Increasing the use of effective contraceptive methods to reduce unintended pregnancy: Building on a broad research base

Almost half of all U.S. pregnancies, 45 percent, are unintended (either unwanted or mistimed), and the proportion is even higher (60 percent) among poor women. Unintended pregnancy has been linked to negative outcomes for mothers and children and costs the public health care system billions of dollars each year. Improving the effectiveness and consistency of contraceptive methods can help reduce high rates of early and unplanned pregnancy.

Child Trends researchers were commissioned by the Planned Parenthood Action Fund to estimate, with the microsimulation model FamilyScape, nationwide pregnancy outcomes if all women not seeking pregnancy used the same mix of effective contraceptive methods as women in high-performing Planned Parenthood clinics. For this simulation, we used the mix of contraceptive methods used by women who had participated in a recent evaluation study conducted by researchers from the University of California, San Francisco.  As compared to women in the United States overall, women at the studied clinics were far more likely to use hormonal and long-acting methods and less likely to use no method or condoms as their primary form of birth control.

The results of our simulation, published in our recently released report “How increasing the use of effective contraceptives could reduce unintended pregnancy and public health care costs,” suggest that the increased use of effective birth control could:

• reduce unintended pregnancies, unintended births, and abortions by approximately two thirds;
• decrease the number of newborns and mothers experiencing negative outcomes such as low birth weight and gestational diabetes; and
• save an estimated $12 billion dollars in public health care costs annually.

This report is part of a broader literature that demonstrates how increases in contraceptive use and effectiveness can reduce early and unplanned pregnancy.

Researchers have demonstrated the importance of contraceptive use in the historical decline of the teen pregnancy rate. A very early study of the declining teen birth rate in the 1990s found that improved contraceptive use at first sex was a factor. Several additional studies have linked increased contraceptive use to between half and all of the reduction in teen pregnancy over the past two decades, depending on the exact time period of interest and measures of sexual activity and contraceptive use utilized in the analysis.

Scholars from Washington University in St. Louis evaluated the Contraceptive CHOICE Project, a program that expanded access to and use of long-acting reversible contraceptive methods (LARCs) through improved contraceptive counseling and free, same-day insertions to a cohort of primarily young, unmarried, and low-income participants at high risk of unintended pregnancy. The program evaluation found that the intervention was linked to dramatic reductions in teen births (82 percent) and abortions (71 percent). A related study found that adopting any kind of hormonal or long-acting contraceptive method would lead to similarly dramatic results. This simulation analysis, using results from the Contraceptive CHOICE Project, found that if women in this population currently using no method or condoms adopted a hormonal method of LARC, their pregnancy rate would drop by nearly 60 percent.

Child Trends’ research has also found that increasing condom use and consistency among men could lead to dramatic declines in nonmarital pregnancies, with the pregnancy, birth, and abortion rates to unmarried women under 25 dropping by up to nearly 50 percent.  In analyses of contraceptive use and nonmarital childbearing among young couples, Child Trends researchers found that both increases in contraceptive use among non-contraceptors (those not using contraception) and improvements in the consistency and effectiveness of contraceptive use among existing contraceptors could lead to up to 25 percent reductions in nonmarital pregnancy rates, 36 percent reductions in abortion rates, and 20 percent reductions in nonmarital birth rates.

Across research studies and program and policy evaluations, Child Trends’ researchers and other scholars have demonstrated that increasing the use of effective contraception can help couples avoid early, nonmarital, and unplanned pregnancy.