Unintended and unwanted pregnancy in Australia: a cross‐sectional, national random telephone survey of prevalence and outcomes

Abstract

P lanned parenthood has important benefits for maternal and infant health. Monitoring and preventing unintended pregnancy is therefore an important public health goal. 1 In the only Australian national household survey about mistimed or unintended pregnancy (undertaken 2005), 18% of women of reproductive age (18e44 years) reported that their most recent pregnancy was mistimed, and a further 17% reported that the pregnancy was unwanted. 2 We undertook a contemporary national population survey to assess the prevalence and outcomes of unintended pregnancy during the preceding ten years. Trained female interviewers (Hunter Valley Research Foundation) undertook a national random computerassisted telephone (mobile and landline) survey (weekdays, 9 ame8 pm) during December 2014 e May 2015. Women aged 18e45 years with adequate English were asked whether they had had an unintended pregnancy during the past ten years, and whether any unintended pregnancy was unwanted. We also asked about the outcomes of all pregnancies. A population sample size of 2000 was required to detect a prevalence of unwanted pregnancy of 10e50% with 90% power. La Trobe University Human Research Ethics Committee approved the study (reference, 14-075).Of 2571 eligible women, 2013 (78.3%) completed interviews. A total of 1390 women (69.1%) had been pregnant during the past ten years, including 362 unintended pregnancies (26%). Most unintended pregnancies (246, 68%) were reported as wanted; 94 (26%) were described as unwanted (Box 1).Half the women with an unintended pregnancy gave birth (194, 53.6%); 110 (30.4%) had abortions, 55 (15.2%) miscarriages, and three (0.8%) were still pregnant at the time of the survey. Of the women who had been pregnant but did not report an unintended pregnancy, 14.7% (151 of 1024) reported having had an abortion (Box 2).Twenty-one of the 246 women (8.5%) with unintended but wanted pregnancies reported abortions. Of the 94 women with unwanted pregnancies, 78 (83%) had abortions, nine (10%) had miscarriages, and seven (8%) carried the pregnancy to term. A total of 261 of 1390 women who had been pregnant (18.8%) reported abortions (Box 1).Most women who had unintended pregnancies (205 of 362, 56.6%) reported not having used contraception at the time. Of the 150 women (41.4%) who had an unintended pregnancy while using contraception, 96 (64%) had used oral contraceptives and 40 (26.9%) had used condoms as their primary methods; nine (6%) were using long-acting reversible contraception (Box 2).

Unintended and unwanted pregnancy in Australia: a cross‐sectional, national random telephone survey of prevalence and outcomes

“…Failed barrier and oral contraception respectively accounted for 52.1% and 29.3% of contraception failures. This differs from the survey findings, where the most common contraception failure was oral contraception, followed by condoms …”

“…Of 309 women (aged 15–46 years) who underwent terminations for unwanted pregnancy from January 2016 to October 2018, 145 chose surgical termination and 164 women chose medical termination. Compared with the national survey, our cohort had similar rates of not using contraception (48.2% v 56.5%) and contraception failure (51.8% v 41.4%) . Failed barrier and oral contraception respectively accounted for 52.1% and 29.3% of contraception failures.…”

“…To the Editor : We note with interest the research letter by Taft and colleagues regarding unplanned pregnancy in Australia . An audit of terminations of pregnancy in our Australian metropolitan hospital service (Austin Health, Melbourne) supports the findings of the national survey while highlighting additional areas of educational need.…”

Factors influencing young women’s contraceptive choices

“…2 One new cross-sectional Australian study found that within the past 10 years, 26% of pregnancies were unintended, and 30% of these ended in abortions. 3 Long-acting reversible contraception (LARC) includes three main methods: copper and progestogen intrauterine devices (IUDs), administered once every 10 and five years respectively; progestogen subdermal implants, administered every three years; and progestogen injections, administered three-monthly. 4 Implants and IUDs are over 99% effective at preventing pregnancy, while progestogen injections are 94-99.8% effective depending on the user.…”

The Guttmacher– Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?

“…A recent survey found that one in four Australian women has experienced an unintended pregnancy in the past 10 years and that most were not using contraception or used a method with relatively low effectiveness due to the demands of consistent use, such as condoms or contraceptive pills . Because of the out‐of‐pocket costs, Australian adolescents face particular barriers in accessing contraception compared with their counterparts in countries such as England .…”