Although the rate of unintended pregnancies in the United States has decreased in recent years, it remains high compared with other developed countries. And though evidence shows how unplanned births affect women’s lives, less is known about what motivates women to avoid unplanned pregnancy, and what stands in their way. New Urban Institute findings are helping fill that gap in knowledge.
Results from focus groups conducted by Urban with women across the country offer a window into the reasons women want to prevent unplanned pregnancy. We learned from them, too, that successfully controlling whether and when to have children can be a challenge: Many women reported that they don’t have access to quality sex education and family planning information. Nor do they have access to different contraceptive options to try, so they can decide what works best for them.
“We wanted to probe further on why the unplanned pregnancy rate in this country remains high despite increases in the availability of free or low-cost birth control,” said Sarah Benatar, a principal research associate in Urban’s Health Policy Center, who helped lead the focus groups. “I think this kind of information from women around the country lends some credible explanations.”
Benatar added that understanding women’s motivations for preventing unplanned pregnancies and their experiences with family planning services can help health care providers, educators, and policymakers better address women’s needs. And doing so can have a ripple effect on women’s lives; evidence shows that being able to use birth control can help improve women’s career, education, and financial futures, as well as that of their families.
To explore the factors that influence their contraceptive choices, Urban researchers spoke with more than 200 women in Delaware, Iowa, Mississippi, California, and Texas—states that represent a range of family planning provider and policy landscapes. The women were 18 to 35 years old, earned low to moderate incomes, and lived in both rural and urban areas of their states.
“Part of the reason we focused on women with lower incomes is because they are at increased risk of having their life trajectories interrupted by an unplanned pregnancy,” Benatar explained. “They are also going to be more dependent on public coverage programs or clinics that provide sliding scale or free services—factors that could affect their access to reproductive health care.”
Women have diverse reasons for wanting to avoid unplanned pregnancies
Nearly all focus group participants said they did not want to become pregnant in the next year. Many had already experienced an unplanned pregnancy. They told us that having a child, or another child, would pose significant financial challenges and strain their relationships with their partner, parents, and other children.
“I’m a single mom, and I’ve been doing this on my own … We’re finally just now getting [financially] stable, and if I got pregnant, all my plans would go out the window,” one woman said.
Many women, especially those who already had children, wanted to avoid having another child because of concerns about the physical stress of pregnancy and the energy required to raise children. Others indicated that the emotional toll of an unexpected pregnancy would make them feel anxious or depressed. “You need to be in your right mind and you need to be in the right part of your life and just be ready physically and mentally,” a woman told Urban researchers, adding that a surprise pregnancy is very difficult.
And some women didn’t want to get pregnant because it was best for their personal well-being: “I’m in recovery from drug addiction and [don’t plan on] having another baby … You have to be more selfish when you’re in recovery because you need to work on yourself.”
An unplanned pregnancy could also jeopardize women’s education and career goals. Some women told us that having another child unexpectedly would require them to drop out of school, and others felt it would delay or disrupt their plans rather than upend them. One woman pointed out that she didn’t want to have a child in the next two years because her focus was elsewhere: “I’m prioritizing my career before all that. Right now, I have a job that I hate, and I don’t want to have kids with a job like that.”
Hers and other women’s sentiments echo findings from Urban’s 2018 Survey of Family Planning and Women’s Lives, a nationally representative survey of women of reproductive age and part of Urban’s body of work on women’s reproductive health and access. In last year’s survey, more than 8 in 10 women said that an unplanned birth would negatively affect their lives. Most (65 percent) worried about how their income would be impacted, followed by concerns about their education (63 percent) and their mental health (59 percent).
Women’s birth control knowledge and experiences vary
Birth control can help women avoid the adverse outcomes they’re concerned about, and the women Urban experts spoke to consistently noted how critical it was for them to have contraceptive choices. However, they each had varying knowledge about birth control, as well as experiences with and perceptions about it. Most women had experience using oral contraceptives to prevent pregnancy. Others practiced abstinence or opted for the birth control shot (Depo-Provera), intrauterine devices (IUDs), and contraceptive implants, though their preference of one of these contraceptive methods over another varied across the states we visited.
Data from Urban’s 2018 family planning survey also show that women throughout the country primarily rely on birth control pills. But, nationally, more are choosing long-acting reversible contraceptives like IUDs, compared with what researchers observed in the focus groups in five states. “There’s definitely a strong movement toward [long-acting reversible contraceptives], and providing women access to that is important,” Urban research associate Emily M. Johnston said. “But I think recognizing that women want the ability to try different methods and decide what works for them is an important message.”
Several focus group participants objected to hormonal methods of birth control, or to birth control in general, because of their religious beliefs or concerns about side effects, which was the primary reason one woman said she and her husband preferred to use condoms.
She shared that she doesn’t want to gain weight from using other forms of birth control, or lose her hair: “I know some people [who experienced hair loss]. I love my hair,” she told Urban researchers. “I don’t want to contaminate my body with taking the pills or the Mirena,” a hormone-releasing IUD.
Though women’s experiences with birth control varied, many said they found it difficult to find a method that worked for them or that they felt comfortable with. Their perceptions were at times influenced by personal experience, as well as by information from family, friends, or health care providers. Those are the people focus group participants most often consulted for guidance about contraceptive choices. They also turned to the internet for information.
When they sought out birth control, many women told Urban researchers they experienced few obstacles. Planned Parenthood clinics, for instance, offered low-cost services in a nonjudgmental environment in many women’s communities. “Medicaid is the bomb because they cover pretty much 100 percent of everything … [My Nexplanon] was covered completely,” one woman said of the contraceptive implant she used.
However, some women perceived that the cost of birth control would be out of their reach. Others reported that they encountered clinics with limited hours, were unable to afford insurance, or did not have access to the full range of contraceptive options.
According to another participant: “If it was easy, I would just go get it. But I have to search on Google for providers and call to see who will take my insurance … No one here wants to talk about birth control. The only way to know about it is if you search for it. It’s not general information everyone knows about.”
Women want more and better reproductive health and family planning information
Across the board, women we spoke to expressed a desire for more access to comprehensive information about sex, reproductive health, and family planning, so they can avoid unintended or mistimed pregnancies. Their prior experiences with sex education differed, depending on the policies in the state they call home. As of February 2019, those policies varied widely:
- California, Delaware, Iowa, and Mississippi mandate some type of sex education in schools; Texas does not.
- Schools in Mississippi require abstinence-only or abstinence-plus education.
- Delaware requires abstinence-plus or comprehensive sex education.
- California mandates comprehensive sex education.
One woman shared that the high school she attended distributed condoms and information about Planned Parenthood. “It was my only option,” she said. “They were okay with you showing up without a parent. I was able to get birth control at 16 and it was fine.”
Others suggested that what they learned about reproductive health and contraception was limited; the sex education they received often lacked substance, leaving them feeling unprepared to make smart decisions about their sexual health and safety. “They had the [abstinence-only program] Worth the Wait after school, but who waits? Some people do, but that’s unrealistic,” one woman told us. “They should at least tell you what to do if you are having sex. They have day cares at school once you have your baby, but it would be nice to know what to do to not have a baby!”
Focus group participants offered ideas for reaching children and young people with accurate, effective messaging about reproductive health. They suggested such efforts could be carried out by schools, churches, after-school programs, and youth groups.
“In school, they used to have pep rallies about smoking, and I feel like they should bring that stuff back … have pep rallies about birth control and being safe and abstinence. You don’t see that,” one focus group participant said.
Another proposed that churches could provide more information about reproductive health care. “We’re kids. It happens. You have sex.” she said. “They talk about abstinence, but that’s it.”
These and other insights that women shared with Urban—from their concerns about the negative effects of unplanned births to their experiences with birth control—underscore “how critical it is for all women to have access to reproductive health and family planning services and care,” said Brigette Courtot, a senior research associate at Urban who conducted the focus groups. “When women can plan their pregnancies, they have more opportunity to achieve their full potential.”
This feature was funded by the William and Flora Hewlett Foundation. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission.
DESIGN Allison Feldman
DEVELOPMENT Jerry Ta
EDITING Rachel Kenney
ILLUSTRATION John Wehmann
WRITING Gillian Gaynair