Don't blame and shame women for unintended pregnancies

The line between “intended” and “unintended” pregnancy can be blurred. Some unintended pregnancies can lead to wanted births, and some intended pregnancies are aborted. But women should not be blamed for getting pregnant accidentally, because factors outside their control are often involved.

Pregnancies that are unexpected, mistimed or unwanted are common everywhere and in Australia up to one-third of pregnancies are unintended. The results of our recent national survey of women and men in Australia aged 18 to 51 show that unintended pregnancies appear to have increased over time despite more reliable contraceptives becoming available.

What other factors are involved?

Our data show that living in a rural area, being socially disadvantaged and sexual violence play a crucial part in pregnancies that are unintentional.

Contraception

Most women in Australia who are potentially able to conceive have access to and report using contraception. However, no contraceptive is foolproof. Long-acting reversible contraceptions are highly effective, but failure rates of the more commonly used methods are higher.

Rural residence

Our survey data showed that living in a rural area significantly increased the odds of experiencing an unintended pregnancy. This suggests access to contraceptives of choice might be a problem. In small communities it can be embarrassing to consult a doctor, who may be known in a social or familial setting, about sexual and reproductive health matters. And health services may be less accessible if they are a long way away.

Inequality

Socioeconomic inequality remains a key factor contributing to reproductive outcomes in Australia. In our survey, women and men living in poorer areas were more likely to report an unintended pregnancy.

The reasons for this are likely to be complicated but we know that GP consultations with people from non-English speaking backgrounds or who are Indigenous or hold a Commonwealth Health Care Card are less likely to involve discussions about contraception than consultations with people from other community sectors. The cost of contraceptives can also be a barrier to uptake.

Sexual coercion

Access to and use of reliable contraception is necessary for avoiding pregnancy but the dynamics of the relationship are also important. Survey respondents were asked about past experiences of sexual coercion.

More than a quarter of women and almost one in ten men reported having been forced to do something sexual that they didn’t want to do during their lifetime. Women and men who had ever experienced unwanted sex were twice as likely also to report unintended pregnancy.

Respectful relationships that enable consistent use of a reliable contraceptive method are crucial. It may be that people with experiences of unwanted sex have generally low agency for negotiating with a sexual partner about using contraception, even in consensual sex.

Why is this important?

Although some people leave conception to chance for a variety of reasons, most women and men want to plan the timing of having children.

Control over when to have children is essential for women’s equality of opportunity and the birth of babies who are wanted and for whom optimal care can be provided. Reproductive autonomy is therefore central to the well-being of women, men and their families.

Seeking health care prior to conception is only possible when a pregnancy is intended. Actions might include getting immunised, changing diet, improving exercise and avoiding alcohol or drugs. These are vital opportunities to optimise the outcomes of pregnancy for mother and baby.

Women who experience an unintended pregnancy have frequently been vilified for being foolish and irresponsible. This pejorative stereotype persists despite the fact that almost all women and men who responded to our survey agreed that responsibility for contraception should be shared by both sexual partners.

What can be done to reduce unintended pregnancies?

Education about contraception and access to effective contraceptives of choice are reproductive rights. But more sophisticated sex education and contraceptive counselling are required. These should build skills to address unequal power between women and men in sexual relationships to enable them to negotiate contraception use effectively.

Governments have a role in improving reproductive autonomy. Investment in sexual violence-prevention is essential but they must also address structural barriers. If guaranteed universal paid maternity leave, flexible family-friendly work conditions for parents, and job security and pay equity for women were universally available, unexpected conceptions might not be so inconvenient or impossible to pursue and therefore less likely to be seen as “unintended”.

Heather Rowe receives funding from the Australian Research Council, Family Planning Victoria, the Victorian Government Department of Health and Human Services, the Royal Women's Hospital, Melbourne IVF, the Australian Government, the National Health and Medical Research Council, Australian Rotary Health, Jean Hailes for Women's Health and philanthropic organisations.

Jane Fisher receives funding from the National Health and Medical Research Council, the Australian Research Council, the Australian Government, the Victorian Department of Health and Human Services, Jean Hailes for Women's Health, Family Planning Victoria, Women's Health Victoria, Monash Health, the Australian Federation of Medical Women, the Parenting Research Centre, Melbourne IVF, Grand Challenges Canada, Australian Rotary Health; the L and H Hecht Trust, the Jack Brockhoff Foundation and the Prostate Cancer Foundation of Australia.

Maggie Kirkman receives funding from the Australian Research Council, the National Health and Medical Research Council, Family Planning Victoria, Melbourne IVF, Monash IVF, the Victorian Government Department of Health and Human Services, the Royal Women's Hospital, Jean Hailes for Women's Health, Women's Health Victoria, and philanthropic and not-for-profit organisations .

Sara Holton is a co-investigator on the 'Understanding fertility management in contemporary Australia' study which was supported by an Australian Research Council Linkage Project Grant (LP100200432) with funding and in-kind contributions from Family Planning Victoria, Melbourne IVF, The Royal Women’s Hospital, and the Victorian Department of Health