The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Abstract

SummaryBackgroundUnplanned pregnancy is a key public health indicator. We describe the prevalence of unplanned pregnancy, and associated factors, in a general population sample in Britain (England, Scotland, and Wales).MethodWe did a probability sample survey, the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), of 15 162 men and women aged 16–74 years in Britain, including 5686 women of child-bearing age (16–44 years) who were included in the pregnancy analysis, between Sept 6, 2010, and Aug 31, 2012. We describe the planning status of pregnancies with known outcomes in the past year, and report the annual population prevalence of unplanned pregnancy, using a validated, multicriteria, multi-outcome measure (the London Measure of Unplanned Pregnancy). We set the findings in the context of secular trends in reproductive health-related events, and patterns across the life course.Findings9·7% of women aged 16–44 years had pregnancies with known outcome in the year before interview, of which 16·2% (95% CI 13·1–19·9) scored as unplanned, 29·0% (25·2–33·2) as ambivalent, and 54·8% (50·3–59·2) as planned, giving an annual prevalence estimate for unplanned pregnancy of 1·5% (1·2–1·9). Pregnancies in women aged 16–19 years were most commonly unplanned (45·2% [30·8–60·5]). However, most unplanned pregnancies were in women aged 20–34 years (62·4% [50·2–73·2]). Factors strongly associated with unplanned pregnancy were first sexual intercourse before 16 years of age (age-adjusted odds ratio 2·85 [95% CI 1·77–4·57], current smoking (2·47 [1·46–4·18]), recent use of drugs other than cannabis (3·41 [1·64–7·11]), and lower educational attainment. Unplanned pregnancy was also associated with lack of sexual competence at first sexual intercourse (1·90 [1·14–3·08]), reporting higher frequency of sex (2·11 [1·25–3·57] for five or more times in the past 4 weeks), receiving sex education mainly from a non-school-based source (1·84 [1·12–3·00]), and current depression (1·96 [1·10–3·47]).InterpretationThe increasing intervals between first sexual intercourse, cohabitation, and childbearing means that, on average, women in Britain spend about 30 years of their life needing to avert an unplanned pregnancy. Our data offer scope for primary prevention aimed at reducing the rate of unplanned conceptions, and secondary prevention aimed at modification of health behaviours and health disorders in unplanned pregnancy that might be harmful for mother and child.FundingGrants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.

Trends in the sexual behaviour of 15-year olds in Scotland: 2002–14

“…We follow Wellings and colleagues 3 definition of early sexual debut as intercourse before age 16 (legal age of sexual consent in Scotland). Early sexual debut without sexual competence can lead to suboptimal sexual health behaviours including a lack of effective contraceptive use resulting in greater risk of unintended pregnancy 5 and sexually transmitted infections (STI) 6,7 .…”

Measuring unintended pregnancies in postpartum Iranian women: validation of the London Measure of Unplanned Pregnancy

“…Unplanned pregnancies can pose serious threats to the health of mothers, their children and families, and to the wider community. Therefore, reduction of the number of unplanned conceptions has been highlighted in many global public health policy mandates (1). Even in optimal conditions, unplanned pregnancies may have poorer outcomes such as abortion or obstetric complications than those that are scheduled (1).…”

“…Therefore, reduction of the number of unplanned conceptions has been highlighted in many global public health policy mandates (1). Even in optimal conditions, unplanned pregnancies may have poorer outcomes such as abortion or obstetric complications than those that are scheduled (1). Women in developing countries are the most affected by the consequences of unintended pregnancies.…”

A survey regarding acceptability of oral emergency contraception according to the posited mechanism of action

“…In the UK, as many as one third of all pregnancies are thought to be unintended [1,2] and over half 44 of these end in termination [1,2]. The US also reports high rates of unintended pregnancy and 45 abortion [3].…”