Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model

Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intenti...

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Veröffentlicht in:The Lancet global health Jg. 6; H. 4; S. e380 - e389
Hauptverfasser: Bearak, Jonathan, Popinchalk, Anna, Alkema, Leontine, Sedgh, Gilda
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 01.04.2018
Elsevier
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ISSN:2214-109X, 2214-109X
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Abstract Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990–2014. We developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries. Worldwide, an estimated 44% (90% uncertainty interval [UI] 42–48) of pregnancies were unintended in 2010–14. The unintended pregnancy rate declined by 30% (90% UI 21–39) in developed regions, from 64 (59–81) per 1000 women aged 15–44 years in 1990–94 to 45 (42–56) in 2010–14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5–24), from 77 (74–88) per 1000 women aged 15–44 years to 65 (62–76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010–14, 59% (90% UI 54–65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52–60) of unintended pregnancies in developing regions. The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies. Dutch Ministry of Foreign Affairs and UK Aid from the UK Government.
AbstractList Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990-2014.BACKGROUNDEstimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990-2014.We developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries.METHODSWe developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries.Worldwide, an estimated 44% (90% uncertainty interval [UI] 42-48) of pregnancies were unintended in 2010-14. The unintended pregnancy rate declined by 30% (90% UI 21-39) in developed regions, from 64 (59-81) per 1000 women aged 15-44 years in 1990-94 to 45 (42-56) in 2010-14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5-24), from 77 (74-88) per 1000 women aged 15-44 years to 65 (62-76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010-14, 59% (90% UI 54-65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52-60) of unintended pregnancies in developing regions.FINDINGSWorldwide, an estimated 44% (90% uncertainty interval [UI] 42-48) of pregnancies were unintended in 2010-14. The unintended pregnancy rate declined by 30% (90% UI 21-39) in developed regions, from 64 (59-81) per 1000 women aged 15-44 years in 1990-94 to 45 (42-56) in 2010-14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5-24), from 77 (74-88) per 1000 women aged 15-44 years to 65 (62-76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010-14, 59% (90% UI 54-65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52-60) of unintended pregnancies in developing regions.The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies.INTERPRETATIONThe unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies.Dutch Ministry of Foreign Affairs and UK Aid from the UK Government.FUNDINGDutch Ministry of Foreign Affairs and UK Aid from the UK Government.
Background: Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990–2014. Methods: We developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries. Findings: Worldwide, an estimated 44% (90% uncertainty interval [UI] 42–48) of pregnancies were unintended in 2010–14. The unintended pregnancy rate declined by 30% (90% UI 21–39) in developed regions, from 64 (59–81) per 1000 women aged 15–44 years in 1990–94 to 45 (42–56) in 2010–14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5–24), from 77 (74–88) per 1000 women aged 15–44 years to 65 (62–76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010–14, 59% (90% UI 54–65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52–60) of unintended pregnancies in developing regions. Interpretation: The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies. Funding: Dutch Ministry of Foreign Affairs and UK Aid from the UK Government.
Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990-2014. We developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries. Worldwide, an estimated 44% (90% uncertainty interval [UI] 42-48) of pregnancies were unintended in 2010-14. The unintended pregnancy rate declined by 30% (90% UI 21-39) in developed regions, from 64 (59-81) per 1000 women aged 15-44 years in 1990-94 to 45 (42-56) in 2010-14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5-24), from 77 (74-88) per 1000 women aged 15-44 years to 65 (62-76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010-14, 59% (90% UI 54-65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52-60) of unintended pregnancies in developing regions. The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies. Dutch Ministry of Foreign Affairs and UK Aid from the UK Government.
Author Popinchalk, Anna
Bearak, Jonathan
Alkema, Leontine
Sedgh, Gilda
Author_xml – sequence: 1
  givenname: Jonathan
  surname: Bearak
  fullname: Bearak, Jonathan
  email: jbearak@guttmacher.org
  organization: Guttmacher Institute, New York, NY, USA
– sequence: 2
  givenname: Anna
  surname: Popinchalk
  fullname: Popinchalk, Anna
  organization: Guttmacher Institute, New York, NY, USA
– sequence: 3
  givenname: Leontine
  surname: Alkema
  fullname: Alkema, Leontine
  organization: University of Massachusetts—Amherst, Amherst, MA, USA
– sequence: 4
  givenname: Gilda
  surname: Sedgh
  fullname: Sedgh, Gilda
  organization: Guttmacher Institute, New York, NY, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29519649$$D View this record in MEDLINE/PubMed
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29519648 - Lancet Glob Health. 2018 Apr;6(4):e352-e353
29595478 - Lancet. 2018 Mar 24;391(10126):1121
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Snippet Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations,...
Background: Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing...
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StartPage e380
SubjectTerms Adolescent
Adult
Bayes Theorem
Developed Countries - statistics & numerical data
Developing Countries - statistics & numerical data
Female
Humans
Models, Statistical
Pregnancy
Pregnancy Outcome
Pregnancy, Unplanned
Young Adult
Title Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model
URI https://www.clinicalkey.com/#!/content/1-s2.0-S2214109X18300299
https://dx.doi.org/10.1016/S2214-109X(18)30029-9
https://www.ncbi.nlm.nih.gov/pubmed/29519649
https://www.proquest.com/docview/2012918881
https://pubmed.ncbi.nlm.nih.gov/PMC6055480
https://doaj.org/article/83001e65420347e78496c8f0bd14781b
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