The Unintended Consequences of Unintended Pregnancy: Unpacking a Public Health Paradigm Shift
By Lisa Stern
Since the mid-twentieth century, government agencies, public health institutions, and health care providers have worked to curb the phenomenon known as “unintended pregnancy.” Reducing unintended pregnancy appears on many lists of public health priorities, and seeking to measure and control unintended pregnancy has guided much public policy, research, and clinical practice.
According to most sources, though, these interventions have largely failed. Rates of unintended pregnancy have hovered around fifty percent for decades, with only slight fluctuations. But does this truly constitute a public health failure? Or have researchers, policymakers, and clinicians been measuring the wrong thing all along?
More evidence, summarized in this recent publication, points to problems in our understanding of pregnancy intention. Over the past decade, this framework has been called into question based on the following understandings:
Planning and intention are not in line with everyone’s beliefs and values about pregnancy and childbearing
Reducing unintended pregnancy has been used as a justification for coercive policies and programs
Consequently, new measures, including pregnancy acceptability, desire to avoid pregnancy, and sexual and reproductive wellbeing are in development.
Shifting toward more just and accurate frameworks and redressing past harms is a core element of CECA’s commitment to sexual and reproductive health equity. We urge a rethinking of traditional public health models; development of new, more holistic measures and understandings; and inclusion of community participation and insight in measure development work.