Unintended pregnancies and abortion

Since the dissolution of the Soviet Union, the Russian Federation has been characterized by extremely low levels of fertility, very high rates of induced abortion, and a lack of consistent use of effective contraception by Russian couples. These characteristics, particularly fertility rates leading to negative population growth, have been a major cause for concern in Russia. A recently completed national survey has found, however, that fertility has risen substantially while abortion utilization has fallen sharply. In late 2011, the Russia Reproductive Health Survey (RRHS) was carried out, providing Russia with its first nationally representative estimates of a wide range of reproductive health indicators. The RRHS, with a national sample of over 10,000 women, found the total fertility rate for Russia to have increased substantially, while the total abortion rate fell even more dramatically. In this paper we decompose information from the 2011 RHS and earlier data sources to analyze the interplay between fertility, fertility intentions, various aspects of contraceptive use, and other reproductive behaviors and decisions to better understand how such factors have served to increase fertility and reduce induced abortion recently.

Using Matlab Health and Demographic Surveillance database, the study initially selected about 18,000 women who had pregnancy outcome during 2008-09 and interviewed them subsequently in 2011 to examine the knowledge, cost of complication, and decision-making processes of pregnancy termination. The study documented that thirty percent non-abortion pregnancies were unwanted, but the women did not abort it mainly due to disagreement with the family members (3/4th cases). By contrast, over 90% of the aborted pregnancies were unwanted and most of the women (over 90%) received support from the family members to abort it. Those women who aborted the pregnancy were more knowledgeable about abortion procedures, less likely think that there was a risk of complications and also said less monetary cost of obtaining services for complication. Among women those who had abortion, 35% were using contraception before the conception, and 93% of them became pregnant during the method use. By contrast, among women those who had non-abortion pregnancy outcome, only 9.7% were using contraception before the conception, and 88% of them became pregnant during the method use; both groups were mainly using temporary contraceptive methods.

More than half (52%) of unintended pregnancies in the United States occur among the 10.7% of women using no contraceptive method. Using a qualitative sample of women obtaining abortions in the U.S. in 2008 (n=49), we explored women’s attitudes towards and beliefs about contraception and found that even though two-thirds of the sample had been pregnant before, 32 respondents perceived themselves to have a low likelihood of becoming pregnant. Respondents’ reasons for this perceived low likelihood feel into three categories: invulnerability to pregnancy, perceptions of sub-fecundity, and lack of attention to the possibility of conception. About half of the women discussed more than one theme when explaining why they perceived themselves to have a low likelihood of becoming pregnant at that time. For some women who were using contraception, their perception was based on their contraceptive use although the majority who fell into this subgroup were using contraception inconsistently or incorrectly. We propose a modified Health Belief Model (Hall 2012) to account for women’s ambivalence about the need for contraception based on our results. Further research is needed to quantify who believe they are not at risk of pregnancy and their reasons why to better address women’s misconceptions about fecundity and conception.

In the late 1980s the East-West division by birth control was identified in Europe as the characteristics of women who had abortions differed sharply between the countries of Eastern and Western Europe. In the EE countries the abortion rates were high and abortion was used to limit family size once certain parity had been reached .Thus it was requested by married women with two or more children. In WE countries most women who had abortions were young, childless and unmarried. Since the early 1990s the incidence of abortions in EE countries rapidly decreased although with different intensity. As a result, cross-national variations in abortion level have been reduced by 2009. Has the East-West division remained or has a new one emerged? Can we distinguish new patterns of abortion behaviour? What was the role of birth control method in transition of reproduction patterns? The relationship between the changes in abortion and contraceptive behaviour in EU countries was studied. 21 EU members were selected for comparative analysis. Cluster analysis of birth control indicators and multivariate statistical analysis of GGS data was used to give more detailed insight into current typology of birth control. Finally, factors behind the recent diversification were identified.