CONTEXT: Many pregnancies are unintended, particularly in certain population groups. Determining whether unintended pregnancy rates and disparities in rates between subgroups are changing may help policymakers target reproductive health services to those women most in need.

METHODS: To calculate rates of unintended pregnancy and related outcomes, data on pregnancy intendedness from the 2002 National Survey of Family Growth were combined with birth, abortion and population data from federal, state and nongovernmental sources.

RESULTS: In 2001, 49% of pregnancies in the United States were unintended. The unintended pregnancy rate was 51 per 1,000 women aged 15–44, meaning that 5% of this group had an unintended pregnancy. This level was unchanged from 1994. The rate of unintended pregnancy in 2001 was substantially above average among women aged 18–24, unmarried (particularly cohabiting) women, low-income women, women who had not completed high school and minority women. Between 1994 and 2001, the rate of unintended pregnancy declined among adolescents, college graduates and the wealthiest women, but increased among poor and less educated women. The abortion rate and the proportion of unintended pregnancies ending in abortion among all women declined, while the unintended birth rate increased. Forty-eight percent of unintended conceptions in 2001 occurred during a month when contraceptives were used, compared with 51% in 1994.

CONCLUSIONS: More research is needed to determine the factors underlying the disparities in unintended pregnancy rates by income and other characteristics. The findings may reflect a need for increased and more effective contraceptive use, particularly among high-risk groups.

Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.

BackgroundThe rate of unintended pregnancy in the United States increased slightly between 2001 and 2008 and is higher than that in many other industrialized countries. National trends have not been reported since 2008. MethodsWe calculated rates of pregnancy for the years 2008 and 2011 according to women’s and girls’ pregnancy intentions and the outcomes of those pregnancies. We obtained data on pregnancy intentions from the National Survey of Family Growth and a national survey of patients who had abortions, data on births from the National Center for Health Statistics, and data on induced abortions from a national census of abortion providers; the number of miscarriages was estimated using data from the National Survey of Family Growth. ResultsLess than half (45%) of pregnancies were unintended in 2011, as compared with 51% in 2008. The rate of unintended pregnancy among women and girls 15 to 44 years of age declined by 18%, from 54 per 1000 in 2008 to 45 per 1000 in 2011. Rates of unintended pregnancy...

https://www.nejm.org/doi/suppl/10.1056/NEJMsa1506575/suppl_file/nejmsa1506575_appendix.pdf

Declines in Unintended Pregnancy in the United States, 2008–2011

In the United States, 71% of all deaths among persons aged 10-24 years result from 4 causes: motorvehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these 4 causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol, 18.5% had carried a weapon, 43.3% had drunk alcohol, and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse, 37.2% of sexually active high school students had not used a condom at last sexual intercourse, and 2.1% had ever injected an illegal drug. Among adults aged > or =25 years, 61% of all deaths result from 2 causes: cardiovascular disease and cancer. Results from the 2005 national YRBS indicated that risk behaviors associated with these 2 causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey, 79.9% had not eaten > or =5 times/day of fruits and vegetables during the 7 days preceding the survey, 67.0% did not attend physical education classes daily, and 13.1% were overweight.

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Youth Risk Behavior Surveillance--United States, 2005.

PROBLEM/CONDITION: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during youth, extend into adulthood, are interrelated, and are preventable. REPORTING PERIOD: This report covers data collected during February-December 2003. DESCRIPTION OF SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults--behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity--plus overweight. YRBSS includes a national school-based survey conducted by CDC as well as state and local school-based surveys conducted by education and health agencies. This report summarizes results from the national survey, 32 state surveys, and 18 local surveys conducted among students in grades 9-12 during February-December 2003. RESULTS AND INTERPRETATION: In the United States, 70.8% of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2003 national Youth Risk Behavior Survey demonstrated that, during the 30 days preceding the survey, numerous high school students engage in behaviors that increase their likelihood of death from these four causes: 30.2% had ridden with a driver who had been drinking alcohol; 17.1% had carried a weapon; 44.9% had drunk alcohol; and 22.4% had used marijuana. In addition, during the 12 months preceding the survey, 33.0% of high school students had been in a physical fight, and 8.5% had attempted suicide. Substantial morbidity and social problems among young persons also result from unintended pregnancies and STDs, including HIV infection. In 2003, 46.7% of high school students had ever had sexual intercourse; 37% of sexually active students had not used a condom at last sexual intercourse; and 3.2% had ever injected an illegal drug. Among adults aged > or =25 years, 62.9% of all deaths results from two causes: cardiovascular diseases and cancer. Results from the 2003 national Youth Risk Behavior Survey demonstrate that the majority of risk behaviors associated with these two causes of death are initiated during adolescence. In 2003, a total of 21.9% of high school students had smoked cigarettes during the 30 days preceding the survey; 78% had not eaten > or =5 servings/day of fruits and vegetables during the 7 days preceding the survey; 33.4% had participated in an insufficient amount of physical activity; and 13.5% were overweight. ACTIONS TAKEN: YRBSS data are being used to measure progress toward achieving 15 national health objectives for 2010 and three of the 10 leading health indicators. In addition, education and health officials at national, state, and local levels are using these YRBSS data to improve policies and programs to reduce priority health-risk behaviors among youth.

Youth risk behavior surveillance--United States, 2003.

The age-related decline of the success in IVF is largely attributable to a progressive decline of ovarian oocyte quality and quantity. Over the past two decades, a number of so-called ovarian reserve tests (ORTs) have been designed to determine oocyte reserve and quality and have been evaluated for their ability to predict the outcome of IVF in terms of oocyte yield and occurrence of pregnancy. Many of these tests have become part of the routine diagnostic procedure for infertility patients who undergo assisted reproductive techniques. The unifying goals are traditionally to find out how a patient will respond to stimulation and what are their chances of pregnancy. Evidence-based medicine has progressively developed as the standard approach for many diagnostic procedures and treatment options in the field of reproductive medicine. We here provide the first comprehensive systematic literature review, including an a priori protocolized information retrieval on all currently available and applied tests, namely early-follicular-phase blood values of FSH, estradiol, inhibin B and anti-Mullerian hormone (AMH), the antral follicle count (AFC), the ovarian volume (OVVOL) and the ovarian blood flow, and furthermore the Clomiphene Citrate Challenge Test (CCCT), the exogenous FSH ORT (EFORT) and the gonadotrophin agonist stimulation test (GAST), all as measures to predict ovarian response and chance of pregnancy. We provide, where possible, an integrated receiver operating characteristic (ROC) analysis and curve of all individual evaluated published papers of each test, as well as a formal judgement upon the clinical value. Our analysis shows that the ORTs known to date have only modest-to-poor predictive properties and are therefore far from suitable for relevant clinical use. Accuracy of testing for the occurrence of poor ovarian response to hyperstimulation appears to be modest. Whether the a priori identification of actual poor responders in the first IVF cycle has any prognostic value for their chances of conception in the course of a series of IVF cycles remains to be established. The accuracy of predicting the occurrence of pregnancy is very limited. If a high threshold is used, to prevent couples from wrongly being refused IVF, a very small minority of IVF-indicated cases (~3%) are identified as having unfavourable prospects in an IVF treatment cycle. Although mostly inexpensive and not very demanding, the use of any ORT for outcome prediction cannot be supported. As poor ovarian response will provide some information on OR status, especially if the stimulation is maximal, entering the first cycle of IVF without any prior testing seems to be the preferable strategy.

/pdf/a-systematic-review-of-tests-predicting-ovarian-reserve-and-1ahxtocxqc.pdf

A systematic review of tests predicting ovarian reserve and IVF outcome

Objectives This report presents detailed pregnancy rates for 1990-2008, updating a national series of rates extending since 1976. Methods Tabular and graphical data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. Results In 2008, an estimated 6,578,000 pregnancies resulted in 4,248,000 live births, 1,212,000 induced abortions, and 1,118,000 fetal losses. The 2008 pregnancy rate of 105.5 pregnancies per 1000 women aged 15-44 is 9 percent below the 1990 peak of 115.8. The teen pregnancy rate dropped 40 percent from 1990 to 2008, reaching a historic low of 69.8 per 1000 women aged 15-19. Pregnancy rates have declined significantly for non-Hispanic white, non-Hispanic black, and Hispanic teenagers. Rates in 2008 for non-Hispanic black and Hispanic teenagers were two to three times higher than the rates for non-Hispanic white teenagers. Pregnancy rates for women in their early 20s declined to the lowest level in more than three decades, although the declines have been more modest than for teenagers. Pregnancy rates for women aged 25-29 have changed relatively little since 1990, while rates for women in their 30s and early 40s increased.

Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008.

Objectives This report presents detailed pregnancy rates for 1990-2005, updating a national series of rates extending since 1976. Methods Tabular data on pregnancy rates by age, race and Hispanic origin, and by marital status are presented and briefly described. Results in 2005, an estimated 6,408,000 pregnancies resulted in 4.14 million live births, 1.21 million induced abortions, and 1.06 million fetal losses. The 2005 pregnancy rate of 103.2 pregnancies per 1000 women aged 15-44 years is 11 percent below the 1990 peak of 115.8. The teenage pregnancy rate dropped 40 percent from 1990 to 2005, reaching an historic low of 70.6 per 1000 women aged 15-19 years. Rates fell much more for younger than for older teenagers.

Estimated pregnancy rates for the United States, 1990-2005: an update.

Objectives This report presents detailed pregnancy rates for 1990-2000, updating a national series of rates extending since 1976. Methods Tabular data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and briefly described. Results In 2000 an estimated 6,401,000 pregnancies resulted in 4.06 million live births, 1.31 million induced abortions, and 1.03 million fetal losses. The 2000 pregnancy rate of 104.0 pregnancies per 1,000 women aged 15-44 years is 10 percent lower than the 1990 peak of 115.6. The teenage pregnancy rate dropped 27 percent during 1990-2000, reaching an historic low of 84.5 pregnancies per 1,000 women aged 15-19 years. Rates for younger teenagers declined relatively more than for older teenagers.

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Estimated pregnancy rates for the United States, 1990-2000: an update.

Objectives—This report presents detailed pregnancy rates for 1996 and 1997 to update a recently published comprehensive report on pregnancies and pregnancy rates for U.S. women. Methods—Tabular and graphic data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. Results—In 1997 an estimated 6.19 million pregnancies resulted in 3.88 million live births, 1.33 million induced abortions, and 0.98 million fetal losses. The 1997 pregnancy rate of 103.7 pregnancies per 1,000 women aged 15–44 years is the lowest recorded since 1976 (102.7), the first year for which a consistent series of national pregnancy rates is available. The 1997 rate was 10 percent lower than the peak rate in 1990 (115.6). The teenage pregnancy rate dropped steadily through 1997, falling to a record low of 94.3 pregnancies per 1,000 teenagers 15–19 years, 19 percent below the 1990 level (116.3). Rates for younger teenagers declined more than for older teenagers.

/pdf/trends-in-pregnancy-rates-for-the-united-states-1976-97-an-2nlmclspkl.pdf

Trends in pregnancy rates for the United States, 1976-97: an update.

OBJECTIVES This report presents detailed pregnancy rates for 1990-99. Rates for 1991-97 are revised using populations consistent with the April 1, 2000, census; the revised populations are also used for the new 1998-99 rates. METHODS Tabular and graphic data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. RESULTS In 1999, an estimated 6.23 million pregnancies resulted in 3.96 million live births, 1.31 million induced abortions, and 1.0 million fetal losses. The pregnancy rate in 1999 was 102.1 pregnancies per 1,000 women aged 15-44 years. The 1999 rate was similar to the rates since the mid 1990s, but it was 12 percent below the peak rate in 1990 (115.6). These data extend a consistent series of pregnancy rates from 1976 through 1999. The teenage pregnancy rate dropped steadily through the 1990s, reaching a record low of 86.7 per 1,000 aged 15-19 years in 1999, 25 percent lower than the 1990 peak (116.3). Rates fell more for younger than for older teenagers. The declines reflect reductions in births and abortions.

Stanley Henshaw

Papers

Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008.

Estimated pregnancy rates for the United States, 1990-2005: an update.

Estimated pregnancy rates for the United States, 1990-2000: an update.

Trends in pregnancy rates for the United States, 1976-97: an update.

Revised pregnancy rates, 1990-97, and new rates for 1998-99: United States.