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May 01, · Currently, an astonishing 45 percent of the 6 million pregnancies in the United States each year are unintended. Every year, millions of women, married and . Oct 25, · As a result, around a quarter of all pregnancies are unplanned. Around two-thirds of sexually active women surveyed in a new UN study indicated that although they wished to avoid or postpone having.
Around two-thirds of sexually active women surveyed in a new UN study indicated that although they wished to avoid or postpone having children, they had stopped relying on contraception out of concern for how it was affecting their health. As a result, around a quarter of all pregnancies are unplanned. The family planning study of more than 10, women aged 15 to 49, across 36 low and middle-income countries confirms that 65 per cent of women with an what percentage of pregnancies are unplanned pregnancy were either not using contraception, or relied on traditional methods such as withdrawal or calendar-based methods.
Report percentaeg make clear that unintended pregnancy does not necessarily equate to unwanted pregnancies, but without proper planning, they may lead prcentage a range of health risks and complications how to apply for catholic charities the expecting child and mother, from malnutrition, illness, neglect and even death. Issues and concerns regarding birth control what percentage of pregnancies are unplanned be addressed through effective family planning, counseling, and support, the health agency explains.
Moreover, around the world, complicated pregnancies and childbirth are the leading killer of adolescent girls, pregnaancies 15 to 19, according to the UN Population Fund UNFPAyet these young women and girls face enormous barriers when it comes to accessing essential reproductive health information and services.
For example in a parallel study by the WHO in the Philippines, only three per cent of women wanting to delay or limit childbearing received contraceptive counseling during their last health visit. It is estimated there are nearly 2 million unplanned pregnancies each year in the country alone, resulting in someunsafe abortions. A key pregnanices of overcoming legal, policy, social, and cultural challenges to enable people to benefit from effective contraceptive services will be to first identify the women who are living with concerns, and follow up with high-quality counseling of skilled professionals to ensure the women receive effective support, WHO recommends.
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Preconception Health Promotion
Jul 23, · The new estimates show that between and , almost half of all pregnancies were unintended. What is more, women living in the poorest regions were nearly three times as likely to face unintended pregnancies than those in the wealthiest regions. Higher rates of abortion in countries with more legal restrictions. Currently, 45% of pregnancies and one third of births in England are unplanned or associated with feelings of ambivalence. Although pregnancies continuing to term mostly lead to positive outcomes. Worldwide, an estimated 44% (90% uncertainty interval [UI] 42–48) of pregnancies were unintended in – The unintended pregnancy rate declined by 30% (90% UI 21–39) in developed regions, from 64 (59–81) per women aged 15–44 years in –94 to 45 (42–56) in –Cited by:
This professional resource focuses on reproductive choice and ensuring that pregnancy, if desired, occurs at the right time and when health is optimised.
Effective contraception and planning for pregnancy means that women and men stay healthy throughout life and take steps to improve the health of the baby they might have some time in the future. Ensuring that women and men achieve and maintain good health in their reproductive years is a public health challenge that impacts on future health for both themselves and their child.
Therefore, reproductive health should be about improving the general health of the whole population through increasing knowledge of healthy lifestyles, which should be an underlying philosophy of all health, education, and social care. Of these, more than three quarters at any one time want to either prevent or achieve pregnancy. Contraception and preconception care are therefore a day-to-day reality for the vast majority of women for most of their reproductive years.
As such, they should be considered as 2 sides of the same coin, rather than preconception care only being considered at the time of trying to conceive. It is crucial that women have a choice and control over reproduction in order to ensure that as many pregnancies as possible are planned and wanted, health is optimised both before a first pregnancy and in the inter-pregnancy period, and women who do not wish to have children can effectively prevent becoming pregnant.
Protecting health in infancy and supporting the transition to parenthood is vital, as what happens in pregnancy and early childhood impacts on physical and emotional health all the way through to adulthood. A planned pregnancy is likely to be a healthier one, as unplanned pregnancies represent a missed opportunity to optimise pre-pregnancy health.
Although pregnancies continuing to term mostly lead to positive outcomes, some unplanned pregnancies can have adverse health impacts for mother, baby and children into later in life. Traditionally, preconception care has focused on women planning a pregnancy. However, as many pregnancies are unintended at the time of conception, the timing of addressing preconception risks poses a challenge.
Additionally, many women of childbearing age do not seek preconception care for themselves until they are pregnant. Supporting people to develop healthy relationships and prevent unplanned pregnancy is vital for enabling them to fulfil their aspirations and potential, and for their emotional wellbeing. Abortion rates are higher amongst some BAME groups, which may indicate either higher rates of total unplanned pregnancies or greater proportions that culminate in abortion. Unplanned pregnancy is also an issue for women who are over the age of 35, and right through to menopause.
This group are the least likely to be using adequate contraception, despite being sexually active and not wanting to conceive. Rising rates of abortion in this age group support this finding. In , the under conception rate in England was Despite the declining number of teenage pregnancies, teenagers remain the group at highest risk of unplanned pregnancy.
Outcomes for young parents and their children are still disproportionately poor, contributing to inter-generational inequity with higher rates of infant mortality, low birthweight and poor maternal mental health, amongst other adverse outcomes. Experience of a previous pregnancy is a risk factor for young women under the age of 18 becoming pregnant again. Contraception is important for all heterosexual women of reproductive age, regardless of whether they are planning a pregnancy, as it enables them to effectively control if and when they desire to conceive.
If pregnancy is the ultimate wanted outcome, contraception provides a longer opportunity to address health issues in advance of the pregnancy, leading to better health outcomes for both mother and child. Women access contraception from a range of sources, with preference for source and method of contraception varying by both age and deprivation. Whilst GPs are the most popular source used by 6 out of 10 women, sexual health clinics and community clinics are also commonly used, particularly by younger and more disadvantaged populations.
Women should be offered a full range of choices in all settings so that they can choose a method of contraception that suits them best. However, not all methods are always available in all settings. However, one third of women are unable to access contraception from their preferred source, and women who are already disadvantaged are less likely to access contraception and preconception care altogether. Women who are not reached by existing contraceptive services are ideally placed to receive opportunistic contraceptive advice, such as after taking emergency hormonal contraception EHC , after having an abortion or a baby, or when they are in contact with health services for other issues or conditions.
Long-acting reversible contraception LARC , including implants, intrauterine devices IUDs , intrauterine system IUS and the contraceptive injection, are the most effective methods of contraception. However, uptake varies by deprivation as they are not always equally available, and prescription by GPs has changed in the last 10 years. Preconception health — the health of both men and women before conception — is important not only for pregnancy outcomes but also for the lifelong health of their children and even the next generation.
There is mounting evidence of the inter-generational impacts of poor maternal and pregnancy health leading to higher risk of non-communicable disease in the future. This means that preconception care is relevant for the population and individuals who may conceive at some point in the future, as well as for the period when a pregnancy is actively being considered.
The World Health Organisation highlights that preconception care improves the health of women and men while reducing the chances that their child will be born prematurely, have low birth weight, birth defects or other birth-related conditions that could hinder optimal child development. The preconception period presents an opportunity for intervention when women and men can adopt healthier behaviours in preparation for a successful pregnancy and positive health outcomes for both themselves and their child.
As well as allowing physical and mental health conditions and social needs to be addressed and managed prior to pregnancy, preconception health is important because:. However, only a minority of future parents make changes in preparation for pregnancy and most only start thinking about preconception care once pregnant. Women seldom disclose that they are planning to become pregnant to health professionals, despite frequently coming into contact with services for related reasons, such as attending a community contraceptive service, buying a pregnancy test from a community pharmacy, or visiting their GP or early pregnancy unit after miscarriage.
These present ideal opportunities for preconception health interventions, but are frequently missed. Preconception care is a way of supporting women and men to adopt healthy behaviours across the reproductive life-course, through aligning local services to provide universal support for everyone, as well as the targeted support where it is most needed.
It should be person-centred and holistic, which requires coordinated, collaborative commissioning within local maternity systems, across primary care, and more broadly within sustainability and transformation partnerships STPs.
It is also about ensuring that services can take a forward view to promote healthy behaviours and support early interventions to manage emerging risks across the life-course, prior to first pregnancy, and then looking ahead to the next pregnancy and beyond. Fertility and preconception care should also be taken into account and prioritised at the individual level, by both women and men, especially if conceiving is the desired outcome.
Leading a healthy lifestyle and having a healthy household is part of this, and is also important for the success of the pregnancy, and the health and happiness of the child once they are born and grow up. Women who are trying to conceive should be advised to take micrograms of folic acid each day. This can help to prevent birth defects known as neural tube defects, including spina bifida.
However, only one fifth of women report taking folic acid before pregnancy, which rises to three fifths of women once their pregnancy is confirmed. Preconception care varies according to multiple factors, which can be exemplified by the differences in folic acid uptake across different demographics:. Addressing the issue of healthy eating and obesity is one of the commonest challenges during the preconception period that has far reaching impacts. Links between both maternal and paternal diet and weight have been associated with fertility and intergenerational impacts on offspring.
Achieving weight loss requires a longer period of time to address adequately before pregnancy, and is therefore an area where changes could be made earlier than the traditional preconception period of 3 months. Obesity is a significant preconception risk factor and is associated with increased risk of many major adverse maternal and perinatal outcomes.
Maternal obesity is one of several influences that appear to underlie the foetal or preconception origins of later risk of non-communicable diseases, such as Type 2 diabetes, cardiovascular disease, asthma and endometrial cancer. As shown by an analysis in the UK, many women of reproductive age in low, middle, and high-income countries will also not be nutritionally prepared for pregnancy, as they are not meeting even the lower reference nutrient intake amounts.
It is also associated with increased chronic disease risk in offspring. Encouraging women to stop smoking before having a baby benefits both mother and child, and may also help them stop smoking for good. Smoking in pregnancy is associated with poor foetal growth and low birthweight, and with obesity in childhood. However, as stopping smoking can reverse the damage, male partners who smoke should also be encouraged to quit to help improve their fertility and to reduce exposure to second-hand smoke.
Updated guidelines from the UK Chief Medical Officers state that, for women who are pregnant or planning a pregnancy, the safest approach is to not drink alcohol at all, to keep risks to the baby to a minimum. Drinking alcohol during pregnancy can increase the risk of miscarriage and low birth weight, as well as the risk of developing Foetal Alcohol Syndrome FAS. In men, drinking too much alcohol can also cause fertility problems, including:.
As with smoking, these effects can be reversed if excess drinking is stopped. Many men support their partner by cutting down or avoiding alcohol too when they are getting pregnant and afterwards. Case study: Preconception and pregnancy: opportunities to intervene. The interpregnancy period is when women are ideally placed to receive contraceptive advice.
This is because the transition from midwifery to health visiting in these time periods offers further potential to continue preconception care, as well as providing contraception immediately postpartum.
Women are also well placed to receive contraception immediately following the delivery of their baby and before they leave the place of birth. This ensures that the issue does not slip through the net at a time when the focus is often on the baby.
Women report this to be highly acceptable, however contraceptive methods including the IUD and implant are often not available at this time. The subsequent postnatal visits by midwives and health visitors are further opportunities to optimise the health of the mother, as they can be watchful for the emergence of any mental health issues and support return to a healthy weight, amongst other matters. Case study: Immediate postnatal contraception.
Most women will get pregnant if they desire a pregnancy. However, 1 in 7 couples experience difficulty in conceiving, and this can have a significant impact on mental health and wellbeing. There are a number of reasons behind this including:. Biologically, the optimum period for childbearing is between 20 to 35 years of age. Beyond the age of 35, it becomes increasingly difficult to fall pregnant, and the chance of miscarriage rises.
Couples who have difficulty conceiving may choose to have fertility treatment. Reproductive health needs to be part of day-to-day business for many key services, and support for healthy behaviour change must be important for all. One way to achieve this is by incorporating contraception and preconception care discussions into appointments for other aspects of care, such as postnatal contraceptive discussions and during cervical screening appointments. The Marmot Review calls for universal action to reduce the steepness of the social gradient of health inequalities, but with a scale and intensity that is proportionate to the level of disadvantage.
This is called proportionate universalism, and the key to this approach is to create the conditions for people to take control of their own lives. This requires action across the social determinants of health and beyond the reach of the NHS.
Along with national government departments, there is renewed emphasis on the role of local government and the voluntary and private sectors in addressing some of the wider determinants of poorer outcomes, such as worklessness, alcohol use and mental health.
Higher risk groups with multiple vulnerabilities are less likely to be well-reached by mainstream services, and the impacts of poor outcomes are likely to be greater and the intergenerational effects are magnified. As such, most of these women require a more intensive and multidisciplinary approach.
Local authorities and NHS commissioners should align work in their local areas towards a focus on contraception and preconception health. They should prioritise including pregnancy prevention and planning in all relevant policies and embed it into existing services. Developing policies that recognise the role of wider determinants in providing optimal circumstances in which to choose if and when to have a child, should also be prioritised.
There should be system leadership and shared accountability mechanisms in place, as many of these areas cross commissioning boundaries. All women should be able to access reproductive health services across their life course.