Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model
Open accessAbstract
BACKGROUND: Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990-2014. METHODS: We developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries. FINDINGS: Worldwide, an estimated 44% (90% uncertainty interval [UI] 42-48) of pregnancies were unintended in 2010-14. The unintended pregnancy rate declined by 30% (90% UI 21-39) in developed regions, from 64 (59-81) per 1000 women aged 15-44 years in 1990-94 to 45 (42-56) in 2010-14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5-24), from 77 (74-88) per 1000 women aged 15-44 years to 65 (62-76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010-14, 59% (90% UI 54-65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52-60) of unintended pregnancies in developing regions. INTERPRETATION: The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies. FUNDING: Dutch Ministry of Foreign Affairs and UK Aid from the UK Government.
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A reduction of unintended pregnancies in developing regions does not coincide with a reduction in abortion rates, indicating that the need for safe abortion care remains besides contraceptive services.
“Studies show that a reduction of unintended pregnancies in the developing regions does not coincide with a reduction in abortion rates, indicating that besides a need for contraceptive services, the need for safe abortion care remains.11”
From Advocating safe abortion: outcomes of a multi‐country needs assessment on the potential role of national societies of obstetrics and gynecology (2020) · cites this paper as [11]
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Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends
Sedgh, G., Bearak, J., Singh, S., Bankole, A., Popinchalk, A., Ganatra, B., Rossier, C., Gerdts, C., Tunçalp, Ö., Johnson, B. R., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30380-4 · Cited by 766 · see citing works
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Hill, B., Skouteris, H., Teede, H. J., Bailey, C., Baxter, J.-A. B., Bergmeier, H. J., Borges, A. L. V., Harrison, C. L., Jack, B., Jorgensen, L., et al. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8122119 · Cited by 65 · see citing works
Taylor, R. M., Wolfson, J. A., Lavelle, F., Dean, M., Frawley, J., Hutchesson, M. J., Collins, C. E., & Shrewsbury, V. A. (2021) · Nutrition Reviews · doi:10.1093/nutrit/nuaa124 · Cited by 36 · see citing works
de Vries, I., van Keizerswaard, L. J., Tolboom, B., Bulthuis, S., van der Kwaak, A., Tank, J., & de Koning, K. (2020) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13092 · Cited by 16 · see citing works
- Authors
- Bearak, J., Popinchalk, A., Alkema, L., & Sedgh, G.
- Affiliations
- Guttmacher Institute (US)
- University of Massachusetts Amherst (US)
- Corresponding author
- Bearak, Jonathan
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 6
- Issue
- 4
- Pages
- e380-e389
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC6055480
- OpenAlex
- W2790928185
- Cited by
- 691
- References
- 1
- Citations by year
- 2026: 29 · 2025: 71 · 2024: 73 · 2023: 68 · 2022: 89 · 2021: 132 · 2020: 140 · 2019: 74 · 2018: 14 · 2015: 1
- FWCI
- 85.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Ministerie van Buitenlandse Zaken
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Social Sciences › Gender Studies › Demographic Trends and Gender Preferences
- Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
- Keywords
- unintended pregnancy, unintended births, abortion, contraceptive use, family planning, regional trends, developed and developing regions, sexual and reproductive health services, pregnancy outcomes, marital status, contraceptive needs, global health monitoring, 1990-2014 trends
- MeSH terms
- Adolescent, Adult, Bayes Theorem, Developing Countries, Female, Humans, Pregnancy, Pregnancy Outcome, Models, Statistical, Developed Countries, Pregnancy, Unplanned, Young Adult
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