Multiple Unintended Pregnancies in U.S. Women: A Systematic Review

Abstract

Context Each year, nearly half of all pregnancies in the United States are unintended. Risk factors of unintended pregnancy have been studied without attention to whether the pregnancy was the woman’s first unintended pregnancy or whether she had had more than one. Little is known about the prevalence, incidence, and risk factors for multiple unintended pregnancies. The purpose of this paper is to present a systematic review of the extant literature on the risk factors for multiple unintended pregnancies in women in the United States, and whether these factors are specific to multiple unintended pregnancies. Methods PubMed, PsychInfo, CINAHL, Web of Science and JSTOR databases were searched for empirical research studies performed after 1979, in the U.S., with a primary outcome of multiple unintended pregnancies. Articles that did not establish the intendedness of the studied pregnancies were excluded. Results Seven studies were identified. For multiple unintended pregnancies, incidence rates ranged from 7.4 to 30.9 per 100 person-years and prevalence rates ranged from 17% to 31.6%. Greater age; identifying as Black or Hispanic; non-voluntary first intercourse, particularly at a young age; sex trade involvement; and previous abortion were found to be associated with multiple unintended pregnancies. Use of IUDs or combined oral contraceptives were found to decrease risk of multiple unintended pregnancies. Conclusions This review suggests a small number of modifiable factors that may be used to better predict and manage multiple unintended pregnancies.

Contraceptive Practices, Preferences, and Barriers Among Abortion Clients in North Carolina

“…Women presenting for abortion are at risk for a subsequent unintended pregnancy and abortion. 1–3 Fertility can return as quickly as 1 to 2 weeks postabortion, 4,5 so timely initiation of contraception after abortion is important. Women who receive a contraceptive method after an abortion are less likely to have a repeat pregnancy postabortion, 2,6–8 and long-acting reversible contraceptive (LARC) methods in particular have been shown to reduce rates of repeat abortion in women who receive them immediately postabortion.…”

Quality assessment with diverse studies (QuADS): an appraisal tool for methodological and reporting quality in systematic reviews of mixed- or multi-method studies

“…- The weighted kappa was 0.5 (indicating moderate agreement), and the Spearman correlation was 0.75 (indicating a strong association or relationship). - Aztlan-James E.A [ 23 ]. 2018 America Medicine A systematic review investigating multiple unintended pregnancies in U.S. women.…”

Contraceptive counselling in abortion care

“…These women face greater socioeconomic challenges than others. This indicates a need to improve contraceptive counselling and services at the time of an abortion [9][10][11][12][13].…”

“…Worldwide, repeat UPs and abortions are strongly associated with socioeconomic challenges and inequalities in SRHR, identified in migrant groups, ethnic minorities, and deprived areas [9,11,12,38,40,[43][44][45].…”

“…Research from different countries indicates that the risk of repeat abortion increases with lower educational attainment [11,13,43,53], foreign origin [38,44], low emotional support [13] and experiences of sexual violence [9,54]. Women who experience more than one abortion within two years seem to have an increased vulnerability, reporting both intimate violence, social deprivation, and difficulties in finding a contraceptive method [54].…”