According to the 1995 National

Survey of Family Growth (NSFG),

49% of all pregnancies in the United

States (excluding miscarriages)

and 31% of pregnancies resulting

in a live birth are unintended.1

An unintended pregnancy is either

mistimed (the woman wanted to be

pregnant later) or unwanted (she did

not want to ever be pregnant).2,3 One

analysis of the NSFG data found that

the numbers of unintended pregnancies and births had declined from

1987 to 1994;1 however, more recent

data from the Pregnancy Risk

Assessment Monitoring System

(PRAMS) show that these rates may

not be declining in all states.2-4 One

of the goals of Healthy People 2010,

which establishes the nation’s health

goals for the coming decade, is to

decrease unintended pregnancies

from 49% to 30% by 2010.5

The Impact of Unintended

Pregnancy on Women and Children

Unintended pregnancy is of national

importance because it may influence

a woman’s behavior and experiences

during pregnancy and affect the health

of her newborn infant.6,7 Because women whose pregnancies are unintended are likely to discover their

pregnancies later than those with intended pregnancies, they are less likely to adopt healthy behaviors and

start prenatal care at the beginning of pregnancy.7 For

example, women with mistimed or unwanted pregnancies are more likely to smoke cigarettes and less likely

to follow their doctor’s advice to quit smoking than

women with intended pregnancies.7,8 Smoking during

pregnancy not only negatively affects

the mother’s health but also can

result in preterm delivery and low

infant birth weight.9 In addition,

women with unintended pregnancies

may have had inadequate prepregnancy folic acid intake, which has

been linked with neural tube

defects.10

Unintended pregnancy can also

affect infant and child health after

delivery. For example, mothers with

unintended pregnancies resulting

in live births are less likely to breastfeed their infants than women with

intended pregnancies.11

PRAMS Importance in Measuring

Unintended Pregnancy

To prevent unintended pregnancy,

programs must understand and

account for the characteristics

of women at risk. The PRAMS

surveillance system collects statespecific data that can be generalized

to the entire population of women

in that state who gave birth to live

infants during that year.

The PRAMS questionnaire asks women what their

pregnancy intentions were at the time of conception.

Because PRAMS addresses multiple topic areas (e.g.,

unintended pregnancy, mistiming, contraception), different maternal characteristics associated with these topics can be compared. The data can then be used

to improve women’s access to family planning services,

increase their knowledge of reproductive health and

contraception, and encourage them to use contraception.

PRAMS and ...

Unintended Pregnancy

What is PRAMS?

The Pregnancy Risk

Assessment Monitoring

System, administered

by the Centers for Disease

Control and Prevention, is

an ongoing, state-specific,

population-based surveillance system of maternal

behaviors and experiences

before, during, and after

pregnancy. Developed

in 1987, PRAMS was

designed to supplement

vital records by providing

state-specific data on

maternal behaviors and

experiences to be used for

planning and assessing

perinatal health programs.

Currently conducted in 31

states and one city, PRAMS

collects data on 60% of

U.S. births.

RA ED

MT ENT OF HEALTH & HUM N ERVICE •U A

P

A S

S S

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Prevalence Rates and Trends in Unintended

Pregnancies Resulting in Live Births

The 1999 PRAMS data on unintended pregnancy

resulting in a live birth in 17 states indicated a prevalence range of 34%–52%.2 From 27% to 36%

of pregnancies were mistimed, and 6%–14% were

unwanted (Figure 1). Recent PRAMS data show little

change in the prevalence of unintended pregnancy

resulting in a live birth. From 1993 to 1999, the prevalence of mistimed or unwanted pregnancies declined

significantly in only two PRAMS states (Florida and

West Virginia).2

Unintended Pregnancy and Maternal Characteristics

PRAMS data for 1999 show that unintended pregnancy

among women giving birth to a live infant was most

common among young women, black women, women

with 12 or fewer years of education, and women whose

prenatal care was paid by Medicaid (Table 1).

Contraception’s Role in Unintended Pregnancy

A large part of many women’s reproductive lives, from

menarche to menopause, may be spent trying not

to become pregnant.12 Effective contraception is important for women who wish to avoid pregnancy at certain

times during their lives. However, recent research

noted that 50% of all unintended pregnancies were

among women who did not use contraception, and that

the overall rate of unintended pregnancy could be cut

in half if these women were to use highly effective

contraception.13

Figure 1. Mistimed and Unwanted Pregnancy Among Women Having a Live Birth, 1999

Mistimed

Unwanted

Source: PRAMS surveillance data, 1999

Percent

Alabama

North Carolina

Alaska

Arkansas

Colorado

Florida

Illinois

Louisiana

Maine

New Mexico

New York

Ohio

Oklahoma

South Carolina

Utah

Washington

West Virginia

Table 1. Unintended Pregnancy Among

Women Having a Live Birth, by Selected

Maternal Characteristics, 1999

Maternal

characteristic

Prevalence

(%) range

State with

lowest value

State with

highest value

Age

Race

Education

Medicaid

recipient

< 20

20 - 24

25 - 34

35 +

66.3 - 84.4

32.4 - 64.7

23.7 - 37.2

18.4 - 35.7

AK

UT

NY*

UT

IL

LA

AR

NM

White

Black

Other †

32.1 - 44.4

46.2 - 76.7

33.4 - 44.4

NY*

CO

OH

AR

IL

LA

< 12 years

12 years

> 12 years

48.0 - 66.7

33.4 - 54.9

25.3 - 39.5

NM

UT

NY

LA

AR

LA

Yes

No

50.1 - 70.0

23.5 - 37.7

UT

ME

LA

OK

* Does not include New York City.

† Other race varies by state, but includes Native American,

Asian, and other nonwhite.

Source: PRAMS surveillance data, 1999.
lence, may influence contraceptive use.17,18

Importantly, the concept of planning and

pregnancy intention may not be meaningful

to all women.17,18 This conceptual issue

affects how we understand and measure

intention. Finally, little is known about the

influence of gender and power on reproductive health decision making and the

role of male partners in determining

pregnancy intention and contraceptive

use.18 Future analyses of PRAMS data

can help to answer these questions.

Using PRAMS Surveillance to Improve the

Health of Mothers and Babies

PRAMS, which is already a valuable data

source for examining unintended pregnancy,

continues to expand questions to better

measure intention and track trends in

unintended pregnancy and contraceptive

use. Learning more about the measurement of intention and the maternal characteristics associated with not intending

to get pregnant may help to improve interventions

aimed at women at high risk for unintended pregnancy. Trends and Prevalence in Contraceptive Use

and Unintended Pregnancy

PRAMS data for 1999 show that the prevalence

of contraceptive use at the time of conception

in 17 states ranged from 33% in Ohio to 46% in Maine

(Figure 2).

2 Between 1996 and 1999, rates of contraceptive use declined significantly in Alabama, Florida,

and New York. Contraceptive use was not significantly

associated with any of the selected characteristics

of women who had an unintended pregnancy.

Building on Research

Unintended pregnancy remains a serious problem

in the United States for sexually active women

of reproductive age. New studies need to build

on existing research and improve our understanding

of pregnancy intention. For example, further exploration

is needed of the finding from earlier studies5,14 that

causal links between unintended pregnancy and poor

birth outcomes may be influenced by social and

cultural factors such as poverty. Other studies have

suggested that unwanted pregnancies are more likely

than mistimed ones to have negative health outcomes,15

and that seriously mistimed pregnancies (more than 24

months) may have a higher risk for negative health

outcomes for mother, child, and family than moderately

mistimed pregnancies (less than 24 months).16

Understanding these differences is vital to measuring

how pregnancy intention influences health outcomes.

We also need to better understand how women’s feelings

about becoming pregnant, especially feelings of ambivaAlabama

North Carolina

Alaska

Arkansas

Colorado

Florida

Illinois

Louisiana

Maine

New Mexico

New York

Ohio

Oklahoma

South Carolina

Utah

Washington

West Virginia

Figure 2. Contraceptive Use at Time of Conception Among Women

With Unintended Pregnancies Having a Live Birth, 1999

Percent

Source: PRAMS surveillance data, 1999

Technical Notes

PRAMS data were collected in 17 states in 1999:

Alabama, Alaska, Arkansas, Colorado, Florida, Illinois,

Louisiana, Maine, New Mexico, New York, North

Carolina, Ohio, Oklahoma, South Carolina, Utah,

Washington, and West Virginia (Figure 3).

Questions Used

Unintended Pregnancy: “Thinking back to just before

you were pregnant, how did you feel about becoming

pregnant?” Responses: (1) I wanted to be pregnant

sooner, (2) I wanted to be pregnant later, (3) I wanted

to be pregnant then, (4) I didn’t want to be pregnant

then or any time in the future, (5) I don’t know. “Don’t

know” responders were excluded from the analysis.

Contraception: “When you got pregnant with your

new baby, were you or your husband or partner

using any kind of birth control? Birth control means

the pill, condoms, diaphragm, foam, rhythm, Norplant,

shots (Depo-Provera), or any other way to keep from

getting pregnant.” Responses: (1) No (2) Yes.
References

1. Henshaw SK. Unintended pregnancy in the United States. Family

Planning Perspectives 1998;30(1):24-29.

2. Beck L, Johnson C, Morrow B, et al. PRAMS 1999 Surveillance

Report. Atlanta, GA: Centers for Disease Control and Prevention,

2003.

3. Colley Gilbert B, Brantley M, Larson M. Family Planning Practices and

Pregnancy Intention, 1997. Atlanta, GA: Centers for Disease Control

and Prevention, 2000.

4. Brown SS, Eisenberg L, editors. The Best Intentions: Unintended

Pregnancy and the Well-Being of Children and Families. Washington,

D.C.: National Academy Press, 1995.

5. U.S. Department of Health and Human Services. Healthy People

2010. 2nd ed. With Understanding and Improving Health and

Objectives for Improving Health. 2 vols. Washington, DC: U.S.

Government Printing Office, 2000.

6. Kost K, Landry DJ, Darroch JE. The effects of pregnancy planning

status on birth outcomes and infant care. Family Planning

Perspectives 1998;30(5):223-230.

7. Kost K, Landry DJ, Darroch JE. Predicting maternal behaviors during

pregnancy: does intention status matter? Family Planning

Perspectives 1998;30(2):79-88.

8. Hellerstedt WL, Pirie P, Lando HA, et al. Differences in preconceptional

and prenatal behaviors in women with intended and unintended

pregnancies. American Journal of Public Health 1998;88(4):663-666.

9. Mainous AG, Hueston WJ. The effect of smoking cessation during

pregnancy on preterm delivery and low birth weight. The Journal

of Family Practice 1994;38(3):262-266.

Locksmith GJ, Duff P. Preventing neural tube defects: the importance

of periconceptional folic acid supplements. Obstetrics and Gynecology

1998;91:1027-1034.

Dye T, Wojtowycz, Aubry RH, Quade J, Kilburn H. Unintended

pregnancy and breast-feeding behavior. American Journal of Public

Health 1997;87(10):1709-1711.

Forrest JD. Timing of reproductive life stages. Obstetrics and

Gynecology 1993;82(1):105-111.

13. Burnhill M. Contraceptive use: the U.S. perspective. International

Journal of Gynecology and Obstetrics 1998;62[Suppl 1]:S17-S23.

14. Santelli J, Rochat R, Hatfield-Timajchy K, et al. The measurement

and meaning of unintended pregnancy. Perspectives on Sexual and

Reproductive Health 2003;35(2):94-101.

15. D’Angelo D. Demographic and psychosocial factors associated with

unintended pregnancy: are women who report mistimed and

unwanted pregnancies different? Emory University Master’s Thesis,

2001.

16. Pulley L, Klerman L, Tang H, Baker B. The extent of pregnancy

mistiming and its association with maternal characteristics and

behaviors and pregnancy outcomes. Perspectives on Sexual and

Reproductive Health 2002;34(4):206-211.

17. Trussel J, Vaughan B, Stanford J. Are all contraceptive failures

unintended pregnancies? Evidence from the 1995 National Survey

of Family Growth. Family Planning Perspectives 1999;31(5):246-247,

260.

18. Sable M. Pregnancy intentions may not be a useful measure for

research on maternal and child health outcomes. Family Planning

Perspectives 1999;31(5):249-250.

MD 

NJ

VT

Figure 3. States Participating in PRAMS

States participating in 1999

States added since 1999

Acknowledgements

Many thanks to Jennifer O’Brien, lead

author. Others providing input and

support include Diana Bensyl, Brenda

Colley Gilbert, Denise D’Angelo, Lisa

Angus, Nedra Whitehead, and the

PRAMS Working Group.

For More Information

For additional information or to obtain copies of this fact sheet, the PRAMS 1999 Surveillance Report, or the Family Planning Practices and

Pregnancy Intention Report, write or call the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention

and Health Promotion, Division of Reproductive Health, 4770 Buford Highway, NE, Mail Stop K-22, Atlanta, Georgia 30341-3717; (770) 488-6260.

To learn more about PRAMS and unintended pregnancy, visit our Web site: http://www.cdc.gov/nccdphp/drh.

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