Despite modern, effective contraception being widely available, half of all pregnancies are unplanned and many are unwanted.
According to the United Nations Population Fund Agency (UNFPA) State of the World Population Report for 2022, this state of affairs is a reminder of how many people, especially women and girls, are limited in exercising their basic rights.
‘It is a sign that gender discrimination continues to wind through the lives of women and girls, as well as transgender, non-binary and gender expansive people,’ the report says.
It says this also points to deep gaps in rights and justice, gender equality, human dignity and broader social well-being.
‘So many unplanned and unwanted pregnancies raise questions about how much the rights and potential of more than half of humanity are prioritised and valued. They signal that the world could fail to reach its development goals for health, education and gender equality, derailing the shared ambitions of the international community,’ the UNFPA report says.
It further says the 121 million unintended pregnancies that occur every year, or 331,000 per day on average, represents a global failure to uphold a basic human right.
‘And that failure is expected to grow,’ the organisation says.
The report further says while recent data also shows that, worldwide, the unintended pregnancy rate fell between 1990 and 2019, continued global population growth means that the absolute number of unintended pregnancies will keep rising without decisive action.
Delivering the sexual and reproductive health services individuals and communities need will only become more difficult in the face of problems like climate change, conflicts, public health emergencies and mass migration.
These megatrends will test the capacity of health systems even as demand grows, especially in the world’s Least Developed Countries (LDCs), where crises will be felt most acutely and where services and resources are already in critically short supply.
The international community has committed to a rights-based roadmap to guide humanity through these monumental changes through the 2030 Agenda for Sustainable Development.
The 2030 Agenda is a framework for sustainable and inclusive development that expressly recognizes, in targets 3.7 and 5.6, the role of sexual and reproductive health and gender equality in unlocking a more prosperous future.
These targets are linked to the right of every individual and couple to choose whether to have children and their number and spacing, where every birth is wanted and every child is valued.
So many unplanned and unwanted pregnancies raise questions about how much the rights and potential of more than half of humanity are prioritised and valued.
The report has established that social and economic development and higher levels of gender equality strongly relate with lower rates of unintended pregnancy.
Coupled with what is known about the consequences of unintended pregnancy to individuals and societies, the report confirms the powerful development case for intensifying efforts to uphold reproductive rights as fundamental to reducing unintended pregnancies.
Many factors linked to reducing unintended pregnancy are themselves core development goals, from poverty reduction to improved maternal health.
One clear illustration of these intersecting forces is the extraordinary cost, to individuals, health systems and whole societies is unsafe abortion, which is an issue that challenges both rights and development.
Over 60 per cent of unintended pregnancies end in abortion, safe or unsafe, legal or illegal Given that an estimated 45 per cent of all abortions remain unsafe (WHO, 2020), this is a public health emergency.
Unsafe abortion hospitalises about seven million women a year in developing countries, costing an estimated $553 million per year in post-abortion treatment costs alone and resulting in an estimated 193,000 maternal deaths between 2003 and 2009.
‘By contrast, reducing unintended pregnancies, and therefore remedy to unsafe abortion, can enable health systems to allocate resources towards comprehensive sexual and reproductive health services, including maternal and newborn health, investments that yield positive impacts across the board,’the UNFPA report says.
Contraception is key but not enough contraception is one of the most obvious areas for investment in reproductive health and rights.
According to a report by United Nations Department of Economic and Social Affairs (UN DESA), 2021, globally, an estimated 257 million women who want to avoid pregnancy are not using safe, modern methods of contraception, and of them, 172 million women are using no method at all.
In response, UNFPA has emphasised contraception access, providing 724 million male condoms, 80 million cycles of oral contraceptives and tens of millions of other forms of contraceptives in 2020 alone.
Many other governments, donor and non-governmental organizations have also provided large quantities of contraceptives.
‘But while such commodities are critically important, they are insufficient by themselves. Research shows that lack of awareness about, and lack of access to contraception are no longer leading causes for non-use. Instead, these barriers are now overshadowed by concerns over side effects, myths, stigma and opposition from others,’ the UNFPA says.
Addressing these reasons for unmet need will require a much broader range of responses. Common assumptions must also be erased.
In too many circles, the term “unintended pregnancy” evokes the image of an unmarried teenager, a girl met with pity or derision or both.
Overcoming the popular narratives around unintended pregnancy will require determined efforts to change discriminatory social norms, to address laws that order these stigmas, and to expand interventions that must continue to reach adolescents but extend beyond them as well.
The report explains that decision-making, or its absence, plays out in the most intimate spheres of an individual’s life, touching on fundamental elements of bodily autonomy and reproductive rights.
‘In these spaces, women and girls usually see their choices narrow, or disappear, at every turn. A woman may be unable to negotiate condom use with her partner. She may not be able to say no to sex as is the case for 23 per cent of all women where United Nations 2022 data is available. She may be a victim of rape at home or by a stranger,’ the report says.
It further says if comprehensive sexuality education is not offered in her school, she may lack accurate information.
Pregnancy may be her default option because she has few opportunities and choices in her life.
‘Without a chance to finish her education, she may not see a reason to postpone childbearing. She may not want children at all, a desire that may be unacceptable in her family or community. Unintended is not always unwanted,” the report says.
It says some unintended pregnancies will be celebrated while others will end in abortion or miscarriage.
A share will remain unwanted but carried to term.
And many will be met with uncertainty.
These pregnancies may be not quite unintended but not fully deliberate either, taking place when an individual lacks the possibility to fully articulate what they want in their lives.