ford Health System
Judy Woodru
Co-Anchor and Managing Editor
PBS NewsHour
National Campaign Board of Directors
The Benets
of Birth Control
in America
━
Getting the Facts Straight
By Kelleen Kaye, Jennifer Appleton Gootman, Alison Stewart Ng, and Cara Finley
The Benefits of Birth Control in America:
Getting the Facts Straight
This report was developed with the support of The JPB Foundation, whose
mission is to enhance the quality of life in the United States through
transformational initiatives that promote the health of our communities by
creating opportunities for those in poverty, promoting pioneering medical
research, and enriching and sustaining our environment.
Copyright 2014 by The National Campaign to Prevent Teen and Unplanned
Pregnancy. All rights reserved.
ISBN Number
1-58671-082-6
Suggested Citation
Kaye, K., Gootman, J.A., Ng, A. S., & Finley, C. (2014). The Benefits of Birth Control
in America: Getting the Facts Straight. Washington, DC: The National Campaign
to Prevent Teen and Unplanned Pregnancy.
About the Authors
Kelleen Kaye is the Senior Director of Research at The National Campaign.
Jennifer Appleton Gootman is the Project Director of The National Campaign’s
Birth Control Initiative. Alison Stewart Ng is The National Campaign’s Research
Coordinator. Cara Finley is the Manager of Research and Evaluation at
The National Campaign.
Acknowledgements
We oer special thanks to Kelly Horton who provided critical help in the early
months of this project by assembling key articles and reports for possible
inclusion in this literature review.
Table of Contents
3 Chapter 1: Summary
9 Chapter 2: Unplanned Pregnancy, Abortion,
and the Benefits of Birth Control in America
15 Chapter 3: Maternal and Infant Health and the
Benefits of Birt h Control in America
23 Chapter 4: Family Formation, Family Wellbeing,
and the Benefits of Birth Control in America
29 Chapter 5: Educational Attainment, Employment,
and the Benefits of Birth Control in America
33 Chapter 6: Savings to Society and the Benefits
of Birth Control in America
━
Getting the Facts Straight • 3
Reduced Unplanned Pregnancy
and Abortions
7
Greater access to and consistent use of birth control is essential to significantly
reducing the number of unplanned pregnancies and abortions in the U.S.
At present, the majority of unplanned pregnancies and abortions occur to women
who were either not using birth control at all, or not using it consistently.
Past improvements in the use of birth control show the role it can play in
reducing unplanned pregnancy and abortion. Between 1982 (when national
data on contraceptive use among unmarried women became available)
and 2002, abortion and unplanned pregnancy fell as use of birth control
increased. Unfortunately, progress has since stalled on this front, particularly
among unmarried women age 20 to 29. Of these women who are at risk of an
unplanned pregnancy, use of birth control has fallen since 2002, while their rate
of unplanned pregnancy has risen.
Currently, women using birth control carefully and consistently account for
only 5% of all unplanned pregnancies. On the other hand, women using no
contraception account for 52% of unplanned pregnancies, and women using
contraception inconsistently account for 43%. Non-use and inconsistent use of
birth control account for similar shares of abortions. Part of the explanation for
these high numbers lies in persistent cost and access barriers to contraceptive
care. For example, a recent study found that one-third of women seeking an
abortion reported that they had not been using their preferred method of birth
control due to cost and access barriers.
Highly eective methods of birth control such as the pill or the intrauterine
device (IUD) are more than 99% eective when used consistently and correctly,
and there are encouraging studies showing the steep declines in unplanned
pregnancy and abortion that can result when cost and access barriers to birth
control are removed. For example, when the St. Louis CHOICE project provided
women with contraceptive counseling, a free method of their choice, and a
Summary
Pregnancy planning in general, and the use of birth
control in particular, are directly linked to a wide array
of benefits to women, men, children, and society,
including fewer unplanned pregnancies and abortions,
more educational and economic opportunities for
young women, improved maternal and infant health,
greater family wellbeing, and reduced public spending.
Given that the large majority of both men and
women are sexually active (for example, more than
three-quarters of young adults age 18 to 24 have had
sex in the past 12 months
1
), birth control is central
to realizing these benefits. In fact, the Centers for
Disease Control and Prevention (CDC) recognizes
the development of modern contraception as one
of the 10 greatest public health achievements of the
20
th
century.
2
Nonetheless, the United States has long
reported high levels of unplanned pregnancy
a
and
very uneven use of contraception. For example,
even though most unmarried women in their 20s
say they don’t want to get pregnant and despite
the availability of many forms of birth control—
including some that are highly eective—only half of
those who are sexually active report using reliable
contraception consistently.
3
Unplanned pregnancy is
nearly 100 percent preventable, yet…
•
Roughly half of all pregnancies in the United States
are reported by women to be unplanned—that is, a
pregnancy that a woman herself said she was not
intending or actively trying to achieve.
4
•
Among unmarried young women age 20 to 29, the
percentage of pregnancies that they report as being
unplanned is nearly 70%. This totaled roughly 1.3
million unplanned pregnancies in 2008 alone, and
unplanned pregnancy among young adults has been
trending up for the past few years, not down.
•
Nearly half (44%) of unplanned pregnancies among
unmarried young women result in an abortion,
leading to nearly 600,000 abortions each year.
•
In addition, unplanned pregnancy is responsible
for more than half of all births to unmarried
women in their twenties, or more than 500,000
births each year
.5
•
Women using birth control carefully and consistently
account for only 5% of all unplanned pregnancies.
6
1
Roughly half of all
pregnancies in the
US are reported by
women themselves
as unplanned.
4 • The Benefits of Birth Control in America
patient-centered clinic experience, the
majority of participants chose the highly
eective, low maintenance IUD. In the
year that followed, the abortion rate
among project participants was less
than half that of nonparticipants in the
same area and roughly one-fourth the
national rate. Researchers concluded that
replicating eorts similar to CHOICE at a
national level could prevent as many as
three-quarters of all abortions.
Family planning—along with aordable
and accessible health care, skilled providers,
and quality service delivery—are essential
tools for helping women and their partners
avoid an unplanned pregnancy, which
in turn would significantly decrease the
nation’s abortion rate.
Advancements in
Women’s Education
and Employment
8
Women’s educational attainment and
participation in the labor market have
increased dramatically since modern
family planning became widely available
to both married and unmarried young
women in the early 1970s. Between
1970 and 2012, the percent of women
25 and older with at least a high school
diploma increased from 55% to 88%, and
the percent with at least a bachelor’s
degree increased from 8% to 31%. Over
roughly that same period, the percent of
women who were employed increased
from 41% to 53%, and weekly wages
among working women age 25 and older
increased roughly 40%, net of inflation.
At the same time that women were
experiencing greater success in the labor
market, they were also delaying the birth
of their first child until they were slightly
older and achieving higher levels of
education before they became mothers.
Many factors have played a role in women’s
growing success, but the weight of the
evidence shows that being able to time
when to become a parent has a significant
and direct eect on employment and
educational gains. Delaying even a couple
years can allow a woman to complete her
education and have a more solid footing
in the labor market. Women earn 3% more
for each year of delayed childbearing,
even after accounting for dierences in
other background characteristics that
aect their earnings. These studies also
suggest that, for those women seeking
to do so, delaying childbearing results in
earnings benefits for both advantaged and
disadvantaged women alike.
The availability of birth control
has played a direct role in these
improvements. Even the modest
expansion in availability of the pill that
occurred in the early 1970s—when
unmarried women in some states gained
access at age 18 rather than at age 21—
was linked to significant improvements
in women’s education and employment.
Compared to women living in states
that were slow to oer broad access to
the pill, women in states with easier and
earlier pill access were 10% to 20% more
likely to be enrolled in college at age 21
and had higher earnings trajectories that
persisted even into their 40s—a finding
that remained robust even after netting
out the influence of other factors.
Improved Maternal
and Infant Health
9
Mothers are healthier when they are able
to control when they become pregnant
through the use of family planning,
and their infants benefit as well. Simply
put, women who plan their pregnancies
are more likely, and in many cases are
more able, to do a variety of things that
increase both maternal and child health—
achieve adequate birth spacing, gain
access to preconception and prenatal
care, and avoid smoking and drinking.
Such practices lower the risk of preterm
birth, low birthweight, infant mortality,
and congenital abnormalities.
Conversely, women whose pregnancies
are not planned are more likely to enter
pregnancy at less than optimal health;
in particular, and by definition, they are
less likely to have secured preconception
care. In the months leading up to
pregnancy, they are significantly less
likely to be physically active and more
likely to be either underweight or obese,
less likely to take daily vitamins, more
likely to be anemic, and more likely
to experience high levels of stress.
Unplanned pregnancies are also more
likely to be closely spaced. Pregnancies
less than 18 months apart are considered
Summary
Pregnancy planning means fewer health disparities and
reduced child poverty.
Among unmarried women
(age 20–29) nearly 70% of all
pregnancies are unplanned.
Low birthweight is 2/3 more
likely following an unwanted
pregnancy.
Getting the Facts Straight • 5
risky and, not surprisingly unplanned pregnancies are more
than twice as likely to fall within this window, compared to
planned pregnancies.
These health disparities continue into the months of pregnancy as
well. Women experiencing unplanned pregnancies are more than
twice as likely to lack prenatal care early in their pregnancy—a
finding that remains significant even after controlling for a variety
of confounding factors. Their participation is particularly low
during the first trimester, in part because they are less likely to be
aware of their pregnancy early on. They are also more likely to
do things that reduce the odds of a healthy birth. For example,
the CDC found that among women reporting their pregnancy
was unplanned, 16% smoked during pregnancy, compared to 10%
among women whose pregnancy was planned. Numerous studies
have found this increased risk held true even after adjusting for
other factors. There is also some evidence suggesting increased
use of alcohol and illicit drugs if the pregnancy was unplanned.
Given the link between unplanned pregnancy and less healthy
behavior in the prenatal period, it’s not surprising that unplanned
pregnancy is also associated with significantly higher rates of
preterm birth and low birthweight, with the risk particularly
great following an unwanted pregnancy (that is, a pregnancy to
a woman who reported that she did not want to get pregnant
then or any time in the future). In fact, babies were two-thirds
more likely to be of low birthweight if they followed an unwanted
pregnancy, as compared to a planned pregnancy.
Furthermore, the behavior of mothers following delivery continued
to be more positive among women whose pregnancies were
planned. Seventy-four percent of babies born following a planned
pregnancy were breastfed, compared to 61% of babies following
mistimed pregnancies and only 56% of babies following unwanted
pregnancies, according to the latest data from the CDC. The CDC
also reports that postpartum depression is nearly twice as high
among women whose pregnancy was unplanned, and numerous
studies conclude that unplanned pregnancy significantly elevates
the risk of postpartum depression or other mental health
problems, even net of other factors.
Improved Family Wellbeing
10
Delaying pregnancy until one is actually seeking parenthood
significantly improves parent-child relations and increases
the odds that children reside in two-parent households.
The average age of marriage has climbed much more steeply
over the last few decades compared to the average age of
parenthood. As a result, since 1970 the percent of children born
outside of marriage among twenty-somethings has increased
dramatically from 7% up to 48%. Yet the vast majority of
unmarried young women say they do not want to become
mothers right now and of those who do have a birth, more than
half (53%) report they were not trying to get pregnant. Either
they did not want to get pregnant ever, or they got pregnant
earlier than they wished—three years too early, on average.
Delaying parenthood until pregnancy is planned increases the
likelihood that children are born to parents who are married
at the time of birth or shortly thereafter, reduces relationship
conflict between the parents, and increases the chances that
the parents stay together. Overwhelming evidence shows that
children, in turn, fare better when both parents are present in the
home and in particular when their parents are married. Children
born to married parents are less likely to live in poverty than
those born to single or cohabiting parents, even if their parents
came from disadvantaged backgrounds. They also tend to
benefit from better parenting and experience fewer behavioral
problems, less transition in the household, and less geographic
instability, even after controlling for other factors.
Pregnancy planning also contributes to family wellbeing
in ways beyond family structure. Parents experience less
depression and greater attachment to their children if a birth
follows a planned pregnancy, and this translates into more
positive child development and parent-child relationships as
the child ages.
Summary
Pregnancy planning and birth control are linked
to advancements in education and economic
opportunities for women.
Planned pregnancy reduces relationship conflict.
Women using birth control carefully and
consistently account for only 5% of all
unplanned pregnancies.
6 • The Benefits of Birth Control in America
Benefits to Society
11
Pregnancy planning achieved through both the availability
and aordability of birth control also benefits society as a
whole in terms of fewer health disparities for disadvantaged
populations, reduced child poverty, and lower public spending.
Public funding of family planning became increasingly available
between 1965 and 1973 but was not available everywhere, and
even as it was becoming more widely available from a legal
standpoint, birth control remained too costly for many women.
This was a hardship for low-income women in particular, who
were more likely to report that the birth of their child followed a
pregnancy they did not intend—either they had wanted to get
pregnant later or they did not want to get pregnant ever. One
study estimates that in areas where family planning grants were
first introduced over this period, use of the pill increased by 16
to 20% among low-income women, enabling them to use birth
control on par with higher income women. By 1980, these areas
experienced a 5% decline in child poverty and a 15% decline in
receipt of public assistance compared to counties that did not
receive family planning grants, net of other factors. Overall,
between 1973 and 1982 the share of low-income mothers who
reported that the birth of their child followed an unplanned
pregnancy fell by 16% and the share following an unwanted
pregnancy fell by more than half, based on data from the CDC
(measured among ever-married mothers).
Despite these early improvements, women today who
are economically disadvantaged remain at higher risk for
unplanned and particularly unwanted pregnancy, compared to
women who are not. That is one reason why publicly funded
programs that make birth control available at low cost or no
cost remain critically important for their families’ wellbeing.
What’s more, an extensive body of literature concludes that
these programs actually reduce public spending overall.
Providing public funding for birth control saves nearly $6 in
medical costs for every $1 spent on contraceptive services.
Increasing access to aordable birth control does entail some
cost. However, the evidence overwhelmingly suggests that
these costs are more than oset by the savings that result from
preventing unplanned pregnancies. Currently, estimates of
public spending due to unplanned pregnancy range between
$9.6 billion and $12.6 billion each year, and one recent report
estimates that this cost would double in the absence of publicly
funded family planning programs.
Increased coverage of family planning is also associated with
private sector savings to insurers, employers, and individuals.
For example, one analysis of medical claims data estimated
that using contraception resulted in a two-year net savings per
person of between $8,827 and $9,815, compared to those who
did not use contraception
What It All Means
Bottom line: The capacity to plan and space pregnancies—which
is typically achieved through the use of birth control—has
significant and meaningful benefits for women, children, families,
taxpayers, and more.
12
Pregnancy planning increases the overall
educational status of women and communities; it advances the
health and wellbeing of children and families; it saves money; and
it reduces abortion. As such, birth control deserves widespread
support, expressed in a number of ways including minimal cost
and access barriers, a prominent place in public health priorities
and health care services, and broad political support.
But it is also true that for the most disadvantaged women and
communities, the widespread use of birth control alone is not a
panacea. For these women and communities, realizing the full
benefit of pregnancy planning, spacing, and prevention also
requires additional eorts to promote educational attainment,
better schools, stronger families, economic opportunities,
job readiness, and more. Put another way, birth control alone
cannot solve crushing poverty, but it can open the door to
increased opportunity.
Notes
a
Unplanned pregnancy (also known as unintended pregnancy) refers to
a pregnancy that a woman herself reports was not intended at the time
of conception. Unplanned pregnancy includes both mistimed pregnancies
(that is, the woman reported she did not want to become pregnant at the
time the pregnancy occurred but did want to become pregnant at some
point in the future) as well as unwanted pregnancies (that is, the woman
reported at time of conception that she did not want to become pregnant
then or at any time in the future). Many studies summarized here report the
eects of unplanned pregnancy overall, while some focus specifically on
either unwanted or mistimed pregnancies, as noted previously.
Sources
1. Chandra, A., Mosher, W.D., Copen, C., & Sionean, C. (2011). Sexual behavior,
sexual attraction, and sexual identity in the United States: Data from the
2006–2008 National Survey of Family Growth. National Health Statistics
Reports, 36, 1–36.
2. Ten great public health achievements—United States, 1900-1999. (1999).
MMWR. Morbidity and Mortality Weekly Report, 48(12), 241–243.
Public funding for contraception saves nearly
$6 in medical costs for every $1 spend on
contraceptive services.
Summary
Getting the Facts Straight • 7
3. Kaye, K., Suellentrop, K., & Sloup, C. (2009). The Fog Zone: How
misperceptions, magical thinking, and ambivalence put young adults at
risk for unplanned pregnancy. Washington, DC: The National Campaign to
Prevent Teen and Unplanned Pregnancy.
4. The National Campaign to Prevent Teen and Unplanned Pregnancy.
(2012). Briefly: Unplanned pregnancy among unmarried young women.
Washington, DC: Author. Retrieved from http://thenationalcampaign.org/
resource/briefly-unplanned-pregnancy-among-unmarried-young-women.
5. Author tabulations based on data in Zolna, M., & Lindberg, L. (2012).
Unintended pregnancy: Incidence and outcomes among young adult
unmarried women in the United States, 2001 and 2008. New York, NY:
Guttmacher Institute. Retrieved from http://www.guttmacher.org/pubs/
unintended-pregnancy-US-2001-2008.pdf.
6. Frost, J.J., Darroch, J.E., & Remez, L. (2008). Improving contraceptive use
in the United States. In Brief, 2008(1), 1–8. Retrieved from the Guttmacher
Institute website http://www.guttmacher.org/pubs/2008/05/09/
ImprovingContraceptiveUse.pdf.
7. Kaye, K., Gootman, J.A., Ng, A.S., & Finley, C. (2014). Unplanned
pregnancy, abortion, and the benefits of birth control in America. In The
benefits of birth control in America: Getting the facts straight. Washington,
DC: The National Campaign to Prevent Teen and Unplanned Pregnancy.
8. Kaye et al., 2014. Educational attainment, employment, and the benefits
of birth control in America.
9. Kaye et al., 2014. Maternal and infant health and the benefits of birth
control in America.
10. Kaye, K., Gootman, J.A., Ng, A.S., & Finley, C. (2014). Family formation,
family wellbeing, and the benefits of birth control in America. In The benefits
of birth control in America: Getting the facts straight. Washington, DC: The
National Campaign to Prevent Teen and Unplanned Pregnancy.
11. Kaye et al., 2014. Family formation, family wellbeing, and the benefits
of birth control in America; Kaye et al., 2014. Savings to society and the
benefits of birth control in America.
12. Sonfield, A., Hasstedt, K., Kavanaugh, M.L., & Anderson, R. (2013). The
social and economic benefits of women’s ability to determine whether and
when to have children. New York, NY: Guttmacher Institute. Retrieved from
http://www.guttmacher.org/pubs/social-economic-benefits.pdf; Logan, C.,
Holcome, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended
childbearing. Washington, DC: Child Trends.
Summary
Getting the Facts Straight • 9
Unplanned Pregnancy, Abortion, and the
Benets of Birth Control in America
2
Pregnancy planning in general, and the use of birth
control in particular, are directly linked to a wide array
of benefits to women, men, children, and society,
including fewer unplanned pregnancies and abortions,
more educational and economic opportunities for
young women, improved maternal and infant health,
greater family wellbeing, and reduced public spending.
Given that the large majority of both men and
women are sexually active (for example, more than
three-quarters of young adults age 18 to 24 have had
sex in the past 12 months
1
), birth control is central
to realizing these benefits. In fact, the Centers for
Disease Control and Prevention (CDC) recognizes
the development of modern contraception as one
of the 10 greatest public health achievements of the
20
th
century.
2
Nonetheless, the United States has long
reported high levels of unplanned pregnancy
a
and
very uneven use of contraception. For example,
even though most unmarried women in their 20s
say they don’t want to get pregnant and despite
the availability of many forms of birth control—
including some that are highly eective—only half of
those who are sexually active report using reliable
contraception consistently.
3
Unplanned pregnancy is
nearly 100 percent preventable, yet…
•
Roughly half of all pregnancies in the United States
are reported by women to be unplanned—that is, a
pregnancy that a woman herself said she was not
intending or actively trying to achieve.
4
•
Among unmarried young women age 20 to 29, the
percentage of pregnancies that they report as being
unplanned is nearly 70%. This totaled roughly 1.3
million unplanned pregnancies in 2008 alone, and
unplanned pregnancy among young adults has been
trending up for the past few years, not down.
•
Nearly half (44%) of unplanned pregnancies among
unmarried young women result in an abortion,
leading to nearly 600,000 abortions each year.
•
In addition, unplanned pregnancy is responsible
for more than half of all births to unmarried
women in their twenties, or more than 500,000
births each year
.5
•
Women using birth control carefully and consistently
account for only 5% of all unplanned pregnancies.
6
Progress in Reducing Unplanned
Pregnancy and Abortion
Family planning is an eective way to prevent unplanned pregnancy—and
because well over 90% of abortions are sought in the wake of an unplanned
pregnancy, family planning also reduces abortion.
7
This is particularly true among
unmarried women, who are more likely than married women to terminate an
unplanned pregnancy.
8
In fact, only one in 20 unplanned pregnancies occur
among women who were using contraception correctly and consistently.
9
Past improvements in the use of contraception show the role it can play in
reducing unplanned pregnancy and therefore abortion, although progress
on this front has stalled more recently.
•
The proportion of unmarried women using some form of contraception
increased from 44% to 57% between 1982 (when data first became
available) and 2002.
10
•
During this same period, there were also declines in unplanned pregnancy,
which in turn led to declines in abortion. In fact, the abortion rate for
unmarried women fell by roughly one-third.
11
•
Unfortunately, more recent news on this front has been less encouraging.
Between 2002 and 2008 (the most recent year for which unplanned pregnancy
data are available), the proportion of unmarried women using contraception has
fallen while their rate of unplanned pregnancy has risen slightly.
12
Roughly half of all
pregnancies in the
US are reported by
women themselves
as unplanned.
The capacity to plan and space pregnancies through the
use of birth control has significant and meaningful benefits
for women, children, families, taxpayers, and more.
10 • The Benefits of Birth Control in America
•
It is important to recognize that, as a general matter, U.S. rates
of unplanned pregnancy far exceed that of many comparable
countries. For example, there were 54 unplanned pregnancies
per 1,000 women in the United States compared to 38 per
1,000 in Europe as of 2008. Furthermore, while the overall rate
of unplanned pregnancy in the United States has been nearly
stagnant since 1995, the rate for Europe has fallen by 42%.
13
•
This, in turn, led to a United States abortion rate (19 per
1,000 women) that exceeded rates in Western, Southern,
and Northern Europe in 2008 (12, 18, and 17 per 1,000
women respectively).
14
And because modern contraception can help women plan
when and if they become pregnant, it clearly plays a significant
role in helping reduce the rates of abortion in America. To be
sure, the evidence is imperfect—we do not have randomized
trials of women with and without access to contraception, or
even recent examples of large comparison groups who have
little or no access, especially here in the United States. Even
so, the weight of the evidence across numerous studies—even
studies netting out the influence of other characteristics—
shows the significant potential of contraceptive availability
and use to reduce unplanned pregnancy and thereby reduce
abortion as well.
The Role of Family Planning
In the United States, women using no contraception or using it
inconsistently account for 52% and 43% of unplanned pregnancies
respectively, and similar proportions of abortions. Only 5% of
unplanned pregnancies result from method failure.
15
The proportion
of unplanned pregnancies and abortions attributable to women
using no contraception is particularly striking given that they
account for only 8% of women at risk of an unplanned pregnancy.
Diculties related to contraceptive cost and access factor
prominently among these women. For example, one study
found that, among women seeking an abortion, nearly one-
third (32%) reported that they had not been using their desired
method of contraception at the time they conceived due to
access or cost barriers.
16
At the same time, highly eective methods of birth control
such as the implant or the intrauterine device (IUD) are more
than 99% eective when used consistently, and research
shows that eorts to improve women’s access to and use of
contraception significantly reduce unplanned pregnancy as well
as the abortions that often follow.
17
•
The most recent research on this topic comes from the
groundbreaking CHOICE project. This eort, which began
in 2007, eliminated cost as a barrier to obtaining and using
eective contraception, encouraged the use of the most
eective, low maintenance methods, and provided counseling
to support and promote consistent use of contraception.
•
Between 2008 and 2010, the abortion rate of women
enrolled in CHOICE was one-third to one-half that of other
women in the same region and roughly one-fourth that of
women nationally.
18
•
The CHOICE project was particularly successful in increasing
the proportion of women using low maintenance, highly
eective methods (LARCs, or long-acting reversible
contraception). Unplanned pregnancy was lowest among those
who used LARCs—less than 1% had an unplanned pregnancy
in the next three years compared to nearly 10% of women who
chose other hormonal methods (the pill, patch, or ring).
19
•
The Iowa Initiative to Reduce Unintended Pregnancy also
highlights the important role of long-acting contraception
in reducing unplanned pregnancy and abortion. Started in
2007, this initiative helped Title X clinics in the state provide
greater access to contraception and to long-acting methods
such as the IUD in particular. Between 2007 and 2009, the
percent of women using a long-acting method more than
doubled, from roughly 5% to nearly 14%.
20
Furthermore,
between 2006 and 2012, the percentage of pregnancies
Unplanned Pregnancy, Abortion, and the
Benets of Birth Control in America
Among unmarried women
(age 20–29) nearly 70% of all
pregnancies are unplanned.
Nearly half of
unplanned pregnancies
among unmarried
women (age 20-29)
result in an abortion—
nearly 600,000
abortions each year.
Improving access to and use of contraception
significantly reduces unplanned pregnancies
and abortions.
Getting the Facts Straight • 11
in Iowa that were unplanned fell by 15% and the percent
ending in abortion fell by 26%. While it is too early to
assess how much of this reduction in unplanned pregnancy
and abortion resulted directly from the initiative, because
we lack comparable data from most other states and the
national overall beyond 2008, the results are encouraging.
•
Results from an eort in New Zealand—a country whose
demographics and rates of unplanned pregnancy are
somewhat similar to the United States—underscore the role
that LARC methods can play in preventing abortion and repeat
abortion specifically. This study found that, among abortion
patients, those immediately receiving a LARC method were
less than half as likely to seek another abortion within the next
24 months compared to abortion patients who didn’t receive
a LARC method (6% compared to 15%).
21
This is an important
finding because in the U.S. at present, about one-half of
women obtaining an abortion have had a previous abortion.
22
•
Initiatives such as these have not been done on a national
scale, at least not here in the United States, but researchers
estimate that if the CHOICE project—or other eorts that
significantly improved contraceptive use—were available
nationwide, unplanned pregnancy would fall dramatically,
thereby reducing abortion as well, by perhaps as much as
62% to 78% of all abortions.
23
•
The potential for reducing unplanned pregnancy and abortion
rates through increased use of contraception is further
illustrated by a recent micro-simulation study jointly released
by the Brookings Institution and Child Trends. The researchers
estimate that, among young unmarried women who are at
risk of pregnancy, shifting even 11% of them from using no
female contraception to using either hormonal or long-acting
methods would reduce their abortion rate by 25%.
24
•
Although data on contraceptive use lag several years,
they suggest reason for optimism that the country may be
moving towards greater reliance on LARCs. The percentage
of women using these low maintenance methods, while still
small, has more than doubled just between 2007 and 2009,
from 3% to 8% of women at risk of unplanned pregnancy.
25
•
At the same time, abortion rates continue to fall, and in 2011
had reached their lowest point in two decades (16.9 abortions
per 1,000 women). It is too soon to know what factors
account for this trend, especially given that unplanned
pregnancy data are only available through 2008. However
the continued declines in abortion are encouraging and
contraception has undoubtedly contributed to this trend.
26
What It All Means
Bottom line: The capacity to plan and space pregnancies—which
is typically achieved through the use of birth control—has
significant and meaningful benefits for women, children, families,
taxpayers, and more.
27
Pregnancy planning increases the overall
educational status of women and communities; it advances the
health and wellbeing of children and families; it saves money; and
it reduces abortion. As such, birth control deserves widespread
support, expressed in a number of ways including minimal cost
and access barriers, a prominent place in public health priorities
and health care services, and broad political support.
But it is also true that for the most disadvantaged women and
communities, the widespread use of birth control alone is not a
panacea. For these women and communities, realizing the full
benefit of pregnancy planning, spacing, and prevention also
requires additional eorts to promote educational attainment,
better schools, stronger families, economic opportunities,
job readiness, and more. Put another way, birth control alone
cannot solve crushing poverty, but it can open the door to
increased opportunity.
Notes
a
Unplanned pregnancy (also known as unintended pregnancy) refers to
a pregnancy that a woman herself reports was not intended at the time
of conception. Unplanned pregnancy includes both mistimed pregnancies
(that is, the woman reported she did not want to become pregnant at the
time the pregnancy occurred but did want to become pregnant at some
Unplanned Pregnancy, Abortion, and the
Benets of Birth Control in America
Women using birth control carefully and
consistently account for only 5% of all
unplanned pregnancies.
Unplanned pregnancy accounts for 90%
of abortions.
12 • The Benefits of Birth Control in America
point in the future) as well as unwanted pregnancies (that is, the woman
reported at time of conception that she did not want to become pregnant
then or at any time in the future). Many studies summarized here report the
eects of unplanned pregnancy overall, while some focus specifically on
either unwanted or mistimed pregnancies, as noted previously.
Sources
1. Chandra, A., Mosher, W.D., Copen, C., & Sionean, C. (2011). Sexual behavior,
sexual attraction, and sexual identity in the United States: Data from the
2006–2008 National Survey of Family Growth. National Health Statistics
Reports, 36, 1–36.
2. Ten great public health achievements—United States, 1900–1999. (1999).
MMWR: Morbidity and Mortality Weekly Report, 48(12), 241–243.
3. Kaye, K., Suellentrop, K., & Sloup, C. (2009). The Fog Zone: How
misperceptions, magical thinking, and ambivalence put young adults at
risk for unplanned pregnancy. Washington, DC: The National Campaign to
Prevent Teen and Unplanned Pregnancy.
4. The National Campaign to Prevent Teen and Unplanned Pregnancy.
(2012). Briefly: Unplanned pregnancy among unmarried young women.
Washington, DC: Author. Retrieved from http://thenationalcampaign.org/
resource/briefly-unplanned-pregnancy-among-unmarried-young-women.
5. Author tabulations based on data in Zolna, M., & Lindberg, L. (2012).
Unintended pregnancy: Incidence and outcomes among young adult
unmarried women in the United States, 2001 and 2008. New York, NY:
Guttmacher Institute. Retrieved from http://www.guttmacher.org/pubs/
unintended-pregnancy-US-2001-2008.pdf.
6. Frost, J.J., Darroch, J.E., & Remez, L. (2008). Improving contraceptive use
in the United States. In Brief, 2008(1), 1–8. Retrieved from the Guttmacher
Institute website http://www.guttmacher.org/pubs/2008/05/09/
ImprovingContraceptiveUse.pdf.
7. Author tabulations based on unpublished data provided by the
Guttmacher Institute [Data file].
8. Finer, L.B., & Zolna, M.R. (2014). Shifts in intended and unintended
pregnancies in the United States, 2001–2008. American Journal of Public
Health, 104(S1), S43–S48.
9. Frost et al., 2008.
10. Conclusions about trends in contraceptives use are based on reported
results from: Abma, J.C., Chandra, A., Mosher, W.D., Peterson, L.S., & Piccinino,
L.J. (1997). Fertility, family planning, and women’s health: New data from the
1995 National Survey of Family Growth. Vital and Health Statistics, 23(19),
1-114; Chandra, A., Martinez, G.M., Mosher, W.D., Abma, J.C., & Jones, J. (2005).
Fertility, family planning, and reproductive health of U.S. women: Data from
the 2002 National Survey of Family Growth. Vital and Health Statistics, 23(25),
1–160; Jones, J., Mosher, W.D., & Daniels, K. (2012). Current contraceptive use
in the United States, 2006–2010, and changes in pattern of use since 1995.
National Health Statistics Reports, 60, 1–26; Mosher, W.D., & Bachrach, C.A.
(1986). Contraceptive use: United States, 1982. Vital and Health Statistics,
23(12), 1–52; Mosher, W.D., & Pratt, W.F. (1990). Contraceptive use in the
United States, 1973–88. Advance Data from Vital Health and Statistics, 182,
1–12; Mosher, W.D., & Jones, J. (2010). Use of contraception in the United
States: 1982–2008. Vital and Health Statistics, 23(29), 1–44. Women who were
pregnant, seeking to become pregnant or reported being noncontraceptively
sterile were excluded from the tabulations.
11. Conclusions about trends in unplanned pregnancy and abortion are based on
results reported in Zolna & Lindberg, 2012; Finer & Zolna, 2014; Chandra et al.,
2005; Boonstra, H.D., Gold, R.B., Richards, C.L., & Finer, L.B. (2006). Abortion
in women’s lives. New York, NY: Guttmacher Institute. Retrieved from http://
www.guttmacher.org/pubs/2006/05/04/AiWL.pdf; Finer, L.B., & Henshaw,
S.K. (2006). Disparities in rates of unintended pregnancy in the United States,
1994 and 2001. Perspectives on Sexual and Reproductive Health, 38(2), 90–96;
Finer, L.B., & Zolna, M.R. (2011). Unintended pregnancy in the United States:
Incidence and disparities, 2006. Contraception, 84(5), 478–485; Henshaw,
S.K., & Kost, K. (2008). Trends in the characteristics of women obtaining
abortions, 1974 to 2004. New York, NY: Guttmacher Institute. Retrieved from
http://www.guttmacher.org/pubs/2008/09/23/TrendsWomenAbortions-
wTables.pdf; Jones, R.K., Kost, K., Singh, S., Henshaw, S.K., & Finer, L.B. (2009).
Trends in abortion in the United States. Clinical Obstetrics and Gynecology,
52(2), 119–129.; Jones, R.K., & Kavanaugh, M.L. (2011). Changes in abortion
rates between 2000 and 2008 and lifetime incidence of abortion. Obstetrics
and Gynecology, 117(6), 1358–1366; Martin, J.A., Hamilton, B.E., Ventura, A.J.,
Osterman, M.J.K., & Matthews, T.J. (2013). Births: Final data for 2011. National
Vital Statistics Reports, 62(1), 1–70; Mosher, W.D., Jones, J., & Abma, J.C. (2012).
Intended and unintended births in the United States: 1982–2010. National
Health Statistics Reports, 55, 1–28.; Ventura, S.J., & Bachrach, C.A. (2000).
Nonmarital childbearing in the United States, 1940–99. National Vital Statistics
Reports, 48(16), 1–39; Williams, L.B., & Pratt, W.F. (1990). Wanted and unwanted
childbearing in the United States: 1973-88. Advance Data from Vital Health and
Statistics, 189, 1–8. Trends for unplanned pregnancy among unmarried women
are not reported consistently over this period; therefore the sum of the abortion
rate for unmarried women and the rate of births resulting from an unplanned
pregnancy among unmarried women is used as a proxy.
12. We note that this increase in unplanned pregnancies led to an increase
in unplanned births rather than an increase in abortions, as women
became more likely to carry their unplanned pregnancies to term rather
than terminate them. In fact, the abortion rate to unmarried women fell
between 2002 and 2008. Even so, this increase in unplanned pregnancy
is not inconsequential. Had unplanned pregnancy been falling during this
period instead of rising, it is likely that the decline in abortion would have
been even greater. Furthermore, births following unplanned pregnancies are
themselves linked to a variety of other hardships for families, as summarized
elsewhere in this volume.
13. Singh, S., Sedgh, G., & Hussain, R. (2010). Unintended pregnancy:
Worldwide levels, trends, and outcomes. Studies in Family Planning,
41(4), 241–250.
Unplanned Pregnancy, Abortion, and the
Benets of Birth Control in America
Getting the Facts Straight • 13
14. Sedgh, G., Singh, S., Shah, I.H., Åhman, E., Henshaw, S.K., & Bankole, A.
(2012). Induced abortion: Incidence and trends worldwide from 1995 to
2008. The Lancet, 379(9816), 625–632.
15. Frost et al., 2008; Jones, R.K., Darroch, J.E., & Henshaw, S.K. (2002).
Contraceptive use among U.S. women having abortions in 2000–2001.
Perspectives on Sexual and Reproductive Health, 34(6), 294–303.
16. Homco, J.B., Peipert, J.F., Secura, G.M., Lewis, V.A., & Allsworth, J.E. (2009).
Reasons for ineective pre-pregnancy contraception use in patients seeking
abortion services. Contraception, 80(6), 569–574. We note that while cost and
access may not be prevalent reasons for using no contraception whatsoever
(given that condoms are low cost and methods such as withdrawal and natural
family planning are essentially free), consistent use of highly eective (i.e.
hormonal) methods requires access to a physician, follow-up visits in some
cases, regular trips to the pharmacy in many cases and co-pays of varying
amounts. Therefore, it is not surprising that results from the CHOICE project
strongly point to cost and access as barriers to consistent and eective use of
contraception for many women, and suggest that eliminating these barriers can
significantly reduce both unplanned pregnancy and abortion.
17. Zieman, M., & Hatcher, R.A. (2012). Managing Contraception. Tiger, GA:
Bridging the Gap Foundation.
18. Peipert, J.F., Madden, T., Allsworth, J.E., & Secura, G.M. (2012). Preventing
unintended pregnancies by providing no-cost contraception. Obstetrics and
Gynecology, 120(6), 1291–1297. Comparison to national rates is based on 2008
(the most recent year available for national data at the time of the study).
19. LARCs include IUDs (intra-uterine device) such as Mirena and Paragard
as well as implants such as Implanon and Nexplanon. Winner, B., Peipert,
J.F., Zhao, Q., Buckel, C., Madden, T., Allsworth, J.E., & Secura, G.M. (2012).
Eectiveness of long-acting reversible contraception. New England Journal
of Medicine, 366, 1998–2007.
20. Hirsch, H., Turner, R., Philliber, A., Philliber, S., & Biggs, M.A. (2013).
Increasing LARC use in an eort to reduce unintended pregnancies: A look at
the Iowa initiative to reduce unintended pregnancies. Paper presented at the
141st APHA Annual Meeting and Exposition, Boston, MA.
21. Rose, S.B., & Lawton, B.A. (2012). Impact of long-acting reversible
contraception on return for repeat abortion. American Journal of Obstetrics
and Gynecology, 206(1), 37 e31–36.
22. Jones & Kavanaugh, 2011.
23. Peipert et al., 2012.
24. Note that this 11% shift of young unmarried women equates to a 25%
reduction in the proportion of these women who are using no female
contraception. Karpilow, Q., Manlove, J., Sawhill, I., & Thomas, A. (2013). The
role of contraception in preventing abortion, nonmarital childbearing, and
child poverty. Paper presented at the Association for Public Policy Analysis
and Management Fall Research Conference, Washington, DC. Retrieved
from http://www.appam.org/assets/1/7/The_Role_Of_Contraception_In_
Preventing_Abortion_Nonmarital_Childbearing_And_Child_Poverty.pdf.
25. Finer, L.B., Jerman, J., & Kavanaugh, M.L. (2012). Changes in use of long-
acting contraceptive methods in the United States, 2007–2009. Fertility and
Sterility, 98(4), 893–897.
26. Jones, R.K., & Jerman, J. (2014). Abortion incidence and service
availability in the United States, 2011. Perspectives on Sexual and
Reproductive Health, 46(1), 3–14.
27. Kaye, K., Gootman, J.A., Ng, A.S., & Finley, C. (2014). Summary. In The
benefits of birth control in America: Getting the facts straight. Washington,
DC: The National Campaign to Prevent Teen and Unplanned Pregnancy;
Sonfield, A., Hasstedt, K., Kavanaugh, M.L., & Anderson, R. (2013). The
social and economic benefits of women’s ability to determine whether and
when to have children. New York, NY: Guttmacher Institute. Retrieved from
http://www.guttmacher.org/pubs/social-economic-benefits.pdf; Logan, C.,
Holcome, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended
childbearing. Washington, DC: Child Trends.
Unplanned Pregnancy, Abortion, and the
Benets of Birth Control in America
Getting the Facts Straight • 15
3
Pregnancy planning in general, and the use of birth
control in particular, are directly linked to a wide array
of benefits to women, men, children, and society,
including fewer unplanned pregnancies and abortions,
more educational and economic opportunities for
young women, improved maternal and infant health,
greater family wellbeing, and reduced public spending.
Given that the large majority of both men and
women are sexually active (for example, more than
three-quarters of young adults age 18 to 24 have had
sex in the past 12 months
1
), birth control is central
to realizing these benefits. In fact, the Centers for
Disease Control and Prevention (CDC) recognizes
the development of modern contraception as one
of the 10 greatest public health achievements of the
20
th
century.
2
Nonetheless, the United States has long
reported high levels of unplanned pregnancy
a
and
very uneven use of contraception. For example,
even though most unmarried women in their 20s
say they don’t want to get pregnant and despite
the availability of many forms of birth control—
including some that are highly eective—only half of
those who are sexually active report using reliable
contraception consistently.
3
Unplanned pregnancy is
nearly 100 percent preventable, yet…
•
Roughly half of all pregnancies in the United States
are reported by women to be unplanned—that is, a
pregnancy that a woman herself said she was not
intending or actively trying to achieve.
4
•
Among unmarried young women age 20 to 29, the
percentage of pregnancies that they report as being
unplanned is nearly 70%. This totaled roughly 1.3
million unplanned pregnancies in 2008 alone, and
unplanned pregnancy among young adults has been
trending up for the past few years, not down.
•
Nearly half (44%) of unplanned pregnancies among
unmarried young women result in an abortion,
leading to nearly 600,000 abortions each year.
•
In addition, unplanned pregnancy is responsible
for more than half of all births to unmarried
women in their twenties, or more than 500,000
births each year
.5
•
Women using birth control carefully and consistently
account for only 5% of all unplanned pregnancies.
6
Planning for a Healthy Pregnancy
Extensive evidence shows that maternal and infant health are greatly improved
through adequate birth spacing, timely and high quality preconception and
prenatal care, and avoiding known health risks like smoking. For example:
•
Very short intervals between pregnancies raise the risk of preterm birth,
low birthweight, slow neonatal growth, and infant death.
7
In fact, the risk of
infant mortality is 67% higher for births occurring less than 12 months after
a previous birth, compared to births spaced at least 18 months apart, even
after controlling for other infant risk factors.
8
•
Prenatal and preconception care can help identify maternal health risks
early on, improve the mother’s nutritional status, and encourage other
healthy behavior (such as quitting smoking).
9
The benefits of prenatal care,
in particular, have been studied extensively, and although the results vary
by study, the weight of evidence indicates that prenatal care can improve
maternal and infant health.
10
One recent study found that receiving prenatal
care significantly cut the risk of premature birth, still birth, neonatal death,
and infant death, net of other factors.
11
•
Conversely, certain risky behaviors during pregnancy—behaviors that
are a major focus of both preconception and prenatal care—reduce the
odds of a healthy birth. For example, smoking during pregnancy is widely
linked to preterm birth, infant death, and birth defects such as missing/
deformed limbs and gastrointestinal disorders.
12
Smoking is also linked to
complications during pregnancy that can be dangerous for both the fetus
and the woman, including ectopic pregnancy, vaginal bleeding, placental
abruption, and placenta previa.
Women having a birth following an unplanned pregnancy are less likely to have
benefitted from preconception care, to have optimal spacing between births,
and to have been aware of their pregnancy early on, which in turn makes it less
likely that they will have engaged in healthy prenatal behavior and/or enrolled
in prenatal care early in pregnancy.
Maternal and Infant Health and the
Benets of Birth Control in America
Roughly half of all
pregnancies in the
US are reported by
women themselves
as unplanned.
16 • The Benefits of Birth Control in America
Because women having a planned
pregnancy tend to fair better on all
the dimensions mentioned above
(and others as well), and because
contraception helps women plan their
pregnancies, it clearly plays a significant
role in supporting maternal and infant
health. To be sure, the evidence is
imperfect—we do not have randomized
trials of women with and without access
to contraception or even recent examples
of large comparison groups who have
little or no access, especially here in the
United States. Even so, the weight of the
evidence across numerous studies—even
studies netting out the influence of other
characteristics—is that both women and
infants fare significantly better when
women are able to plan and control
when they become pregnant.
Put another way, women who have an
unplanned pregnancy are less likely,
and in many cases less able, to do the
things that best support their health
and that of their baby. They are also less
likely to enjoy the types of supportive
environments and relationships that
promote healthy families.
13
Preconception and
Prenatal Care
Women who chose to become pregnant
are, by definition, better positioned to take
advantage of preconception care and also
are more likely to start prenatal care early
in pregnancy. This is especially true during
the first trimester, because they are aware
of their pregnancy earlier.
14
We know that:
•
According to the CDC, only 8% of
women lacked prenatal care during
their first trimester if their pregnancy
was planned. This more than doubles
among women whose pregnancy
was unplanned (19%) and rises to 21%
among women whose pregnancy
was unwanted (as opposed to
mistimed pregnancies or unplanned
pregnancy overall).
15
•
A recent review summarizing more than
two decades of research concludes that
pregnancy intentions play a significant
role in whether women get prenatal
care, especially early in their pregnancy,
even after controlling for demographic
and background characteristics—that is,
receipt of prenatal care is likely a direct
function of whether the pregnancy
was planned or unplanned rather than
simply due to other disadvantages that
tend to be correlated with planning
status. Results were most striking
among women whose pregnancy
was unwanted.
16
•
In fact, one recent study found that
women with unwanted pregnancies
are twice as likely to underutilize
prenatal care compared to women
whose pregnancies were planned,
even net of other factors.
17
•
Other studies suggest that intentions
among both parents matter, with
prenatal care less likely if either the
mother or the father reported the
pregnancy was unplanned, compared
to pregnancies they both reported
were planned.
18
Maternal Behavior
Preconception and prenatal care typically
include a focus on the value of a healthy
lifestyle leading into and during pregnancy.
Given that women whose pregnancies
are unplanned are less likely to receive
these services, and given that they are
less likely to know that they are pregnant
early on, it is not surprising that they are
also less likely to be in optimal health in
the months prior to and during pregnancy.
For example, the CDC reports that prior to
pregnancy (generally in the three months
leading up to pregnancy), women whose
pregnancies are unplanned are:
19
•
Less likely to be physically active and
more likely to be either underweight
or obese,
•
Less likely to take daily vitamins and
more likely to be anemic, and
•
More likely to smoke, consume
alcohol, binge drink, and experience
high levels of stress.
Maternal and Infant Health and the
Benets of Birth Control in America
Unplanned pregnancy is associated with significantly higher
rates of preterm birth and low birthweight and subsequent
serious health problems.
Women who have an unplanned
pregnancy are twice as likely to
lack prenatal care as those with
a planned pregnancy.
Women are about one and a
half times more likely to smoke
during pregnancy if their
pregnancy was unplanned.
Getting the Facts Straight • 17
Many of these dierences, including higher risks of anemia,
smoking, and alcohol consumption, are significant even after
controlling for other factors.
20
Women whose pregnancies are unplanned are also more likely
to do things during pregnancy—such as smoking—that may
compromise their health and the health of their child:
•
The CDC reports that, among women reporting that
their pregnancies were unplanned, 16% smoked during
pregnancy, compared to 10% of women whose pregnancies
were planned.
21
The CDC also finds that women who
smoked before pregnancy, who continued to smoke during
pregnancy, or who relapsed during pregnancy if they had
quit, were disproportionately more likely to report that their
pregnancies were unplanned.
22
•
Other studies report higher exposure to alcohol, illicit drugs,
and secondhand smoke during pregnancy among women
whose pregnancies were unplanned.
23
•
One recent study further suggests that the increased risk of
adverse behavior associated with unplanned pregnancy is
particularly great in the period before the pregnancy is known.
24
•
Although the evidence is somewhat varied as to whether
this higher risk is a direct function of pregnancy intentions
or of other characteristics such as socioeconomic status,
the balance of the literature and the most recent studies
suggest that pregnancy intentions significantly and directly
aect risk, even net of these factors.
Maternal behavior following delivery continues to be more
positive among women whose pregnancies were planned,
particularly in terms of breastfeeding:
•
According to the latest data from the CDC, 74% of babies born
following planned pregnancies were breastfed, compared to
61% of births following unplanned pregnancies overall and only
56% of births following unwanted pregnancies.
25
•
Numerous studies find that such dierences persist even after
controlling for both observable and unobservable dierences in
background and demographic characteristics of the mothers.
26
•
One study found that women whose pregnancies were
unwanted were both less likely to begin breastfeeding and,
if they did, more likely to discontinue within a short period
of time.
27
Birth Spacing
Preventing unplanned pregnancy and better timing of pregnancy
can contribute to maternal and infant health not only by supporting
healthier maternal behavior, but also by increasing intervals
between births. Pregnancies spaced closer than 18 months apart
are considered to be risky, and one goal of Healthy People 2020—
the Federal Government’s 10 year national objectives for improving
the health of Americans—is reducing the percentage of these
pregnancies that are too closely spaced from 33% to 30%.
28
While there is extensive research on the benefits of adequate
pregnancy spacing, research is limited regarding what factors
promote or hinder pregnancy spacing. Even so, it stands to
reason that being able to plan pregnancy can help promote
adequate pregnancy spacing, and one recent study found
strong evidence to this eect:
29
•
The study found, not surprisingly, that unplanned
pregnancy accounted for more than half (55%) of all
births occurring within 18 months or less of a prior birth.
•
A birth was significantly more likely to fall within 18 months
or less of a previous birth if it resulted from an unplanned
pregnancy, even after netting out the influence of mothers’
other characteristics.
•
In fact, compared to a birth resulting from a planned
pregnancy, the odds of short birth interval were nearly
five times greater for births resulting from mistimed
pregnancies and roughly two times greater for births
following unwanted pregnancies, net of other factors.
Given that contraception can help women plan their pregnancies,
it is not surprising that another recent study found a strong link
between using eective birth control methods and healthier
spacing of pregnancies. Specifically, the odds of achieving optimal
birth spacing were nearly four times greater among women
using the most eective methods (either the IUD or the implant)
after their most recent birth and nearly two times greater among
women using other hormonal methods, compared to women
using barrier methods such as the condom, net of other factors.
30
Maternal and Infant Health and the
Benets of Birth Control in America
Maternal and child health are greatly improved
through adequate birth spacing and good
preconception and prenatal care.
Optimal birth spacing is nearly four times greater
among women using the most eective contraception.
18 • The Benefits of Birth Control in America
Infant Health
Each year, 12% of infants are born preterm and 8% of infants are
born with low birthweight.
31
Although the preterm birth rate has
declined steadily since 2006, it still remains higher than in 1990.
In addition to increasing the infant’s risk of death in its first few
days of life, infants born preterm and/or with low birthweight
are at risk of serious health problems—primary among these
are visual and hearing impairments, developmental delays,
and behavioral and emotional problems that range from mild
to severe.
32
And while infant mortality remains a relatively rare
event, it is nonetheless nearly twice as prevalent in the United
States as compared to Western Europe.
33
Unplanned pregnancy overall is associated with significantly
higher rates of preterm birth and low birthweight,
34
and the risk
of low birthweight is particularly great following an unwanted
pregnancy.
35
In fact, babies were two-thirds more likely to
be born with low birthweight if they followed an unwanted
pregnancy as compared to a planned pregnancy.
There is some evidence that the risk of preterm birth and low
birthweight is higher following an unplanned pregnancy even
after controlling for background and demographic characteristics,
though this varies depending on the sample of women observed,
the measure of pregnancy intention, and the statistical methods
used. One recent meta-analysis of available studies concluded
that unplanned pregnancy is associated with greater risk of low
birthweight and preterm birth net of other risk factors, while
another recent review summarized the results as “inconclusive.”
36
However, some of these studies controlled for the very reasons
why pregnancy intention may matter, such as receipt of prenatal
care. What remains clear is that unwanted pregnancy, and to some
extent all unplanned pregnancy, is a strong risk factor for preterm
birth and low birthweight, in part because they are significantly
linked to maternal behaviors that contribute to these outcomes.
Mother’s Health
Women’s health, including maternal health, matters in its own
right, quite apart from the health of infants. Pregnancy—all
pregnancy—has health implications for women. Fully one-
third of pregnant women in the United States experience
complications during delivery, ranging from depression to
cesarean delivery.
37
Even excluding the incidence of cesarean
delivery, one in four deliveries is associated with serious health
concerns including laceration, infection, hemorrhage, gestational
diabetes, and preeclampsia. Obviously, contraception can
help those women not seeking pregnancy to avoid these risks.
What’s more, the risk of many adverse health outcomes is even
greater for women whose pregnancy is unplanned. For example:
•
The CDC reports that postpartum depression is nearly twice
as high among women whose pregnancy was unplanned
(21% compared to 12%).
38
•
The link between pregnancy intention and maternal mental
health has been widely studied. The majority of studies
and literature reviews conclude that unplanned pregnancy
significantly elevates the risk of postpartum depression or
other mental health problems, even net of other factors.
39
•
Another study found that women whose pregnancies were
unplanned were significantly more likely to be hospitalized
during pregnancy for conditions including kidney infections,
vaginal bleeding, high blood pressure, premature labor, and
premature rupture of membranes.
40
•
This same study found that most dierences were greatly
diminished after controlling for other factors such as getting
prenatal care and risky behavior such as smoking, suggesting
that it may be the link between pregnancy planning and
prenatal behavior rather than pregnancy planning itself that
has the greatest impact on maternal health.
What It All Means
Bottom line: The capacity to plan and space pregnancies—which
is typically achieved through the use of birth control—has
significant and meaningful benefits for women, children, families,
taxpayers, and more.
41
Pregnancy planning increases the overall
educational status of women and communities; it advances the
health and wellbeing of children and families; it saves money; and
it reduces abortion. As such, birth control deserves widespread
support, expressed in a number of ways including minimal cost
and access barriers, a prominent place in public health priorities
and health care services, and broad political support.
Women who have an unplanned pregnancy
are less likely, and often less able, to do the
things that best support their health and the
health of their baby.
Postpartum depression is nearly twice as high
among women whose pregnancy was unplanned
as those with a planned pregnancy.
Maternal and Infant Health and the
Benets of Birth Control in America
Getting the Facts Straight • 19
But it is also true that for the most disadvantaged women and
communities, the widespread use of birth control alone is not a
panacea. For these women and communities, realizing the full
benefit of pregnancy planning, spacing, and prevention also
requires additional eorts to promote educational attainment,
better schools, stronger families, economic opportunities,
job readiness, and more. Put another way, birth control alone
cannot solve crushing poverty, but it can open the door to
increased opportunity.
Notes
a
Unplanned pregnancy (also known as unintended pregnancy) refers to
a pregnancy that a woman herself reported was not intended at the time
of conception. Unplanned pregnancy includes both mistimed pregnancies
(that is, the woman reported she did not want to become pregnant at the
time the pregnancy occurred but did want to become pregnant at some
point in the future) as well as unwanted pregnancies (that is, the woman
reported at time of conception that she did not want to become pregnant
then or at any time in the future). Many studies summarized here report the
eects of unplanned pregnancy overall, while some focus specifically on
either unwanted or mistimed pregnancies, as noted previously
Sources
1. Chandra, A., Mosher, W.D., Copen, C., & Sionean, C. (2011). Sexual behavior,
sexual attraction, and sexual identity in the United States: Data from the
2006–2008 National Survey of Family Growth. National Health Statistics
Reports, 36, 1-36.
2. Ten great public health achievements—United States, 1900-1999. (1999).
MMWR: Morbidity and Mortality Weekly Report, 48(12), 241–243.
3. Kaye, K., Suellentrop, K., & Sloup, C. (2009). The Fog Zone: How
misperceptions, magical thinking, and ambivalence put young adults at
risk for unplanned pregnancy. Washington, DC: The National Campaign to
Prevent Teen and Unplanned Pregnancy.
4. The National Campaign to Prevent Teen and Unplanned Pregnancy.
(2012). Briefly: Unplanned pregnancy among unmarried young women.
Washington, DC: Author. Retrieved from http://thenationalcampaign.org/
resource/briefly-unplanned-pregnancy-among-unmarried-
young-women.
5. Author tabulations based on data in Zolna, M., & Lindberg, L. (2012).
Unintended pregnancy: Incidence and outcomes among young adult
unmarried women in the United States, 2001 and 2008. New York, NY:
Guttmacher Institute. Retrieved from http://www.guttmacher.org/pubs/
unintended-pregnancy-US-2001-2008.pdf.
6. Frost, J.J., Darroch, J.E., & Remez, L. (2008). Improving contraceptive use
in the United States. In Brief, 2008(1), 1–8. Retrieved from the Guttmacher
Institute website http://www.guttmacher.org/pubs/2008/05/09/
ImprovingContraceptiveUse.pdf.
7. Gemmill, A., & Lindberg, L.D. (2013). Short interpregnancy intervals in the
United States. Obstetrics and Gynecology, 122(1), 64–71; Conde-Agudelo, A.,
Rosas-Bermudez, A., & Kafury-Goeta, A.C. (2006). Birth spacing and risk of
adverse perinatal outcomes: A meta-analysis. JAMA, 295(15), 1809–1823.
8. Hussaini, K.S., Ritenour, D., & Coonrod, D.V. (2013). Interpregnancy
intervals and the risk for infant mortality: A case control study of Arizona
infants 2003–2007. Maternal and Child Health Journal, 17(4), 646–653.
9. Johnson, K., Posner, S.F., Biermann, J., Cordero, J.F., Atrash, H.K., Parker,
C.S., . . . Curtis, M.G. (2006). Recommendations to improve preconception
health and health care —United States. A report of the CDC/ATSDR
Preconception Care Work Group and the Select Panel on Preconception
Care. MMWR: Recommendations and Reports, 55(RR-6), 1–23.
10. Alexander, G.R., & Kotelchuck, M. (2001). Assessing the role and
eectiveness of prenatal care: History, challenges, and directions for future
research. Public Health Reports, 116(4), 306–316; Vintzileos, A.M., Ananth,
C.V., Smulian, J.C., Scorza, W.E., & Knuppel, R.A. (2002). The impact of
prenatal care in the United States on preterm births in the presence and
absence of antenatal high-risk conditions. American Journal of Obstetrics
and Gynecology, 187(5), 1254–1257; Herbst, M.A., Mercer, B.M., Beazley, D.,
Meyer, N., & Carr, T. (2003). Relationship of prenatal care and perinatal
morbidity in low-birth-weight infants. American Journal of Obstetrics and
Gynecology, 189(4), 930–933; Coley, S.L., & Aronson, R.E. (2013). Exploring
birth outcome disparities and the impact of prenatal care utilization among
North Carolina teen mothers. Women’s Health Issues, 23(5), e287–294;
Hueston, W.J., Gilbert, G.E., Davis, L., & Sturgill, V. (2003). Delayed prenatal
care and the risk of low birthweight delivery. Journal of Community Health,
28(3), 199–208; Laditka, S.B., Laditka, J.N., Mastanduno, M.P., Lauria, M.R.,
& Foster, T.C. (2005). Potentially avoidable maternity complications: An
indicator of access to prenatal and primary care during pregnancy. Women
and Health, 41(3), 1–26; Partridge, S., Balayla, J., Holcroft, C.A., & Abenhaim,
H.A. (2012). Inadequate prenatal care utilization and risks of infant mortality
and poor birth outcome: A retrospective analysis of 28,729,765 U.S.
deliveries over 8 years. American Journal of Perinatology, 29(10), 787–793;
El-Mohandes, A., Herman, A.A., Nabil El-Khorazaty, M., Katta, P.S., White, D.,
& Grylack, L. (2003). Prenatal care reduces the impact of illicit drug use on
perinatal outcomes. Journal of Perinatology, 23(5), 354–360.
11. Partridge et al., 2012.
12. Hackshaw, A., Rodeck, C., & Boniface, S. (2011). Maternal smoking
in pregnancy and birth defects: A systematic review based on 173,687
malformed cases and 11.7 million controls. Human Reproduction Update,
17(5), 589–604; March of Dimes. (2013). Smoking during pregnancy.
Retrieved from http://www.marchofdimes.com/pregnancy/print/smoking-
during-pregnancy.html.
13. Kaye, K., Gootman, J.A., Ng, A.S., & Finley, C. (2014). Family formation,
family wellbeing, and the benefits of birth control in America. In The
benefits of birth control in America: Getting the facts straight. Washington,
DC: The National Campaign to Prevent Teen and Unplanned Pregnancy.
Maternal and Infant Health and the
Benets of Birth Control in America
20 • The Benefits of Birth Control in America
14. Kost, K., Landry, D.J., & Darroch, J.E. (1998). Predicting maternal
behaviors during pregnancy: Does intention status matter? Family Planning
Perspectives, 30(2), 79–88.
15. Mosher, W.D., Jones, J., & Abma, J.C. (2012). Intended and unintended
births in the United States: 1982-2010. National Health Statistics Reports,
55, 1–28.
16. Gipson, J.D., Koenig, M.A., & Hindin, M.J. (2008). The eects of
unintended pregnancy on infant, child, and parental health: A review of the
literature. Studies in Family Planning, 39(1), 18–38.
17. Humbert, L., Saywell, R.M., Jr., Zollinger, T.W., Priest, C.F., Reger, M.K., &
Kochhar, K. (2011). The eect of pregnancy intention on important maternal
behaviors and satisfaction with care in a socially and economically at-risk
population. Maternal and Child Health Journal, 15(7), 1055–1066.
18. Korenman, S., Kaestner, R., & Joyce, T. (2002). Consequences for infants
of parental disagreement in pregnancy intention. Perspectives on Sexual
and Reproductive Health, 34(4), 198–205; Martin, L.T., McNamara, M.J., Milot,
A.S., Halle, T., & Hair, E.C. (2007). The eects of father involvement during
pregnancy on receipt of prenatal care and maternal smoking. Maternal and
Child Health Journal, 11(6), 595–602.
19. D’Angelo, D., Williams, L., Morrow, B., Cox, S., Harris, N., Harrison, L.,
. . . Zapata, L. (2007). Preconception and interconception health status
of women who recently gave birth to a live-born infant—Pregnancy Risk
Assessment Monitoring System (PRAMS), United States, 26 reporting areas,
2004. MMWR: Surveillance Summaries, 56(10), 1–35.
20. Preconception health indicators among women—Texas, 2002–2010.
(2012). MMWR: Morbidity and Mortality Weekly Report, 61(29), 550–555.
21. Mosher et al., 2012.
22. Tong, V.T., Jones, J.R., Dietz, P.M., D’Angelo, D., & Bombard, J.M. (2009).
Trends in smoking before, during, and after pregnancy—Pregnancy Risk
Assessment Monitoring System (PRAMS), United States, 31 sites, 2000–
2005. MMWR: Surveillance Summaries, 58(4), 1–29.
23. Kost et al., 1998; Gipson et al., 2008; Humbert et al., 2011; Korenman
et al., 2002; Joyce, T.J., Kaestner, R., & Korenman, S. (2000). The eect of
pregnancy intention on child development. Demography, 37(1), 83–94; Dott,
M., Rasmussen, S.A., Hogue, C.J., & Reefhuis, J. (2010). Association between
pregnancy intention and reproductive-health related behaviors before and
after pregnancy recognition, National Birth Defects Prevention Study, 1997–
2002. Maternal and Child Health Journal, 14(3), 373–381; Altfeld, S., Handler,
A., Burton, D., & Berman, L. (1997). Wantedness of pregnancy and prenatal
health behaviors. Women and Health, 26(4), 29–43; Hellerstedt, W.L., Pirie,
P.L., Lando, H.A., Curry, S.J., McBride, C.M., Grothaus, L.C., & Nelson, J.C.
(1998). Dierences in preconceptional and prenatal behaviors in women
with intended and unintended pregnancies. American Journal of Public
Health, 88(4), 663–666; Than, L.C., Honein, M.A., Watkins, M.L., Yoon, P.W.,
Daniel, K.L., & Correa, A. (2005). Intent to become pregnant as a predictor
of exposures during pregnancy: Is there a relation? Journal of Reproductive
Medicine, 50(6), 389–396.
24. Dott et al., 2010.
25. Mosher et al., 2012.
26. Gipson et al., 2008; Humbert et al., 2011; Korenman et al., 2002; Joyce
et al., 2000; Dye, T.D., Wojtowycz, M.A., Aubry, R.H., Quade, J., & Kilburn,
H. (1997). Unintended pregnancy and breast-feeding behavior. American
Journal of Public Health, 87(10), 1709–1711; Taylor, J.S., & Cabral, H.J. (2002).
Are women with an unintended pregnancy less likely to breastfeed? Journal
of Family Practice, 51(5), 431–436.
27. Taylor & Cabral, 2002.
28. U.S. Department of Health and Human Services. (2010). Healthy People
2020: Topics and objectives: Family planning. Washington, DC: Author.
Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/
objectiveslist.aspx?topicId=13.
29. Gemmill & Lindberg, 2013.
30. Thiel de Bocanegra, H., Chang, R., Howell, M., & Darney, P. (2014).
Interpregnancy intervals: Impact of postpartum contraceptive eectiveness
and coverage. American Journal of Obstetrics and Gynecology, 210(4), 311.
e311–311.e318.
31. Hamilton, B.E., Martin, J.A., & Ventura, S.J. (2013). Births: Preliminary data
for 2012. National Vital Statistics Reports, 62(3), 1–20.
32. National Academy of Sciences. (2007). Preterm birth: Causes,
consequences, and prevention. Behrman, R. E. & Butler, A. S. (Eds.).
Retrieved from http://www.iom.edu/Reports/2006/Preterm-Birth-Causes-
Consequences-and-Prevention.aspx.
33. Population Reference Bureau. (2013). 2013 World population data sheet.
Washington, DC: Author. Retrieved from http://www.prb.org/pdf13/2013-
population-data-sheet_eng.pdf.
34. D’Angelo et al., 2007.
35. Mosher et al., 2012.
36. Gipson et al., 2008; Joyce et al., 2000; Sable, M.R., & Wilkinson, D.S.
(2000). Impact of perceived stress, major life events and pregnancy attitudes
on low birthweight. Family Planning Perspectives, 32(6), 288–294; Tsui, A.O.,
McDonald-Mosley, R., & Burke, A.E. (2010). Family planning and the burden of
unintended pregnancies. Epidemiologic Reviews, 32(1), 152–174; Afable-Munsuz,
A., & Braveman, P. (2008). Pregnancy intention and preterm birth: Dierential
associations among a diverse population of women. Perspectives on Sexual
and Reproductive Health, 40(2), 66–73; Mohllajee, A.P., Curtis, K.M., Morrow,
B., & Marchbanks, P.A. (2007). Pregnancy intention and its relationship to birth
and maternal outcomes. Obstetrics and Gynecology, 109(3), 678–686; Shah,
P.S., Balkhair, T., Ohlsson, A., Beyene, J., Scott, F., & Frick, C. (2011). Intention to
become pregnant and low birthweight and preterm birth: A systematic review.
Maternal and Child Health Journal, 15(2), 205–216; Orr, S.T., Miller, C.A., James,
S.A., & Babones, S. (2000). Unintended pregnancy and preterm birth. Paediatric
and Perinatal Epidemiology, 14(4), 309–313; Keeton, K., & Hayward, R.A. (2007).
Pregnancy intention and birth outcomes: Does the relationship dier by age or
race? Journal of Women’s Health, 16(4), 510–516.
Maternal and Infant Health and the
Benets of Birth Control in America
Getting the Facts Straight • 21
37. Speidel, J.J., Rocca, C.H., Thompson, K.M., & Harper, C.C. (2013).
Pregnancy: Not a disease but still a health risk. Contraception, 88(4),
481–484.
38. D’Angelo et al., 2007.
39. Gipson et al., 2008; Abbasi, S., Chuang, C.H., Dagher, R., Zhu, J., &
Kjerul, K. (2013). Unintended pregnancy and postpartum depression
among first-time mothers. Journal of Women’s Health, 22(5), 412–416;
Leathers, S.J., & Kelley, M.A. (2000). Unintended pregnancy and depressive
symptoms among first-time mothers and fathers. American Journal of
Orthopsychiatry, 70(4), 523–531; Mercier, R.J., Garrett, J., Thorp, J., &
Siega-Riz, A.M. (2013). Pregnancy intention and postpartum depression:
Secondary data analysis from a prospective cohort. BJOG: An International
Journal of Obstetrics and Gynaecology, 120(9), 1116–1122; Cheng, D., Schwarz,
E.B., Douglas, E., & Horon, I. (2009). Unintended pregnancy and associated
maternal preconception, prenatal and postpartum behaviors. Contraception,
79(3), 194–198; Barber, J.S., Axinn, W.G., & Thornton, A. (1999). Unwanted
childbearing, health, and mother-child relationships. Journal of Health
and Social Behavior, 40(3), 231–257; Messer, L.C., Dole, N., Kaufman, J.S., &
Savitz, D.A. (2005). Pregnancy intendedness, maternal psychosocial factors
and preterm birth. Maternal and Child Health Journal, 9(4), 403–412.
40. Mohllajee et al., 2007.
41. Kaye et al., 2014 Summary.; Sonfield, A., Hasstedt, K., Kavanaugh, M.L., &
Anderson, R. (2013). The social and economic benefits of women’s ability to
determine whether and when to have children. New York, NY: Guttmacher
Institute. Retrieved from http://www.guttmacher.org/pubs/social-economic-
benefits.pdf; Logan, C., Holcome, E., Manlove, J., & Ryan, S. (2007). The
consequences of unintended childbearing. Washington, DC: Child Trends.
Getting the Facts Straight • 23
4
Pregnancy planning in general, and the use of birth
control in particular, are directly linked to a wide array
of benefits to women, men, children, and society,
including fewer unplanned pregnancies and abortions,
more educational and economic opportunities for
young women, improved maternal and infant health,
greater family wellbeing, and reduced public spending.
Given that the large majority of both men and
women are sexually active (for example, more than
three-quarters of young adults age 18 to 24 have had
sex in the past 12 months
1
), birth control is central
to realizing these benefits. In fact, the Centers for
Disease Control and Prevention (CDC) recognizes
the development of modern contraception as one
of the 10 greatest public health achievements of the
20
th
century.
2
Nonetheless, the United States has long
reported high levels of unplanned pregnancy
a
and
very uneven use of contraception. For example,
even though most unmarried women in their 20s
say they don’t want to get pregnant and despite
the availability of many forms of birth control—
including some that are highly eective—only half of
those who are sexually active report using reliable
contraception consistently.
3
Unplanned pregnancy is
nearly 100 percent preventable, yet…
•
Roughly half of all pregnancies in the United States
are reported by women to be unplanned—that is, a
pregnancy that a woman herself said she was not
intending or actively trying to achieve.
4
•
Among unmarried young women age 20 to 29, the
percentage of pregnancies that they report as being
unplanned is nearly 70%. This totaled roughly 1.3
million unplanned pregnancies in 2008 alone, and
unplanned pregnancy among young adults has been
trending up for the past few years, not down.
•
Nearly half (44%) of unplanned pregnancies among
unmarried young women result in an abortion,
leading to nearly 600,000 abortions each year.
•
In addition, unplanned pregnancy is responsible
for more than half of all births to unmarried
women in their twenties, or more than 500,000
births each year
.5
•
Women using birth control carefully and consistently
account for only 5% of all unplanned pregnancies.
6
Trends in Family Formation
Overwhelming evidence shows that children and families do best when both
parents live together, and parents are more likely to live together if they are
married when their child is born. However, over time this is becoming less and
less the norm.
•
Since 1970, the median age at which people first marry has increased
steadily, from roughly 21 years of age to roughly 27.
7
•
Young adults are not delaying childbearing in similar fashion, and the
median age at which women have their first child is now a full year earlier
than the age at first marriage.
•
Consequently, the percentage of births among 20– to 29-year-olds that are to
unmarried parents has increased nearly seven-fold since 1970, from 7% to 48%.
8
•
Marital status at the time of birth translates into family stability over time.
Among parents who were married when their child was born, 87% remain
together five years later, compared to only 61% among parents who were
cohabiting,
9
while the vast majority of parents who were single (neither married
nor cohabiting) when their child was born never move in together.
10
These
dierences are significant even after controlling for other demographic factors.
Because modern contraception can help young adults better time their entry
into parenthood, it can also increase the odds that children are born into stable,
two-parent households, which is one hallmark of overall family wellbeing.
To be sure, the evidence is imperfect—we do not have randomized trials of
women with and without access to contraception, or even recent examples of
large comparison groups who have little or no access, especially here in the
United States. Even so, the weight of the evidence shows that the timing of and
circumstances surrounding entry into parenthood significantly improve family
wellbeing—both directly through the impact on parent-child relations as well as
indirectly through increasing the odds of residing in a two parent household.
Family Formation, Family Wellbeing, and
the Benets of Birth Control in America
Nearly half of unplanned
pregnancies among unmarried
women (age 20-29) result in
an abortion—nearly 600,000
abortions each year.
24 • The Benefits of Birth Control in America
Pregnancy Planning and
Family Formation
Nationally representative data suggest that the proportion of
births occurring to married parents (rather than to unmarried
parents) would increase if young adults were more successful
in aligning their entry into parenthood with their pregnancy
intentions. Consider that:
•
The vast majority (87%) of unmarried twenty-somethings say
they do not want to become parents right now,
11
and more
than half (53%) of births among unmarried twenty-somethings
are to women who said they were not seeking pregnancy.
•
These births include 24% to women who said they did not
want to get pregnant ever, and another 29% to women
who said they got pregnant earlier than they wished—three
years too early on average.
12
•
Not only are these mothers reporting that they did not want
a baby at that time (or, in some cases, ever), but many also
report that they did not want a baby with that partner. In
fact, of all unmarried women having a birth following an
unplanned pregnancy, more than 40% say they did not
want a baby with the father of their child.
13
•
Delaying parenthood by even a few years might increase
the odds that children would be born to married parents.
In fact, a young adult is 20% more likely to be married
when she has her first child compared to a peer three
years younger, even after adjusting for dierences in race,
ethnicity, and education.
14
While there are only a few nationally representative studies
examining the direct eect of pregnancy intention on
parental unions, they generally conclude that parents are
more likely to be together and stay together when births
follow planned pregnancies.
•
One recent study found that parents are more than twice
as likely to be married at the time of conception and only
one-quarter as likely to be single if the pregnancy is planned
rather than unplanned, net of other characteristics. In addition,
married couples are half as likely to split up over the next two
years—and cohabiting couples are more likely to get married—
if their child was born following a planned pregnancy.
15
•
Consequently, fully 83% of children born following a
planned pregnancy are living with two married parents at
age two, compared to only 46% of children born following
an unplanned pregnancy—again, after controlling for other
background characteristics.
•
Another study of cohabiting couples found that couples
experiencing an unplanned birth are nearly twice as likely to
split up as are couples experiencing a planned birth,
net of other characteristics.
16
Even when both parents are together (either married or
cohabiting), their relationship is not as strong if the
birth of their child followed an unplanned pregnancy.
17
•
Both mothers and fathers are significantly more likely to
report relationship conflict nine months following the birth
of their child if the pregnancy was unplanned rather than
planned. Mothers are 50% more likely to report conflict and
fathers are 24% more likely to report conflict, after controlling
for other characteristics.
•
Similarly, both mothers and fathers are significantly less
likely to report being happy in their relationship if the birth
followed an unplanned pregnancy, net of other factors. Both
mothers and fathers are also significantly more likely to
report depressive symptoms if the pregnancy was unplanned.
•
In addition to these nationally representative findings, several
smaller scale studies echo the conclusion that an unplanned
pregnancy can decrease relationship quality among parents.
18
Family Formation and
Family Wellbeing
To the extent that pregnancy intention has an impact on the
likelihood that children reside in two-parent households, and in
particular married parent households, there is extensive research
showing that this in turn translates into improved wellbeing for
children and families. Naturally, families can thrive or struggle
under a variety of circumstances; however, on average children
Family Formation, Family Wellbeing, and
the Benets of Birth Control in America
The percent of births to
unmarried women (age
20-29) has increased
nearly seven-fold since
1970, from 7% to 48%.
48%
On average, children born to married parents
are less likely to have health, cognitive,
emotional, and behavioral problems.
Getting the Facts Straight • 25
born to married parents are at lower risk
for many adverse outcomes.
Although to some extent this reflects
the fact that married parents are likely to
come from more advantaged backgrounds
compared to unmarried parents, extensive
literature shows that the benefits of
married parenthood persist even after
controlling for a broad set of demographic
and background characteristics, and that
children in lower-income families benefit
from having two married parents as well.
19
•
Children born to married parents are
significantly less likely to experience
health problems as infants and they
have fewer cognitive, emotional,
and behavioral problems when they
are young.
•
On average, they reach adulthood
with significantly more education,
subsequently earning more income
and spending less time both out of
school and out of work.
•
Cohabitation among parents does
not tend to serve as a substitute
for marriage, and their children still
experience more behavioral problems
and lower school engagement on
average compared to children whose
parents are married.
•
Furthermore, as their children age,
cohabiting parents are also more likely
to separate than married parents,
widening the gap in child wellbeing.
These findings are not surprising, given
that children born to married parents are
more likely to grow up with both parents
in the household, and having a second
parent in the household often means
greater financial resources, more time
available for parenting, as well as lower
levels of conflict between parents.
20
•
Numerous studies have documented
that married parents have more
disposable income and lower rates
of poverty compared to single and
nonresidential parents, due both to
higher earnings and lower expenses.
Furthermore, these benefits extend
to disadvantaged parents as well,
and persist even after controlling
for other observed and unobserved
dierences. Cohabiting parents,
while better o than single parents,
typically do not fare as well as
married parents.
•
Married parents are more likely to
be engaged with their children and
have more eective parenting skills
compared to single and cohabiting
parents, net of other factors—for
example, they tend to be more
emotionally supportive, have more
consistent rules, are less reliant
on harsh discipline, provide more
supervision, and have less conflict
with their children.
•
On average, children of married
parents also witness less conflict
between their parents, are exposed
to fewer changes in the composition
of their household, and experience
less geographic instability, all of
which in turn reduces their risk of
being exposed to domestic violence
and other harmful events and
environments.
Pregnancy planning also contributes
directly to family wellbeing—that is,
over and above its relationship to the
formation of two-parent families and the
gains in income and household stability
this brings. This is reflected primarily in
terms of increased emotional wellbeing
among parents, stronger parenting, and
improved parent-child relationships:
•
The risk of postpartum depression
among women is nearly cut in half
when a birth follows a planned
rather than unplanned pregnancy,
21
and numerous studies indicate
that pregnancy intentions remain
a significant factor in explaining
postpartum depression, even after
controlling for numerous other
background and demographic
factors.
22
One study found that while
Family Formation, Family Wellbeing, and
the Benets of Birth Control in America
Couples who have an unplanned
birth are twice as likely to
split up as couples who have a
planned birth.
83% of children born following
a planned pregnancy are living
with two married parents at
age two, compared to only 46%
of children born following an
unplanned pregnancy.
83%
Parents report that, following an unplanned pregnancy,
their relationship is not as strong, there is more conflict,
and they are less happy.
26 • The Benefits of Birth Control in America
the birth of a child resulting from a planned pregnancy
is significantly associated with increased happiness and
decreased depression, the birth of a child following an
unintended pregnancy is not, net of other factors.
23
•
While less studied, research suggests that new fathers
are similarly aected by births following unplanned
pregnancies, experiencing higher levels of depression and
lower levels of happiness, net of other factors, even among
fathers who are living within the household.
24
•
These fathers also exhibit less parental warmth and
involvement with their children as well as more conflicted
relationships with the mothers of their children. This, in turn,
translates into weaker parenting.
•
Another study found that, even within the same family,
children born following an unplanned pregnancy experience
less cognitive and emotional support from their parents
compared to siblings born following planned pregnancies.
25
•
It’s not surprising, then, that children born following planned
pregnancies also experience better health and stronger
childhood development. While results are somewhat mixed
as to whether this is a direct result of pregnancy intention or
other related factors, the most recent studies find that these
benefits remain significant even after controlling for various
background characteristics.
26
•
The benefits to children of being born following a planned
pregnancy often continue into late adolescence and early
adulthood, as reflected in terms of higher levels of self-
esteem and stronger child-mother relationships.
27
•
Perhaps one of the strongest indicators of adverse child
and family outcomes is domestic violence, and having an
unwanted pregnancy has been found to directly increase
the risk of intimate partner violence, both during pregnancy
and after the child is born.
28
Another study in the U.K. found
that children born following unplanned pregnancies were
roughly 50% more likely to be the subject of a child services
investigation compared to children born following planned
pregnancies, net of other factors.
29
Low income mothers are disproportionately more likely to
report that the birth of their child followed a pregnancy that
they did not intend
30
—either they became pregnant earlier than
they planned, or they did not want to become pregnant ever—
and they often stand the most to gain from eorts that make
contraception more available and aordable.
To better understand the benefits to families of making
contraception more aordable, one study focused on a unique
period of time when publicly funded family planning grants
were first introduced (in the early 1970s), and were adopted
in some counties earlier than others. This study found that
low-income women living in areas with early adoption of public
family planning grants were 16% to 20% more likely to use the
pill compared to other low-income women, enabling them
to use birth control on par with higher income women.
31
By
1980, these family planning grants were associated with a 6%
reduction in child poverty and a 15% reduction in the percent of
families receiving public assistance. Furthermore, between 1973
and 1982 the proportion of low-income mothers who reported
that the birth of their child followed an unplanned pregnancy
fell by 16%, and the proportion saying the birth followed an
unwanted pregnancy fell by more than half based on data from
the CDC (measured among ever-married mothers).
32
What It All Means
Bottom line: The capacity to plan and space pregnancies—
which is typically achieved through the use of birth control—
has significant and meaningful benefits for women, children,
families, taxpayers, and more.
33
Pregnancy planning increases
the overall educational status of women and communities; it
advances the health and wellbeing of children and families; it
saves money; and it reduces abortion. As such, birth control
deserves widespread support, expressed in a number of ways
including minimal cost and access barriers, a prominent place
in public health priorities and health care services, and broad
political support.
But it is also true that for the most disadvantaged women and
communities, the widespread use of birth control alone is not a
panacea. For these women and communities, realizing the full
benefit of pregnancy planning, spacing, and prevention also
requires additional eorts to promote educational attainment,
better schools, stronger families, economic opportunities, job
Children and families do best when both
parents live together, and parents are more
likely to live together if they are married when
their child is born.
87% of unmarried
20-somethings say
they do not want to
be parents right now.
Family Formation, Family Wellbeing, and
the Benets of Birth Control in America
87%
Getting the Facts Straight • 27
readiness, and more. Put another way,
birth control alone cannot solve crushing
poverty, but it can open the door to
increased opportunity.
Notes
a
Unplanned pregnancy (also known as
unintended pregnancy) refers to a pregnancy
that a woman herself reported was not intended
at the time of conception. Unplanned pregnancy
includes both mistimed pregnancies (that is, the
woman reported she did not want to become
pregnant at the time the pregnancy occurred but
did want to become pregnant at some point in
the future) as well as unwanted pregnancies (that
is, the woman reported at time of conception
that she did not want to become pregnant
then or at any time in the future). Many studies
summarized here report the eects of unplanned
pregnancy overall, while some focus specifically
on either unwanted or mistimed pregnancies, as
noted previously.
Sources
1. Chandra, A., Mosher, W.D., Copen, C., & Sionean,
C. (2011). Sexual behavior, sexual attraction, and
sexual identity in the United States: Data from the
2006-2008 National Survey of Family Growth.
National Health Statistics Reports, 36, 1–36.
2. Ten great public health achievements—United
States, 1900–1999. (1999). MMWR: Morbidity and
Mortality Weekly Report, 48(12), 241–243.
3. Kaye, K., Suellentrop, K., & Sloup, C. (2009).
The Fog Zone: How misperceptions, magical
thinking, and ambivalence put young adults at
risk for unplanned pregnancy. Washington, DC:
The National Campaign to Prevent Teen and
Unplanned Pregnancy.
4. The National Campaign to Prevent Teen and
Unplanned Pregnancy. (2012). Briefly: Unplanned
pregnancy among unmarried young women.
Washington, DC: Author. Retrieved from http://
thenationalcampaign.org/resource/briefly-
unplanned-pregnancy-among-unmarried-
young-women.
5. Author tabulations based on data in Zolna, M.,
& Lindberg, L. (2012). Unintended pregnancy:
Incidence and outcomes among young adult
unmarried women in the United States, 2001
and 2008. New York, NY: Guttmacher Institute.
Retrieved from http://www.guttmacher.org/pubs/
unintended-pregnancy-US-2001-2008.pdf.
6. Frost, J.J., Darroch, J.E., & Remez, L. (2008).
Improving contraceptive use in the United
States. In Brief, 2008(1), 1–8. Retrieved from
the Guttmacher Institute website http://
www.guttmacher.org/pubs/2008/05/09/
ImprovingContraceptiveUse.pdf.
7. Hymowitz, K., Carroll, J.S., Wilcox, B.W., & Kaye, K.
(2013). Knot yet: The benefits and costs of delayed
marriage in America. Charlottesville, VA: The
National Marriage Project. Retrieved from http://
twentysomethingmarriage.org/.
8. Martin, J.A., Hamilton, B.E., Ventura, S.J.,
Osterman, M.J., & Mathews, T.J. (2013). Births:
Final data for 2011. National Vital Statistics
Reports, 62(1), 1–90; Ventura, S.J., & Bachrach,
C.A. (2000). Nonmarital childbearing in the
United States, 1940–99. National Vital Statistics
Reports, 48(16), 1–40.
9. Hymowitz et al., 2013.
10. Child Trends tabulations based on data in The
National Center for Education Statistics. (2009).
Early Childhood Longitudinal Study, Birth Cohort
(ECLS-B) [Data file]. Available from http://nces.
ed.gov/ecls/birth.asp.
11. Kaye et al., 2009.
12. Author tabulations based on data in Mosher,
W.D., Jones, J., & Abma, J.C. (2012). Intended and
unintended births in the United States: 1982–2010.
National Health Statistics Reports, 55, 1–28.
13. Abma, J., Mosher, B., & Jones, J. (2008).
Wanted and unwanted births in the United States:
Trends, measurement, and implications. Paper
presented at the 2008 Annual Meeting of the
Population Association of America, New Orleans,
LA. Retrieved from http://paa2008.princeton.
edu/papers/81355.
14. Author tabulations based on data in Centers
for Disease Control (CDC). (2014). VitalStats—
Births [Data file]. Available from http://www.cdc.
gov/nchs/vitalstats.htm.
15. The National Campaign to Prevent Teen and
Unplanned Pregnancy. (2008). Science Says
#34: Unplanned pregnancy and family turmoil.
Washington, DC: Author. Retrieved from http://
thenationalcampaign.org/resource/science-says-34.
16. Guzzo, K.B., & Hayford, S.R. (2014). Fertility
and the stability of cohabiting unions: Variation
by intendedness. Journal of Family Issues, 35(4),
547–576.
17. The National Campaign to Prevent Teen and
Unplanned Pregnancy, 2008. Science Says #34:
Unplanned pregnancy and family turmoil.
18. Lawrence, E., Rothman, A.D., Cobb, R.J.,
Rothman, M.T., & Bradbury, T.N. (2008). Marital
satisfaction across the transition to parenthood.
Journal of Family Psychology, 22(1), 41–50;
Bouchard, G. (2005). Adult couples facing
a planned or an unplanned pregnancy: Two
realities. Journal of Family Issues, 26(5), 619–637.
19. Hymowitz et al., 2013; Amato, P.R. (2005).
The impact of family formation change on the
cognitive, social, and emotional well-being of the
next generation. The Future of Children, 15(2),
75–96. Retrieved from the Princeton University and
Brookings Institution website www.futureofchildren.
org; Waldfogel, J., Craigie, T.A., & Brooks-Gunn, J.
(2010). Fragile families and child wellbeing. The
Future of Children, 20(2), 87–112. Retrieved from
the Princeton University and Brookings Institution
website www.thefutureofchildren.org; Manning,
W.D., & Lamb, K.A. (2003). Adolescent well-being
in cohabiting, married, and single-parent families.
Journal of Marriage and Family, 65(4), 876–893;
Brown, S.L., & Manning, W.D. (2009). Family
boundary ambiguity and the measurement of
family structure: The significance of cohabitation.
Demography, 46(1), 85–101; Bachman, H.J., Coley,
R.L., & Chase-Lansdale, P.L. (2003). Marriage and
family formation among low-income couples: What
do we know from research? Paper presented at the
National Poverty Center conference, Washington,
D.C. Retrieved from http://www.npc.umich.edu/
news/events/past/Bachman%20Coley%20and%20
Chase-Lansdale%20NPC%20Working%20Paper.pdf.
20. Amato, 2005; Waldfogel et al., 2010; Lerman,
R.I. (2002). Marriage and the economic well-being
of families with children: A review of the literature.
Washington, DC: Urban Institute. Retrieved from
http://www.urban.org/UploadedPDF/410541_
LitReview.pdf; Kaye, K. (2002). Eects of marriage
on family economic well-being: Summary.
Family Formation, Family Wellbeing, and
the Benets of Birth Control in America
28 • The Benefits of Birth Control in America
Washington, DC: U.S. Department of Health and
Human Services. Retrieved from http://aspe.hhs.
gov/hsp/marriage-well-being03/summary.htm;
Thomas, A., & Sawhill, I. (2010). For love and money?
The impact of family structure on family income.
The Future of Children, 15(2), 57–74. Retrieved from
the Princeton University and Brookings Institution
website www.futureofchildren.org; Cherlin, A.J.
(2005). American marriage in the early twenty-
first century. The Future of Children, 15(2), 33–55.
Retrieved from the Princeton University and
Brookings Institution website www.futureofchildren.
org; Berger, L.M., Paxson, C., & Waldfogel, J.
(2009). Mothers, men, and child protective services
involvement. Child Maltreatment, 14(3), 263–276.
21. D’Angelo, D., Williams, L., Morrow, B., Cox,
S., Harris, N., Harrison, L., . . . Zapata, L. (2007).
Preconception and interconception health status
of women who recently gave birth to a live-born
infant—Pregnancy Risk Assessment Monitoring
System (PRAMS), United States, 26 reporting
areas, 2004. MMWR: Surveillance Summaries,
56(10), 1–35.
22. Abbasi, S., Chuang, C.H., Dagher, R., Zhu, J.,
& Kjerul, K. (2013). Unintended pregnancy and
postpartum depression among first-time mothers.
Journal of Women’s Health, 22(5), 412–416;
Leathers, S.J., & Kelley, M.A. (2000). Unintended
pregnancy and depressive symptoms among
first-time mothers and fathers. American Journal
of Orthopsychiatry, 70(4), 523–531; Mercier, R.J.,
Garrett, J., Thorp, J., & Siega-Riz, A.M. (2013).
Pregnancy intention and postpartum depression:
Secondary data analysis from a prospective cohort.
BJOG: An International Journal of Obstetrics
and Gynaecology, 120(9), 1116–1122; Gipson, J.D.,
Koenig, M.A., & Hindin, M.J. (2008). The eects
of unintended pregnancy on infant, child, and
parental health: A review of the literature. Studies
in Family Planning, 39(1), 18–38; Cheng, D., Schwarz,
E.B., Douglas, E., & Horon, I. (2009). Unintended
pregnancy and associated maternal preconception,
prenatal and postpartum behaviors. Contraception,
79(3), 194–198; Barber, J.S., Axinn, W.G., & Thornton,
A. (1999). Unwanted childbearing, health, and
mother-child relationships. Journal of Health and
Social Behavior, 40(3), 231–257; Messer, L.C., Dole,
N., Kaufman, J.S., & Savitz, D.A. (2005). Pregnancy
intendedness, maternal psychosocial factors and
preterm birth. Maternal and Child Health Journal,
9(4), 403–412.
23. Su, J.H. (2011). Unexpectedly expecting:
Pregnancy intentions and parental well-being.
Paper presented at the 2011 Annual Meeting
of the Population Association of America,
Washington, D.C. Retrieved from http://paa2011.
princeton.edu/papers/111658.
24. Su, 2011; Bronte-Tinkew, J., Ryan, S., Carrano,
J., & Moore, K.A. (2007). Resident fathers’
pregnancy intentions, prenatal behaviors, and
links to involvement with infants. Journal of
Marriage and Family, 69(4), 977–990; Bronte-
Tinkew, J., Scott, M.E., Horowitz, A., & Lilja,
E. (2009). Pregnancy intentions during the
transition to parenthood and links to coparenting
for first-time fathers of infants. Parenting: Science
& Practice, 9(1–2), 1–35.
25. Barber, J.S., & East, P.L. (2009). Home
and parenting resources available to siblings
depending on their birth intention status. Child
Development, 80(3), 921–939.
26. Gipson et al., 2008; Joyce, T.J., Kaestner, R.,
& Korenman, S. (2000). The eect of pregnancy
intention on child development. Demography,
37(1), 83–94; Hummer, R.A., Hack, K.A., & Raley,
R.K. (2004). Retrospective reports of pregnancy
wantedness and child well-being in the United
States. Journal of Family Issues, 25(3), 404–428;
Crissey, S.R. (2005). Eect of pregnancy
intention on child well-being and development:
Combining retrospective reports of attitude
and contraceptive use. Population Research
and Policy Review, 24(6), 593–615; Saleem,
H.T., & Surkan, P.J. (2014). Parental pregnancy
wantedness and child social-emotional
development. Maternal and Child Health Journal,
18(4), 930–938.
27. Barber et al., 1999; Axinn, W.G., Barber, J.S.,
& Thornton, A. (1998). The long-term impact of
parents’ childbearing decisions on children’s self-
esteem. Demography, 35(4), 435–443; Nelson,
J.A., & O’Brien, M. (2012). Does an unplanned
pregnancy have long-term implications for
mother–child relationships? Journal of Family
Issues, 33(4), 506–526.
28. Charles, P., & Perreira, K. (2007). Intimate
partner violence during pregnancy and 1-year post-
partum. Journal of Family Violence, 22(7), 609–619.
29. Gipson et al., 2008; Sidebotham, P., & Heron, J.
(2006). Child maltreatment in the “children of the
nineties”: A cohort study of risk factors. Child Abuse
and Neglect, 30(5), 497–522.
30. Finer, L.B., & Zolna, M.R. (2014). Shifts in
intended and unintended pregnancies in the
United States, 2001–2008. American Journal of
Public Health, 104(S1), S43–S48.
31. Bailey, M.J., Malkova, O., & McLaren, Z.
(2014). Does family planning increase children’s
opportunities? Evidence from the war on poverty
and the early years of Title X. Retrieved from
the University of Michigan website http://www-
personal.umich.edu/~baileymj/Bailey_McLaren_
Malkova.pdf.
32. Williams, L.B., & Pratt, W.F. (1990). Wanted
and unwanted childbearing in the United States:
1973–88. Advance Data from Vital Health and
Statistics, 189, 1–8.
33. Kaye, K., Gootman, J.A., Ng, A.S., & Finley,
C. (2014). Summary. In The benefits of birth
control in America: Getting the facts straight.
Washington, DC: The National Campaign to
Prevent Teen and Unplanned Pregnancy; Sonfield,
A., Hasstedt, K., Kavanaugh, M.L., & Anderson,
R. (2013). The social and economic benefits of
women’s ability to determine whether and when
to have children. New York, NY: Guttmacher
Institute. Retrieved from http://www.guttmacher.
org/pubs/social-economic-benefits.pdf; Logan,
C., Holcome, E., Manlove, J., & Ryan, S. (2007).
The consequences of unintended childbearing.
Washington, DC: Child Trends.
Family Formation, Family Wellbeing, and
the Benets of Birth Control in America
Getting the Facts Straight • 29
5
Pregnancy planning in general, and the use of birth
control in particular, are directly linked to a wide array
of benefits to women, men, children, and society,
including fewer unplanned pregnancies and abortions,
more educational and economic opportunities for
young women, improved maternal and infant health,
greater family wellbeing, and reduced public spending.
Given that the large majority of both men and
women are sexually active (for example, more than
three-quarters of young adults age 18 to 24 have had
sex in the past 12 months
1
), birth control is central
to realizing these benefits. In fact, the Centers for
Disease Control and Prevention (CDC) recognizes
the development of modern contraception as one
of the 10 greatest public health achievements of the
20
th
century.
2
Nonetheless, the United States has long
reported high levels of unplanned pregnancy
a
and
very uneven use of contraception. For example,
even though most unmarried women in their 20s
say they don’t want to get pregnant and despite
the availability of many forms of birth control—
including some that are highly eective—only half of
those who are sexually active report using reliable
contraception consistently.
3
Unplanned pregnancy is
nearly 100 percent preventable, yet…
•
Roughly half of all pregnancies in the United States
are reported by women to be unplanned—that is, a
pregnancy that a woman herself said she was not
intending or actively trying to achieve.
4
•
Among unmarried young women age 20 to 29, the
percentage of pregnancies that they report as being
unplanned is nearly 70%. This totaled roughly 1.3
million unplanned pregnancies in 2008 alone, and
unplanned pregnancy among young adults has been
trending up for the past few years, not down.
•
Nearly half (44%) of unplanned pregnancies among
unmarried young women result in an abortion,
leading to nearly 600,000 abortions each year.
•
In addition, unplanned pregnancy is responsible
for more than half of all births to unmarried
women in their twenties, or more than 500,000
births each year
.5
•
Women using birth control carefully and consistently
account for only 5% of all unplanned pregnancies.
6
Advancements in Women’s Education
and Employment
Since the early 1970s, women’s educational attainment and labor market
participation have increased dramatically:
•
Between 1970 and 2012, the proportion of women 25 and older with at least
a high school diploma increased from 55% to 88%, and the proportion with
at least a bachelor’s degree increased from 8% to 31%.
7
•
Over roughly that same period, the percent of women age 16 and older who
were employed increased from 41% to 53%.
8
•
Wages for working women age 25 and older also increased during this
period by roughly 40%, net of inflation.
9
Because modern contraception can help young women time when they
become parents, it can enable them to complete their education before starting
a family and, in turn, improve the employment and financial prospects of
themselves and their families. To be sure, the evidence is imperfect—we do not
have randomized trials of women with and without access to contraception,
or even recent examples of large comparison groups who have little or no
access, especially here in the United States. Even so, the weight of the evidence
across numerous studies shows significant employment and educational gains
have followed directly from women’s ability to better time their entry into
parenthood, and that the availability of contraception has played a clear role in
such progress, even after netting out the influence of other characteristics.
Educational Attainment,
Employment, and the Benets
of Birth Control in America
Roughly half of all
pregnancies in the
US are reported by
women themselves
as unplanned.
The wage gains associated with pregnancy planning and
prevention extend across the socioeconomic spectrum.
30 • The Benefits of Birth Control in America
The Benefits of
Timing Entry
Into Parenthood
Women’s growing success in both
education and employment has clearly
depended to some degree on being
able to postpone first births until after
completing their education and/or
gaining a foothold in the labor market.
•
Since 1970 the mean age at which
women first had a child increased
from 21 to 26 years of age
10
while the
share of first-time mothers with more
than 12 years of education increased
from 26% to 52% (measured through
2003, the most recent year for
which we have comparable data on
educational attainment).
11
•
Economists find that women do
significantly better in the labor
market when they can better time
their entry into parenthood.
12
Recent
research suggests a 3% increase in
weekly wages and a 9% increase
in career earnings for each year of
delayed childbearing, even after
accounting for dierences in other
background characteristics that could
aect women’s earnings.
13
•
Furthermore, this wage premium
extends across the socioeconomic
spectrum. Women from many parts of
the working world who chose to delay
childbearing—those in managerial,
clerical, and service occupations—
experience wage gains from delays in
childbearing, as did those whose high
school aptitude scores fell into the
lower, middle, and upper percentiles,
though gains were smaller among
those with lower scores.
14
•
Naturally, a woman’s prospects in
the labor market and her decision
about when to become a parent
are intertwined—women who
delay parenthood may tend to be
those who have a greater stake in
or connection to the labor market.
Results that try to control for such
dierences by focusing strictly on
more random delays in parenthood
(for example delays resulting from
miscarriages) find smaller benefits
of delay (though still significant) and
find that the benefits are limited to
more advantaged women.
15
•
However, using contraception to
better time when one becomes a
parent is hardly a random event, and
results based on miscarriages do
not necessarily reflect the potential
benefits of delaying parenthood among
women seeking to do so. For these
women, the balance of the research
suggests significant benefits of being
able to time entry into parenthood.
The Role of
Family Planning
The majority of young adults are sexually
active. Consequently, contraception is
central to women’s ability to control
when they become parents, and to the
educational and employment benefits
they experience as a result. It is dicult
to estimate the full impact of family
planning on education and employment
because we have no comparison group
to illustrate what life would be like in
the absence of access to contraception,
at least here in the United States. Most
of the available evidence focuses on
a unique moment in history primarily
during the late 1960s and early 1970s
when access to the pill was expanding
incrementally across states. (In particular,
over that time period, more and more
states were allowing unmarried women
access to the pill at age 18 instead of
at age 21, through changes in age of
majority and consent laws.
16
) Numerous
studies have found that even this
modest increase in the availability of
contraception during young adulthood
led to significant and lasting educational
and employment gains among women.
Specifically, the most recent studies
find that:
•
Women with early access to the pill
during this period were significantly
more likely to enroll in college—an
estimated 10% to 20% more women
enrolled in college at age 21 as a
result of expanded access to the pill,
net of other factors, explaining up
to one-third of the increase in young
women’s college enrollment during
the 1970s. They were also one-third
less likely to drop out within the
first year. Similarly, enrollment in job
training programs was 15% higher.
17
•
After reaching age 21, all unmarried
women had legal access to the pill, so
it is not surprising that the educational
attainment gap narrowed later in life.
Once unmarried women reached age
30 or older, early access to the pill
was significantly associated with an
estimated 2% to 3% increase in the
proportion of women holding four-year
Educational Attainment, Employment, and
the Benets of Birth Control in America
Birth control helps women time when they become parents,
complete their education, and improve the financial and
employment prospects of themselves and their families.
For young adults, even
modest increases in the
availability of contraception
lead to significant and lasting
educational and employment
gains for women.
Getting the Facts Straight • 31
degrees, net of other factors.
18
Even
so, it is noteworthy that expanding
pill access by just a few years in
early adulthood led to significant
improvements in women’s educational
attainment that persisted into one’s
thirties and beyond.
•
The educational benefits of early pill
access are not limited to women from
advantaged economic circumstances—
in fact, it was women from the
most economically disadvantaged
backgrounds who experienced the
largest gains in education.
19
It should
also be noted, however, that gains
in education were limited to women
with high school aptitude scores in the
middle or upper range—those with
scores in the lowest range did not
experience educational gains due to
early pill access.
•
Given these advancements in
education, it is not surprising that
early pill access is also associated
with a growing share of women
in professional occupations and
especially nontraditional professions
(those other than nursing and
teaching).
20
In fact one study
estimated that increased availability
of the pill was responsible for
roughly one-third of the increase in
professional employment among
women between 1970 and 1990.
21
•
More broadly, research shows
significant increases in employment
and wages among women who had
early access to the pill, though these
benefits typically didn’t show up
until later in life, presumably because
many of these women initially
delayed entry into the labor force
in order to pursue more education.
•
By their early forties, working women
who had early pill access earned
11% more each year compared to
working women who didn’t, all else
being equal.
22
•
These benefits extended to women
with high school aptitude scores in
both the middle and upper tiers, but
not to women with aptitude scores in
the lowest tier.
23
What It All Means
Bottom line: The capacity to plan
and space pregnancies—which is
typically achieved through the use
of birth control—has significant and
meaningful benefits for women,
children, families, taxpayers, and
more.
24
Pregnancy planning increases
the overall educational status of women
and communities; it advances the health
and wellbeing of children and families; it
saves money; and it reduces abortion. As
such, birth control deserves widespread
support, expressed in a number of
ways including minimal cost and access
barriers, a prominent place in public
health priorities and health care services,
and broad political support.
But it is also true that for the most
disadvantaged women and communities,
the widespread use of birth control
alone is not a panacea. For these
women and communities, realizing
the full benefit of pregnancy planning,
spacing, and prevention also requires
additional eorts to promote educational
attainment, better schools, stronger
families, economic opportunities, job
readiness, and more. Put another way,
birth control alone cannot solve crushing
poverty, but it can open the door to
increased opportunity.
Notes
a
Unplanned pregnancy (also known as unintended
pregnancy) refers to a pregnancy that a woman
herself reports was not intended at the time
of conception. Unplanned pregnancy includes
both mistimed pregnancies (that is, the woman
reported she did not want to become pregnant at
the time the pregnancy occurred but did want to
become pregnant at some point in the future) as
well as unwanted pregnancies (that is, the woman
reported at time of conception that she did not
want to become pregnant then or at any time in
the future). Many studies summarized here report
the eects of unplanned pregnancy overall, while
some focus specifically on either unwanted or
mistimed pregnancies, as noted previously.
Sources
1. Chandra, A., Mosher, W.D., Copen, C., & Sionean,
C. (2011). Sexual behavior, sexual attraction, and
sexual identity in the United States: Data from the
2006–2008 National Survey of Family Growth.
National Health Statistics Reports, 36, 1–36.
2. Ten great public health achievements—United
States, 1900–1999. (1999). MMWR: Morbidity and
Mortality Weekly Report, 48(12), 241–243.
3. Kaye, K., Suellentrop, K., & Sloup, C. (2009).
The Fog Zone: How misperceptions, magical
thinking, and ambivalence put young adults at
risk for unplanned pregnancy. Washington, DC:
The National Campaign to Prevent Teen and
Unplanned Pregnancy. Retrieved from http://
thenationalcampaign.org/resource/fog-zone.
4. The National Campaign to Prevent Teen and
Unplanned Pregnancy. (2012). Briefly: Unplanned
pregnancy among unmarried young women.
Pregnancy timing matters: There is a
3% increase in weekly wages and a 9%
increase in career earnings for each
year of delayed childbearing.
Educational Attainment, Employment, and
the Benets of Birth Control in America
The proportion of women graduating high school and college
increased dramatically since access to birth control pills expanded.
32 • The Benefits of Birth Control in America
Washington, DC: Author. Retrieved from http://thenationalcampaign.org/
resource/briefly-unplanned-pregnancy-among-unmarried-
young-women.
5. Author tabulations based on data in Zolna, M., & Lindberg, L. (2012).
Unintended pregnancy: Incidence and outcomes among young adult
unmarried women in the United States, 2001 and 2008. New York, NY:
Guttmacher Institute. Retrieved from http://www.guttmacher.org/pubs/
unintended-pregnancy-US-2001-2008.pdf.
6. Frost, J.J., Darroch, J.E., & Remez, L. (2008). Improving contraceptive use
in the United States. In Brief, 2008(1), 1–8. Retrieved from the Guttmacher
Institute website http://www.guttmacher.org/pubs/2008/05/09/
ImprovingContraceptiveUse.pdf.
7. Snyder, T.D., & Dillow, S.A. (2012). Digest of education statistics, 2012
[Table 8]. Retrieved from http://nces.ed.gov/programs/digest/d12/tables/
dt12_008.asp.
8. The Bureau of Labor Statistics. (2013). Women in the labor force: A
databook. Washington, DC: Author. Retrieved from http://www.bls.gov/cps/
wlf-databook-2012.pdf.
9. The Bureau of Labor Statistics. (2013). Highlights of women’s earnings
in 2012. Washington, DC: Author. Retrieved from http://www.bls.gov/cps/
cpswom2012.pdf; Blau, F.D. (1999). Women’s economic well-being, 1970–1995:
Indicators and trends. Focus, 20(1), 4–10. Retrieved from the Institute for
Research on Poverty website http://www.irp.wisc.edu/publications/focus.htm.
10. Matthews, T.J., & Hamilton, B.E. (2009). Delayed childbearing: More
women are having their first child later in life. NCHS Data Brief, 21, 1–8; Martin,
J.A., Hamilton, B.E., Osterman, M.J.K., Curtin, S.C., & Mathews, T.J. (2013).
Births: Final data for 2012. National Vital Statistics Reports, 62(9), 1–87.
11. Author tabulations based on data in Centers for Disease Control (CDC).
(2014). VitalStats—Births [Data file]. Available from http://www.cdc.gov/
nchs/vitalstats.htm; National Center for Health Statistics. (1974). Summary
report: Final natality statistics, 1970. Monthly Vital Statistics Reports, 22(12),
S1-S15. Tabulations are limited to those states reporting educational status in
both 1970 and 2003.
12. Miller, A. (2011). The eects of motherhood timing on career path.
Journal of Population Economics, 24(3), 1071–1100; Buckles, K. (2008).
Understanding the returns to delayed childbearing for working women.
The American Economic Review, 98(2), 403–407; Taniguchi, H. (1999).
The Timing of Childbearing and Women’s Wages. Journal of Marriage and
Family, 61(4), 1008–1019.
13. Miller, 2011.
14. Miller, 2011; Buckles, 2008.
15. Miller, 2011.
16. Goldin, C., & Katz, L.F. (2002). The power of the pill: Oral contraceptives
and women’s career and marriage decisions. Journal of Political Economy,
110(4), 730–770; Bailey, M.J., Hershbein, B., & Miller, A.R. (2012). The Opt-
In Revolution? Contraception and the gender gap in wages. American
Economics Journals: Applied Economics, 4(3), 225–254; Hock, H. (2007).
The Pill and the college attainment of American women and men. Retrieved
from Florida State University website ftp://econpapers.fsu.edu/RePEc/fsu/
wpaper/wp2007_10_01.pdf.
17. Bailey et al., 2012; Hock, 2007.
18. Hock, 2007; Ananat, E.O., & Hungerman, D.M. (2012). The power of the
pill for the next generation: Oral contraception’s eects on fertility, abortion,
and maternal & child characteristics. Review of Economics and Statistics,
94(1), 37–51.
19. Bailey et al., 2012.
20. Goldin & Katz, 2002., Bailey et al., 2012.
21. Goldin & Katz, 2002.
22. Bailey et al., 2012.
23. Bailey et al., 2012.
24. Kaye, K., Gootman, J.A., Ng, A.S., & Finley, C. (2014). Summary. In The
benefits of birth control in America: Getting the facts straight. Washington,
DC: The National Campaign to Prevent Teen and Unplanned Pregnancy;
Sonfield, A., Hasstedt, K., Kavanaugh, M.L., & Anderson, R. (2013). The
social and economic benefits of women’s ability to determine whether and
when to have children. New York, NY: Guttmacher Institute. Retrieved from
http://www.guttmacher.org/pubs/social-economic-benefits.pdf; Logan, C.,
Holcome, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended
childbearing. Washington, DC: Child Trends.
Educational Attainment, Employment, and
the Benets of Birth Control in America
Getting the Facts Straight • 33
6
Pregnancy planning in general, and the use of birth
control in particular, are directly linked to a wide array
of benefits to women, men, children, and society,
including fewer unplanned pregnancies and abortions,
more educational and economic opportunities for
young women, improved maternal and infant health,
greater family wellbeing, and reduced public spending.
Given that the large majority of both men and
women are sexually active (for example, more than
three-quarters of young adults age 18 to 24 have had
sex in the past 12 months
1
), birth control is central
to realizing these benefits. In fact, the Centers for
Disease Control and Prevention (CDC) recognizes
the development of modern contraception as one
of the 10 greatest public health achievements of the
20
th
century.
2
Nonetheless, the United States has long
reported high levels of unplanned pregnancy
a
and
very uneven use of contraception. For example,
even though most unmarried women in their 20s
say they don’t want to get pregnant and despite
the availability of many forms of birth control—
including some that are highly eective—only half of
those who are sexually active report using reliable
contraception consistently.
3
Unplanned pregnancy is
nearly 100 percent preventable, yet…
•
Roughly half of all pregnancies in the United States
are reported by women to be unplanned—that is, a
pregnancy that a woman herself said she was not
intending or actively trying to achieve.
4
•
Among unmarried young women age 20 to 29, the
percentage of pregnancies that they report as being
unplanned is nearly 70%. This totaled roughly 1.3
million unplanned pregnancies in 2008 alone, and
unplanned pregnancy among young adults has been
trending up for the past few years, not down.
•
Nearly half (44%) of unplanned pregnancies among
unmarried young women result in an abortion,
leading to nearly 600,000 abortions each year.
•
In addition, unplanned pregnancy is responsible
for more than half of all births to unmarried
women in their twenties, or more than 500,000
births each year
.5
•
Women using birth control carefully and consistently
account for only 5% of all unplanned pregnancies.
6
The Medical Costs of Unplanned Pregnancy
In 2008 (the most recent year for which data are available), the number of
unplanned pregnancies for all women—including both younger and older women,
married and unmarried—totaled 3.4 million.
7
This included nearly 1.6 million
pregnancies that resulted in a live birth, 1.1 million pregnancies that ended in an
abortion, and more than 600,000 pregnancies that resulted in a miscarriage.
Unplanned pregnancies are associated with serious consequences for parents
and their children, as well as for our economy and workforce.
8
They are
also quite costly—unplanned pregnancies lead to substantial medical costs
associated with the births, abortions, and miscarriages that result from these
pregnancies. There are several recent studies that estimate these costs and,
while each varies somewhat, all find that the medical costs associated with
unplanned pregnancy total billions of dollars each year:
•
The Brookings Institution estimates that unplanned pregnancy costs federal
and state taxpayers between $9.6 and $12.6 billion annually in medical costs.
9
•
These costs are primarily attributable to prenatal, labor and delivery, and
postpartum care for women as well as one year of infant care, measured
among women who have a birth following an unplanned pregnancy and who
participate in Medicaid or the Children’s Health Insurance Program (CHIP).
•
A similar study estimates that the public costs of unplanned pregnancy
through the Medicaid and CHIP programs to be $12.5 billion annually, and
that the cost would have been double in the absence of publicly funded
family planning services.
10
•
This same study found that roughly half (53%) of all births paid for through
Medicaid and CHIP are the result of unplanned pregnancy.
•
A slightly dierent estimate includes all unplanned pregnancies rather than
just those that are publicly funded, but focuses on just the immediate medical
costs (related to labor and delivery, miscarriage, and abortion). This study
estimates $4.6 billion annually in costs associated with unplanned pregnancy.
11
Savings to Society and the Benets
of Birth Control in America
Roughly half of all
pregnancies in the
US are reported by
women themselves
as unplanned.
34 • The Benefits of Birth Control in America
The average cost for each unplanned pregnancy varies
depending on what factors are included, but across various
studies, there is a consistently high cost to society:
•
When looking at the immediate medical costs for all unplanned
pregnancies, costs average $1,500 for a single pregnancy.
12
•
Studies that include prenatal, postpartum, and infant care
but only for unplanned pregnancies that were publicly
funded estimate costs ranging between $7,664 and $12,613
per pregnancy.
13
Because modern contraception can help women avoid
pregnancies that they themselves say they are not intending,
contraceptive supplies and services can substantially reduce the
societal costs associated with unplanned pregnancy. To be sure,
the evidence is imperfect—we do not have randomized trials of
women with and without access to contraception, or even recent
examples of large comparison groups who have little or no access,
especially in the United States. Even so, the weight of the evidence
across numerous studies shows that preventing unplanned
pregnancy results in significant cost savings to society, and that
making contraception aordable and accessible plays a direct and
obvious role in helping women avoid such pregnancies.
The Eectiveness of Family
Planning Programs in Preventing
Unplanned Pregnancy
Women who have diculty aording eective methods of
contraception are, not surprisingly, less likely to use them,
14
which in turn leaves them at greater risk of unplanned
pregnancy. The benefits of publicly funded family planning
services can be seen historically, when contraception remained
cost prohibitive for many women during the 1960s and early
1970s, even as it was becoming more widely available from a
legal standpoint. This was a hardship for low income women in
particular, who were more likely to report that the birth of their
child followed a pregnancy they did not intend.
15
According to
one study, the limited number of counties who benefitted from
early family planning grants during this time saw pill use increase
by 16% to 20% among low income women, enabling them to
use birth control on par with higher income women.
16
Today,
numerous studies document the direct role that publicly funded
family planning programs play in making contraception more
aordable and in preventing unplanned pregnancy and abortion:
•
In 2010, nine million women—47% of all women in need
of publicly subsidized care—received publicly funded
contraceptive services,
17
which in turn prevented 2.2 million
unplanned pregnancies and 760,000 abortions.
•
Researchers estimate that the rate of unplanned pregnancy
would be 66% higher for adult women and 73% higher for
teens had it not been for the provision of these services.
18
•
A recent study published by the National Bureau of
Economic Research that focused just on the state-level
expansions of eligibility for Medicaid family planning found
(after controlling for other factors) that these policies
significantly improved women’s use of contraception,
resulting in a 9% decline in the number of births among
women aected by the Medicaid expansions.
19
•
The Iowa Initiative to Reduce Unintended Pregnancy also
highlights the important role of publicly funded family
planning. Started in 2007, this initiative helped Title X
clinics in the state provide greater access to contraception
and to long-acting methods such as the IUD in particular.
Between 2007 and 2009, the percent of women using a
long-acting method increased from roughly 5% to nearly
14%.
20
Furthermore, between 2006 and 2012, the percent of
pregnancies in Iowa that were unplanned fell by 15% and the
percent ending in abortion fell by 26%. While it is too early to
assess how much of this reduction in unplanned pregnancy
and abortion resulted directly from the initiative, because
we lack comparable data from most other states and the
national overall beyond 2008, the results are encouraging.
The Cost Savings Resulting from
Publicly Funded Family Planning
Even though increasing access to aordable contraception
obviously entails upfront costs, the evidence overwhelmingly
suggests that these costs are more than oset by the savings
that result from reducing unplanned pregnancies.
21
This is not
surprising given that Medicaid finances 48%
22
of all births in the
The costs associated with increasing access
to aordable contraception are more than
oset by the savings that result from reducing
unplanned pregnancies.
Savings to Society and the Benets
of Birth Control in America
Unplanned pregnancy
costs federal and state
taxpayers between $9.6
and $12.6 billion annually
in medical costs.
Getting the Facts Straight • 35
United States, at a cost approaching $13,000 per birth (depending
on the estimate), whereas the annual cost of providing publicly
funded contraception for a woman was $239.
23
Nationally, these
savings total billions of dollars. For example:
•
A study published in 2012 by the Brookings Institution
estimated a return of $5.62 for every dollar spent on
expansion of Medicaid-financed family planning services.
24
•
These results are nearly identical to estimates released in
2013 by the Guttmacher Institute, which found that the
nation saves $5.68 for every $1 spent on publicly funded
family planning services.
25
•
This same study estimated that the total net savings resulting
from public spending on family planning services was $10.5
billion annually. Roughly half of the savings, and roughly
half of the reduction in unplanned pregnancies, births,
and abortions occurred among women receiving services
specifically through clinics receiving Title X funding.
State-implemented Medicaid family planning waivers are
required to be budget neutral in terms of federal spending. As
a result, there are numerous state-level studies demonstrating
that funding to expand family planning services under Medicaid
reduces federal spending, as well as state costs.
26
•
One study done for the state of Iowa in 2009 estimated
a savings of $3.78 for every $1 spent on expanding family
planning services through Medicaid.
27
•
When this same analysis expanded its estimates to include
not only the short term medical costs of unplanned
pregnancy and infant care but also the costs associated
with five years of services needed for children born
following unplanned pregnancies, it estimated a savings
of $15.12 for every $1 spent on family planning services.
•
A 2007 study of California’s Family PACT publicly funded
family planning services program estimated public-sector
savings of $4.30 for every $1 spent when counting costs of
unplanned pregnancy from conception through age two
of the child, and $9.25 in savings when counting costs of
unplanned pregnancy from conception through age five.
28
Family PACT provided family planning services to nearly
one million women in 2007, and averted an estimated
296,000 unplanned pregnancies in that one year alone.
•
This same California study determined that the contraceptive
implant and the IUD were the most cost eective methods—
saving more than $7 for every $1 spent in services and supplies.
Injectable contraceptives were the next most cost eective
method ($5.60 in savings per $1 spent) followed by oral
contraceptives ($4.07 in savings), the patch ($2.99 in savings),
the vaginal ring ($2.55 in savings), barrier methods ($1.34 in
savings), and emergency contraception ($1.43 in savings).
29
•
In its review of the Texas Medicaid family planning waiver,
the Texas Health and Human Services Commission found that
for every $1 the state put into the program, it saved roughly
$10 in expenditures associated with prenatal care, delivery,
postpartum care, and one year of infant care. In 2008, the
program helped to prevent 5,726 unplanned pregnancies.
30
•
Another study focused on the 19 states that, as of 2011,
had not expanded eligibility for Medicaid family planning
through an income-based waiver or state plan amendment.
It found that by expanding Medicaid eligibility under the
new state plan amendment option, each state could have
served at least 10,000 individuals, averted at least 1,500
unintended pregnancies, and saved at least $2.3 million in
state funds in a single year.
31
The Cost Eectiveness of
Contraception More Broadly
The benefits of contraception in preventing unplanned pregnancy
and the associated cost savings are not limited to publicly funded
programs and taxpayers. Under the Aordable Care Act (ACA),
most women seeking contraception through private health plans
will have those services covered with no copays, co-insurance, or
deductibles as part of the broad women’s preventive care benefit.
Although implementation of the ACA is still unfolding and it is not
yet feasible to measure the savings that result specifically from
this provision, several studies in the past few years have looked
at the coverage of contraceptive services through the private
sector more generally and found that it is highly cost eective for
insurers, employers, and individuals.
Eective contraception can help reduce
unplanned pregnancy and substantially
reduce the societal costs associated with
unplanned pregnancy.
Savings to Society and the Benets
of Birth Control in America
Publicly funded
contraception saves
nearly $6 in medical costs
for every $1 spent on
contraceptive services.
36 • The Benefits of Birth Control in America
•
One analysis, based on medical
claims data, simulated the health
care costs associated with using
various methods of contraception,
compared to the costs associated
with using no method. The study
found that using Depo-Provera (the
shot) was associated with a two-year
net reduction in health care costs
of $9,815. Similarly, the estimated
reduction in health care costs would
be $9,763 for use of the hormonal
IUD, $8,996 for the vaginal ring, and
$8,827 for oral contraceptives.
32
•
Another study determined that, in
addition to medical cost savings,
employer-based family planning
coverage also yields savings due to
decreased absenteeism, increased
productivity, and improved
employee morale.
33
•
Research finds that the IUD is among
the most cost eective methods of
contraception, due to that the fact
that it is nearly 100 percent eective
and that it is less expensive to use
over a five year period than many
other methods, including the pill.
34
•
In fact, researchers estimate that
switching from methods such as the
condom, pill, or patch to long-acting,
low maintenance, reversible methods
(either the IUD or the implant) would
lead to millions of dollars in additional
cost savings. For example, if just 10%
of women age 20–29 switched to
the IUD or implant, an additional
savings of $375 million annually
would be realized.
35
Furthermore, the cost of oering family
planning coverage to employees is minimal,
accounting for less than one percent of
total employee health insurance coverage
costs.
36
These costs are easily oset by
savings to the employer due to averted
unplanned pregnancies. In fact, even
before passage of the ACA, the National
Business Group on Health recommended
that employers oer services that help to
reduce unplanned pregnancies (including
coverage of all FDA-approved prescription
methods) at no cost to employees based
on evidence that such coverage results in
cost savings to companies.
37
What It All Means
Bottom line: The capacity to plan and
space pregnancies—which is typically
achieved through the use of birth
control—has significant and meaningful
benefits for our society. This includes
reductions in spending on the health
care costs associated with unplanned
pregnancy (as summarized here), as well
as improvements in the educational status
of women and communities, stronger
labor markets, advancements in the health
and wellbeing of children and families,
reductions in child poverty and fewer
abortions (as summarized elsewhere
in this volume).
38
As such, birth control
deserves widespread support, expressed
in a number of ways including minimal
cost and access barriers, a prominent place
in public health priorities and health care
services, and broad political support.
But it is also true that for the most
disadvantaged women and communities,
the widespread use of birth control
alone is not a panacea. For these
women and communities, realizing
the full benefit of pregnancy planning,
spacing, and prevention also requires
additional eorts to promote educational
attainment, better schools, stronger
families, economic opportunities, job
readiness, and more. Put another way,
birth control alone cannot solve crushing
poverty, but it can open the door to
increased opportunity.
Notes
a
Unplanned pregnancy (also known as unintended
pregnancy) refers to a pregnancy that a woman
herself reports was not intended at the time
of conception. Unplanned pregnancy includes
both mistimed pregnancies (that is, the woman
reported she did not want to become pregnant at
the time the pregnancy occurred but did want to
become pregnant at some point in the future) as
well as unwanted pregnancies (that is, the woman
reported at time of conception that she did not
want to become pregnant then or at any time in
the future). Many studies summarized here report
the eects of unplanned pregnancy overall, while
some focus specifically on either unwanted or
mistimed pregnancies, as noted previously.
Sources
1. Chandra, A., Mosher, W.D., Copen, C., & Sionean,
C. (2011). Sexual behavior, sexual attraction, and
sexual identity in the United States: Data from the
2006-2008 National Survey of Family Growth.
National Health Statistics Reports, 36, 1–36.
2. Ten great public health achievements—United
States, 1900–1999. (1999). MMWR: Morbidity and
Mortality Weekly Report, 48(12), 241–243.
3. Kaye, K., Suellentrop, K., & Sloup, C. (2009).
The Fog Zone: How misperceptions, magical
thinking, and ambivalence put young adults at
risk for unplanned pregnancy. Washington, DC:
The National Campaign to Prevent Teen and
Unplanned Pregnancy.
4. The National Campaign to Prevent Teen and
Unplanned Pregnancy. (2012). Briefly: Unplanned
pregnancy among unmarried young women.
Washington, DC: Author. Retrieved from http://
thenationalcampaign.org/resource/briefly-
unplanned-pregnancy-among-unmarried-
young-women.
5. Author tabulations based on data in Zolna, M.,
& Lindberg, L. (2012). Unintended pregnancy:
Savings to Society and the Benets
of Birth Control in America
Roughly half of all births
paid for through Medicaid
and CHIP are the result of
unplanned pregnancy.
Getting the Facts Straight • 37
Incidence and outcomes among young adult
unmarried women in the United States, 2001
and 2008. New York, NY: Guttmacher Institute.
Retrieved from http://www.guttmacher.org/pubs/
unintended-pregnancy-US-2001-2008.pdf.
6. Frost, J.J., Darroch, J.E., & Remez, L. (2008).
Improving contraceptive use in the United States. In
Brief, 2008(1), 1–8. Retrieved from the Guttmacher
Institute website http://www.guttmacher.org/
pubs/2008/05/09/ImprovingContraceptiveUse.pdf.
7. Author tabulations based on unpublished data
provided by the Guttmacher Institute [Data file].
8. Kaye, K., Gootman, J.A., Ng, A.S., & Finley, C.
(2014). Summary. In The benefits of birth control
in America: Getting the facts straight. Washington,
DC: The National Campaign to Prevent Teen and
Unplanned Pregnancy.
9. Monea, E., & Thomas, A. (2011). Unintended
Pregnancy and Taxpayer Spending. Perspectives on
Sexual & Reproductive Health, 43(2), 88–93.
10. Sonfield, A., & Kost, K. (2013). Public costs from
unintended pregnancies and the role of public
insurance programs in paying for pregnancy and
infant care: Estimates for 2008. New York, NY:
Guttmacher Institute. Retrieved from http://www.
guttmacher.org/pubs/public-costs-of-UP.pdf.
11. Trussell, J., Henry, N., Hassan, F., Prezioso, A., Law,
A., & Filonenko, A. (2013). Burden of unintended
pregnancy in the United States: Potential savings
with increased use of long-acting reversible
contraception. Contraception, 87(2), 154–161.
12. Trussell et al., 2013.
13. Monea & Thomas, 2011; Sonfield & Kost, 2013.
14. Frost, J.J., Zolna, M.R., & Frohwirth, L. (2013).
Contraceptive Needs and Services, 2010. New York,
NY: Guttmacher Institute. Retrieved from http://
www.guttmacher.org/pubs/win/contraceptive-
needs-2010.pdf.
15. Williams, L.B., & Pratt, W.F. (1990). Wanted
and unwanted childbearing in the United States:
1973-88. Advance Data from Vital Health and
Statistics, 189, 1–8.
16. Bailey, M.J., Malkova, O., & McLaren, Z.
(2014). Does family planning increase children’s
opportunities? Evidence from the war on poverty
and the early years of Title X. Retrieved from the
University of Michigan website http://www-personal.
umich.edu/~baileymj/Bailey_McLaren_Malkova.pdf.
17. Frost et al., 2013.
18. Frost et al., 2013.
19. Kearney, M.S., & Levine, P.B. (2007). Subsidized
contraception, fertility, and sexual behavior. (NBER
Working Paper No. 13045). Retrieved from The
National Bureau of Economic Research website
http://www.nber.org/papers/w13045.
20. Hirsch, H., Turner, R., Philliber, A., Philliber, S., &
Biggs, M.A. (2013). Increasing LARC use in an eort
to reduce unintended pregnancies: A look at the
Iowa initiative to reduce unintended pregnancies.
Paper presented at the 141st APHA Annual Meeting
and Exposition, Boston, MA.
21. Laliberte, F., Lefebvre, P., Law, A., Duh, M.,
Pocoski, J., Lynen, R., & Darney, P. (2014). Medicaid
spending on contraceptive coverage and pregnancy-
related care. Reproductive Health, 11(1), 20.
22. Markus, A.R., Andres, E., West, K.D., Garro, N., &
Pellegrini, C. Medicaid covered births, 2008 through
2010, in the context of the implementation of health
reform. Women’s Health Issues, 23(5), e273–e280.
23. Frost et al., 2013.
24. Thomas, A. (2012). Three strategies to prevent
unintended pregnancy. Journal of Policy Analysis
and Management, 31(2), 280–311.
25. Frost et al., 2013.
26. Edwards, J., Bronstein, J., & Adams, K.
(2003). Evaluation of Medicaid family planning
demonstrations. (CMS Contract No. 752-2-415921).
Alexandria, Virginia: The CNA Corporation.
27. Udeh, B., Losch, M., & Spies, E. (2009). The cost
of unplanned pregnancy in Iowa: A benefit-cost
analysis of public funded family planning services.
Des Moines, IA: University of Iowa. Retrieved from
http://ir.uiowa.edu/ppc_health/48/.
28. Biggs, M.A., Foster, D.G., Hulett, D., & Brindis,
C. (2010). Cost-benefit analysis of the California
Family PACT Program for calendar year 2007. San
Francisco, CA: Bixby Center for Global Reproductive
Health. Retrieved from http://bixbycenter.
ucsf.edu/publications/files/FamilyPACTCost-
BenefitAnalysis2007_2010Apr.pdf.
29. Foster, D.G., Rostovtseva, D.P., Brindis, C.D.,
Biggs, M.A., Hulett, D., & Darney, P.D. (2009). Cost
savings from the provision of specific methods
of contraception in a publicly funded program.
American Journal of Public Health, 99(3), 446–451.
30. Texas Health and Human Services Commission.
(2010). Annual savings and performance report for
the women’s health program. Austin, TX: Author.
Retrieved from http://www.hhsc.state.tx.us/
reports/2010/Rider64-Oct2010.pdf.
31. Sonfield, A., Frost, J.J., & Benson Gold, R. (2011).
Estimating the impact of expanding Medicaid
eligibility for family planning services: 2011 update.
New York, NY: Guttmacher Institute. Retrieved from
http://www.guttmacher.org/pubs/Medicaid-Family-
Planning-2011.pdf.
32. Sonnenberg, F.A., Burkman, R.T., Hagerty, C.G.,
Spero, L., & Spero, T. (2004). Costs and net health
eects of contraceptive methods. Contraception,
69(6), 447–459.
33. Mercer Human Resources Consulting. (2005).
Women’s health care: Understanding the cost
and value of contraceptive benefits. New York,
NY: Author.
34. Trussell, J., Lalla, A.M., Doan, Q.V., Reyes, E.,
Pinto, L., & Gricar, J. (2009). Cost eectiveness of
contraceptives in the United States. Contraception,
79(1), 5–14.
35. Trussell et al., 2013.
36. Mercer Human Resources Consulting, 2005.
37. Campbell, K.P., Waters, A., Luckman, J., &
Rothermel, S. (2007). Investing in maternal and
child health: An employer’s toolkit. Washington,
DC: National Business Group on Health. Retrieved
from http://www.businessgrouphealth.org/pub/
f3004374-2354-d714-5186-b5bc1885758a.
38. Kaye et al., 2014; Sonfield, A., Hasstedt, K.,
Kavanaugh, M.L., & Anderson, R. (2013). The
social and economic benefits of women’s ability
to determine whether and when to have children.
New York, NY: Guttmacher Institute. Retrieved from
http://www.guttmacher.org/pubs/social-economic-
benefits.pdf; Logan, C., Holcome, E., Manlove, J., &
Ryan, S. (2007). The consequences of unintended
childbearing. Washington, DC: Child Trends.
Savings to Society and the Benets
of Birth Control in America
Getting the Facts Straight • 39
Our mission is to improve the lives and future prospects of children
and families and, in particular, to help ensure that children are born
into stable, two-parent families who are committed to and ready for
the demanding task of raising the next generation.
Our strategy is to prevent teen pregnancy and unplanned pregnancy,
especially among single, young adults.
We support a combination of responsible behavior by both men and
women and responsible policies in both the public and private sectors.
When we are successful, child and family wellbeing will improve.
There will be less poverty, more opportunities for young men and
women to complete their education or achieve other life goals,
fewer abortions, and a stronger nation.
The National Campaign to Prevent Teen and Unplanned Pregnancy
1776 Massachusetts Avenue, NW • Suite 200 • Washington, DC 20036
www.TheNationalCampaign.org
40 • The Benefits of Birth Control in America
The National Campaign to Prevent Teen and Unplanned Pregnancy
1776 Massachusetts Avenue, NW • Suite 200 • Washington, DC 20036
www.TheNationalCampaign.org
