In the United States, one out of every two pregnancies is unintended1 – meaning that nearly half of all pregnancies are either mistimed or unwanted. The percent is even higher among teens; eight in 10 pregnancies among 15 to 19 year olds are classified as unintended.1 Moreover, four out of ten births are unintended,7 although this number differs based on race/ethnicity and marital status.3 The high proportions of unintended pregnancies and births warrant attention, given their link to negative outcomes for mothers (including less education and labor force participation and more reliance on welfare and public assistance) and for the children (including lower educational performance and attainment and high levels of poverty and crime).2,4 Unintended pregnancies also result in high costs to society; roughly $11 billion per year (based on Medicaid and CHIP expenditures for births, including costs for prenatal care, labor and delivery, postpartum care and one year of care for the infant).5
Recently, a brief published by The Brookings Institution highlighted three key reasons behind unintended pregnancies: lack of motivation to prevent pregnancy, lack of knowledge about how to prevent pregnancy, and lack of access to reproductive health services or contraception.6 The author reviewed three policies that address these three reasons and that have previously shown to be effective in reducing unintended pregnancies. These three policies included: 1) a national mass-media campaign encouraging condom use; 2) a national pregnancy prevention program targeted at risky teens; and 3) an expansion of Medicaid-funded family planning services. The author used a computer-based policy simulation to calculate the effects of each policy on the number of unintended pregnancies and the societal costs associated with these pregnancies.
Given our work conducting and synthesizing the impacts of rigorous evaluations in LINKS (our database of programs that work to enhance children’s development), Child Trends is delighted to see these analyses, which build on the findings from research and evaluation studies to assess their implications at the societal level. We are also thrilled that the well-being of children and youth are central to the work.
The results of the Brookings simulations indicate that each of the three policy approaches would result in considerable reductions in unintended pregnancies. Specifically, the reductions ranged from two to four percent, or between 15,000 and 23,000 pregnancies per year. Moreover, these policies would reduce the number of teen pregnancies (reductions between one and eight percent), and the number of children born into poverty (reductions between one and two percent), and the number of nonmarital births (reductions between two and three percent). The latter has important implications given our recent work demonstrating the increases in nonmarital childbearing described in our brief and our national and state fact sheets. They would also save taxpayers between two and six dollars for every dollar spent to implement these policies.
The bottom line, according to this brief, is that any of these three policies would lead to reductions in unintended pregnancies and to taxpayer savings – win-win situations, according to the author. Beyond the significance of these specific analyses, it is important to acknowledge the general importance of rigorously assessing the effects, and the benefits versus the costs, of varied program and policy initiatives. Child Trends is working with Brookings to update and enhance the simulation model so that it incorporates additional outcomes and examines outcomes for children and youth at older ages. Such a tool makes research and evaluation more accessible to decision makers and easier to apply to some of the nation’s most challenging social policy issues.
By Amanda Berger, Jennifer Manlove, Kristin A. Moore, and Kate Welti
1 Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84, 478-485.
2 Gipson, J., Koenig, M., & Hindin, M. (2008). The effects of unintended pregnancy on infant, child, and parental health: A review of the literature. Studies in Family Planning, 39(1), 18-38.
3 Guzman, L., Wildsmith, E., Manlove, J., & Franzetta, K. (2010). Unintended births: Patterns by race and ethnicity and relationship type. Perspectives on Sexual and Reproductive Health, 42(3), 176-185.
4 Logan, C., Holcombe, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended childbearing: A white paper. Washington, DC: Child Trends and The National Campaign to Prevent Teen and Unplanned Pregnancy.
5 Sonfield, A., Kost, K., Gold, R. B., & Finer, L. B. (2011). The public costs of births resulting from unintended pregnancies: National and state-level estimates. Perspectives on Sexual and Reproductive Health, 43(2), 94-102.
6 Thomas, A. (2012). Policy Solutions for Preventing Unplanned Pregnancy. Washington, DC: Brookings.
7 U.S. Department of Health and Human Service, Health Resources and Services Administration, & Maternal and Child Health Bureau. (2011). Unintended pregnancy and contraception, from http://www.mchb.hrsa.gov/whusa11/hstat/hsrmh/pages/227upc.html