High rates of unintended pregnancies linked to gaps

A new study conducted by the World Health Organization (WHO) in 36 countries found that two-thirds of sexually active women who wished to delay or limit childbearing stopped using contraception for fear of side effects, health concerns and underestimation of the likelihood of conception. This led to one in four pregnancies being unintended.

Whilst unintended pregnancies do not necessarily equate to pregnancies that are unwanted, they may lead to a wide range of health risks for the mother and child, such as malnutrition, illness, abuse and neglect, and even death. Unintended pregnancies can further lead to cycles of high fertility, as well as lower educational and employment potential and poverty – challenges which can span generations.

A need for high quality family planning services

Modern methods of contraception have a vital role in preventing unintended pregnancies. Studies show that 85% of women who stopped using contraception became pregnant during the first year. Among women who experienced an unintended pregnancy leading to an abortion, half had discontinued their contraceptive methods due to issues related to use of the method such as health concerns, side effects or inconvenience of use.

Many such issues could be addressed through effective family planning counselling and support.

“High quality family planning offers a range of potential benefits that encompass not only improved maternal and child health, but also social and economic development, education, and women’s empowerment,” explained Dr Mari Nagai, former Medical Officer for Reproductive and Maternal Health at WHO’s Western Pacific Regional Office, and an author of the report.

Unintended pregnancies remain an important public health issue. Globally, 74 million women living in low and middle-income countries have unintended pregnancies annually. This leads to 25 million unsafe abortions and 47 000 maternal deaths every year.

Findings and recommendations

The WHO study found 4794 women who had an unintended pregnancy after they stopped using contraception. 56% of the women who became pregnant were not using a contraceptive method in the 5 years prior to conceiving. 9.9% of women with an unintended pregnancy indicated that the last method that they had used was a traditional method (e.g. withdrawal or calendar-based method), 31.2% used a short-acting modern method (e.g. pills and condoms) and 2.6% long-acting reversible methods of contraception (e.g. intrauterine device (IUD) and implants).

The study’s findings highlight the need for services that:

  • take a shared decision-making approach to selecting and using effective methods of contraception that most fit the needs and preferences of clients;
  • identify early when women and girls are having concerns about the method they are using;
  • enable women and girls to change modern methods while remaining protected through effective counselling and respect of their rights and dignity.

Missed opportunities to support women’s contraceptive choiceA related WHO study, recently published in the Philippines, found that only 3% of women wanting to delay or limit childbearing received contraceptive counselling during their last visit for any reason to a health facility. Screening all women for family planning concerns could help prevent the large numbers of unintended pregnancies and unsafe abortions occurring in many countries in Asia. In the Philippines alone, it is estimated that there are almost 2 million unintended pregnancies each year and over 600 000 unsafe abortions.

Without adequate counselling, improved quality of service, expansion of effective and acceptable contraceptive choices and respect for the rights of all women and girls, the cycle will continue. Equity is also an important concern. The recent Philippines study showed that women with the least education who did not want to be pregnant were one-third as likely to use modern contraceptives as the most educated.

“Access to high-quality, affordable sexual and reproductive health services and information, including a full range of contraceptive methods, can play a vital role in building a healthier future for women and girls, as well as contributing to attainment of the Sustainable Development Goals,” said Dr Ian Askew, Director of the Department of Reproductive Health and Research at WHO.

Ensuring more people benefit from modern contraception

Overcoming legal, policy, social, cultural and structural barriers will enable more people to benefit from effective contraceptive services. A key component of such services will be firstly, to identify women who may have concerns about their method of contraception and wish to switch methods; and secondly, to provide high-quality counselling, free of stigma, discrimination or coercion to those women in order to ensure that their reproductive intentions are respected, and their sexual health protected.

It is also essential to improve the skills of doctors, nurses and midwives through training and professional development, so that they can provide effective family-centred counselling to all women who need it.

Reasons for discontinuation of contraception among women with a current unintended pregnancy in 36 low and middle-income countries

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