The cost of unintended pregnancy in the United States

doi:10.1016/j.contraception.2006.11.009

Contraception

Volume 75, Issue 3, March 2007, Pages 168-170

https://doi.org/10.1016/j.contraception.2006.11.009 Get rights and content

Abstract

Introduction

Despite the many contraceptive options available in the United States, nearly half (49%) of the 6.4 million pregnancies each year are unintended; these represent a significant cost to the health care system.

Methods

The total number of unintended pregnancies and their outcomes were obtained from the literature. Direct medical costs were estimated for each unintended pregnancy outcome.

Results

The direct medical costs of unintended pregnancies were US$5 billion in 2002. Direct medical cost savings due to contraceptive use were US$19 billion.

Discussion

Unintended pregnancies are a costly problem in the United States. Contraceptive use can reduce direct and indirect costs; hence, payers may realize cost savings by providing coverage of contraceptive products.

Introduction

Despite the many contraceptive options available in the United States, nearly half (49%) of the 6.4 million pregnancies each year are unintended, which means that at the time that the pregnancy occurred, the woman either did not want to have children anymore (unwanted pregnancy) or wanted additional children but at a later time (mistimed pregnancy) [1]. These unintended pregnancies result in significant costs regardless of the outcome that the woman chooses for her pregnancy.

Previous studies have evaluated the costs of contraception, including the cost of unintended pregnancies associated with contraceptive failures, and the cost-effectiveness of contraceptive methods [2], [3], [4], [5], [6]. However, there are currently no studies that examine the total economic health care burden of unintended pregnancy in the United States. We fill that gap by estimating the direct medical cost of unintended pregnancy in the United States in 2002. We also estimate the savings in unintended pregnancy costs attributable to contraceptive use.

Section snippets

Methods

We obtained the number of unintended pregnancies from the literature. The number of unintended births was obtained from the 2002 National Survey of Family Growth (NSFG); the number of induced abortions was obtained from a 2000 survey of abortion providers by the Guttmacher Institute; the number of fetal losses resulting from unintended pregnancies was estimated as the product of the ratio of fetal losses to births in the 2002 NSFG, the total number of births and the fraction of fetal losses

Results

Direct medical costs of unintended pregnancy are shown in Table 1. The total, US$5.0 billion, comprises US$3.924 billion for births, US$797 million for induced abortions and US$266 million for fetal losses. The average cost of an unintended pregnancy is US$1609.

The total annual number of pregnancies averted by contraceptive use is shown in Table 2. Since each pregnancy averted is associated with an average of US$1609 in direct medical expenditures, the total of 12.0 million pregnancies averted

Discussion

As shown in our analysis, unintended pregnancies are clearly a costly problem in the United States. Direct medical costs of unintended pregnancies are high (US$5 billion). This cost is likely to be understated because we assumed that the medical care cost of an unintended birth is no greater than the average cost of all births. A report from the Institute of Medicine concludes:

With an unwanted pregnancy especially, the mother is more likely to seek prenatal care after the first trimester or not

References (19)

C.F. Chiou et al.
Economic analysis of contraceptives for women
Contraception
(2003)
J. Trussell
Contraceptive failure in the United States
Contraception
(2004)
J. Trussell et al.
Cost savings from emergency contraceptive pills in Canada
Obstet Gynecol
(2001)
L.B. Finer et al.
Disparities in rates of unintended pregnancy in the United States, 1994 and 2001
Perspect Sex Reprod Health
(2006)
B.G. Ortmeier et al.
A cost–benefit analysis of four hormonal contraceptive methods
Clin Ther
(1994)
C.J. Phillips
Economic analysis of long-term reversible contraceptives. Focus on Implanon
Pharmacoeconomics
(2000)
Trussell J, Koenig J, Stewart F, Darroch JE. Medical care cost savings from adolescent contraceptive use. Fam Plann...
J. Trussell et al.
The economic value of contraception: a comparison of 15 methods
Am J Public Health
(1995)
A. Chandra et al.
Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth
Vital Health Stat 23
(1997)

There are more references available in the full text version of this article.

Cited by (145)

Factors associated with contraceptive use among postpartum women with substance use disorder
2022, Sexual and Reproductive Healthcare
Rates of unintended pregnancy among women with substance use disorder (SUD) are much higher than the general reproductive-age population, suggesting lower rates of contraceptive use. This study aims to determine the prevalence of contraceptive use in postpartum women with SUD and identify factors associated with its use.
This retrospective cohort study using electronic health record data from 2016 to 2019 included postpartum adult women with any SUD who received care at a high-risk pregnancy clinic (n = 353). The primary outcome was contraception utilization as identified using diagnosis and procedure codes. An adjusted multivariate logistic regression was used to evaluate the relationship between postpartum contraceptive use and sample characteristics.
Of the 353 postpartum women with SUD, contraceptive use was found in 128 (36.3%) women. Among the study population, the most commonly reported substance use disorders were nicotine use disorder (70.3%), opioid use disorder (51.3%), and cannabis use disorder (15.0%). Among those with opioid use disorder, 45.3% were found to be using medication for opioid use disorder (MOUD). Women who attended a postpartum visit had 2.23 times the odds of using contraception compared to women who did not (OR: 2.23, 95% CI: 1.20–4.15). Those using MOUD had 3.69 times the odds of using contraception compared to those who were not (OR: 3.69, 95% CI: 1.89–7.19). Overall, women who utilized contraception were more likely to be younger than 25, receiving MOUD, and participating in postpartum care.
Postpartum women with SUD are not using contraceptive methods and this is associated with a lack of appropriate healthcare interventions in the perinatal period, which can reduce the odds of receiving effective family planning services. Specialized whole-health interventions and policies to increase access to care for women with SUD should be developed.
Antiseizure medications and oral contraceptives: Impact of enzyme inducers on pregnancy outcomes and costs
2021, Epilepsy and Behavior
To show the impact of drug–drug interactions (DDIs) associated with co-administration of enzyme-inducing (EI) antiseizure medications and oral contraceptives (OCs) on the annual number of unintended pregnancies, their outcomes, and their associated costs in the United States (US).
A Microsoft Excel pregnancy-outcomes model was developed to determine the impact of DDIs in women who take an OC as well as an EI antiseizure medication known to lower the effectiveness of the OC in preventing pregnancy. The model compared the number of unintended pregnancies, the expected pregnancy outcomes, and associated costs in women taking an OC and an EI medication with a matched cohort of women who took an OC and an enzyme-neutral (EN) antiseizure medication that is known not to interact with OCs. The model perspectives were patients and third-party payers in the US. Unintended pregnancy rates, pregnancy outcomes, and cost inputs for the model were taken from published studies.
The results of the analysis showed an estimated increase in the annual number of unintended pregnancies in the US of 503 (a change from 1151 to 1654), an increase of 44.7%, for the estimated 71,922 women currently taking an OC plus an EI medication in the US when compared with a matched cohort taking an OC plus an EN medication. This resulted in an estimated annual healthcare cost increase of $3 million, which is an increase of 5.5% in the annual costs for contraception and pregnancy care. A scenario analysis showed that the annual number of unintended pregnancies could be lower (575 vs 1654) for a matched cohort of women taking EI medications and using a copper intrauterine device, a highly effective and nonhormonal form of contraception, rather than an OC.
Physicians treating women of reproductive age for epilepsy who wish to avoid pregnancy should consider the potential for DDIs that might result in unintended pregnancies. Thus, physicians should alert women using EI medications for epilepsy control to the increased potential for unintended pregnancies if they use OCs for contraception.
Access Denied: The Proliferation of American Medical Abortion Laws, 2000–2018
2021, American Journal of Preventive Medicine
Medical abortion is a safe, effective, and often preferred method of terminating an unintended pregnancy, but access can be made difficult by the laws of a state. Despite modern efforts to prevent unintended pregnancies in the U.S., they comprise almost half of pregnancies and 95% of abortions, signifying that abortion is a necessary and desired healthcare service. This study's purpose is to describe the proliferation of American medical abortion access laws between 2000 and 2018.
Policy surveillance methods were used in 2018 to collect 7 types of U.S. medical abortion access restriction laws in place as of December 1, 2018. Statutory histories were reviewed in 2019 to record the laws’ years of enactment, substantive amendment, and repeal.
A total of 35 states restricted medical abortion access as of 2018. Medical abortion laws increased from 16 in 2000 to 96 by 2018, and only 1 was repealed. A total of 25 states had multiple laws restricting medical abortion access in 2018. Medical abortion access laws surged from 2010 to 2017, but none were passed in 2018. Medical abortion access is generally most restricted in Midwestern and Southern states and least restricted in Western and Northeastern states.
Although evidence demonstrates medical abortion's safety and efficacy, its access is increasingly limited by law in many states. Further research examining the impacts of these laws on women's health and the consequences of unintended births on women, children, families, and society is needed.
Emergency contraception and impact on abortion rates
2020, Best Practice and Research: Clinical Obstetrics and Gynaecology
Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5 mg) or ulipristal acetate (30 mg). Although all EC methods are extremely safe, access to EC is often limited due to prevailing misconceptions over how EC works. Although EC can prevent unintended pregnancy for an individual woman, it has failed to make an impact on abortion rates at a population level. This may be because it is not used after every episode of unprotected sex and because existing oral EC methods are only effective if used before ovulation. Future strategies around EC should focus on maximising uptake of Cu-IUD, facilitating initiation of effective regular contraception after EC and developing a more effective oral EC.
Emergency Department Directors Are Willing to Expand Reproductive Health Services for Adolescents
2019, Journal of Pediatric and Adolescent Gynecology
Nearly 20 million adolescents receive emergency department (ED) care each year, many of whom have untreated reproductive health issues. ED visits represent an opportunity to provide appropriate care, however, ED physician reproductive health care practices and capabilities in the United States have not been described. We sought to characterize pediatric ED director's individual practice and ED system resources for providing adolescent reproductive health care.
We invited pediatric ED division and/or medical directors nationally to participate in an anonymous, online survey.
Outcomes included ED directors' personal practice regarding providing adolescent patients reproductive health care, and their ED's resources and standard practice regarding screening adolescents for sexually transmitted infections (STIs) and other reproductive health concerns.
One hundred thirty-five of 442 (30.5%) ED directors responded. Respondents were 73% (90/124) male, with a median of 18 (interquartile range, 13-23) years of experience and 63% (84/134) working in urban EDs. Seventy-one percent (90/130) preferred face-to-face interviews for obtaining a sexual history, but only 59% (77/130) of participants “always ask parents to leave the room for sensitive questions.” Eighty-four percent (106/127) were receptive to pregnancy prevention interventions being initiated in the ED, with 75% (80/106) of those willing to provide an intervention. Only 16% (21/128) indicated their ED has a universal STI screening program, and only 18% (23/126) “always” successfully notify patients of a positive STI test.
ED directors are comfortable providing adolescent reproductive health care, and many individual- and ED-level opportunities exist to provide improved reproductive health care for adolescents in the ED.
Family planning and contraception use in transgender men
2018, Contraception
Female-to-male (FTM) transgender men (affirmed males) can experience planned and unplanned pregnancy during and after testosterone therapy. We conducted an exploratory study to understand current contraceptive practices and fertility desires among transgender men during and after transitioning.
Self-identified transgender and transmasculine individuals assigned female at birth, ages 18–45, completed an anonymous online survey derived from standardized family planning surveys. We recruited participants from LGBT health centers, online listservs, and online groups for transgender men and used a mixed-methods analysis to evaluate quantitative and qualitative data.
Of the one hundred and ninety-seven participants included in the study, the median age was 30 years old, most respondents were white, and 86% were taking masculinizing hormones (testosterone). Of the 60 pregnancies reported, 10 (17%) pregnancies occurred after stopping testosterone, 1 (1.6%) while taking testosterone irregularly, and 5 of 7 abortions occurred in participants who had been using testosterone in the past. Over half of the respondents desired at least one child, and a quarter reported fears of not getting pregnant. The majority of participants reporting using contraception (n=110, 60.1%), with condoms and pills used most commonly (n=90, 49.2% and n=62, 33.9% respectively). Methods of contraception used did not differ between testosterone users and non-users, except for hormonal IUDs (20% testosterone versus 7% non-testosterone). Thirty participants (16.4%) believed that testosterone was a form of contraception, and 10 (5.5%) participants reported that their healthcare providers advised testosterone as contraception.
Transgender men use contraception and can experience pregnancy and abortion, even after transitioning socially and hormonally. Transgender men need counseling and care regarding reproductive health, including contraceptive and conception counseling.
Providers should be aware that transgender men may desire pregnancy and use contraception; this study highlights the need for further research regarding fertility, fertility desires, and optimal contraception among transgender men.

View all citing articles on Scopus

^☆: This research was partially supported by grants from Berlex, Inc., and Organon, Inc. The content of this article was not influenced by these companies, nor does it reflect in any way the companies' views or positions.

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CommentaryThe cost of unintended pregnancy in the United States☆

Abstract

Introduction

Methods

Results

Discussion

Introduction

Section snippets

Methods

Results

Discussion

Contraception

Contraception

Obstet Gynecol

Disparities in rates of unintended pregnancy in the United States, 1994 and 2001

Perspect Sex Reprod Health

A cost–benefit analysis of four hormonal contraceptive methods

Clin Ther

Economic analysis of long-term reversible contraceptives. Focus on Implanon

Pharmacoeconomics

The economic value of contraception: a comparison of 15 methods

Am J Public Health

Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth

Vital Health Stat 23

Commentary
The cost of unintended pregnancy in the United States☆