The 80 million unintended pregnancies that occur worldwide each year (38% of all pregnancies) can justifiably be deemed an epidemic. These pregnancies result in 42 million induced abortions and 34 million unintended births - births that contribute substantially to the annual world population growth of 78 million. Among developed countries the US record of family planning is uniquely deficient. Of 6.1 million pregnancies in 2001 half were unintended (as were more than 80% of the 800000 annual teen pregnancies) resulting in 1.3 million abortions 4 million births (of which one-third were unintended) and 800000 miscarriages. ... Leading causes of unintended pregnancy are closely related to contraceptive method choice. In 2002 more than half of contraceptive users relied on methods with high failure rates under typical use: 31% used the pill 18% the male condom and 5% the 3-month injectable. While with perfect use these methods are highly effective 9% of pill users 17% of condom users and 5% of injectable users will become pregnant during the first year of typical use. To make matters worse about half of condom and injectable contraception users - and almost one-third of pill users - will discontinue within a year. ... Past experience with the successful introduction of new contraceptives or reintroduction in the case of the IUC provides guidance to improve provision and use. Recommended activities include the following: 1) Undertake research; 2) Develop information and training materials; 3) Provide training and technical assistance; 4) Address the high cost of LARC methods; 5) Increase patient awareness; and 6) Fully fund family planning programs for low-income clients. (excerpt)
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