What does ‘unintended’ pregnancy really mean?
The United States Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative targets unintended pregnancy as a “common and costly health condition” in need of prevention through increasing access to contraception. While access to contraception is an important tenet of reproductive health and rights, we should be wary of the assumptions behind the construct of unintended pregnancy and what it means for people with childbearing capabilities.
The CDC, along with other researchers, policymakers, and health organizations, use a definition of unintended pregnancy that was first introduced during the Baby Boom era. Along with ignoring the dramatic demographic changes of the last 70 years, this definition values white, middle-class, heterosexual, married childbearing over other types of childbearing, leading to a significant overestimation in the number of unintended pregnancies. More importantly, it has led many researchers and organizations to ignore a much more significant factor affecting fertility choices today: a pernicious lack of structural support for mothers.
Unintended pregnancy was first measured systematically in a 1941 survey of families in Indianapolis, and later nationally in 1955 and 1960 in the Growth of American Families Studies. All three of these surveys were limited to married women and defined unintended pregnancy as one that was unwanted, occurring when no or no more children were desired. The 1965 National Fertility Survey also looked at unmarried mothers and introduced the concept of mistimed pregnancies, ones occurring when the pregnancy was wanted at a later time. Today, unintended pregnancy rates are on the decline, coinciding with decreasing pregnancy rates among teens and adults under 24 years old. Over half of U.S. pregnancies are unintended—about half result in live births and the other half end in abortion.
The Baby Boom was a surprise to demographers of the 1940s and 1950s, who had not predicted the sharp increase in fertility after World War II. Pregnancy intention questions and other measures of fertility largely came about during an era when researchers were increasingly interested in population growth, population control, and fertility patterns. This time period in the U.S. was also marked by the stigmatization of sex and childbearing before marriage and other conservative social and cultural norms, including the enforcement of gender roles, largely intended for middle-class, white women.
The social and demographic landscape of the 1940s and 1950s was vastly different from what it is today. “In the 1950s’ people were getting married very, very young and were having children rapidly,” says Pamela Smock, a sociologist at the University of Michigan, Ann Arbor.
But the sexual revolution, the advent of birth control technology, and the legalization of abortion allowed more U.S. women the ability to control their fertility and enter the workforce than women in previous generations, she says. The escalation of divorce and cohabitation also changed the landscape of fertility. “A lot of people don’t know that two-thirds of non-marital births are to cohabiting couples and not just single women,” Smock notes. “Everything has changed since the 1950s. Men’s labor market opportunities, especially if they don’t have a college degree, have declined since this time. That’s huge. People can’t create that family of the ‘50s.”
As sociologist Kristin C. Luker wrote over 20 years ago, pregnancy intention questions of the Baby Boom era were intended to measure the number of children couples had beyond their planned family size. But many men and women think about fertility, reproduction, and sexuality in ways that don’t find timing and planning salient. Research has shown that an unplanned pregnancy doesn’t necessarily mean a woman isn’t happy with that pregnancy. Rather than accurately reflecting a mother’s mindset, calling a pregnancy “unintended” merely labels her deviant from a hegemonic white cultural model of reproduction.
“Rather than accurately reflecting a mother’s mindset, calling a pregnancy “unintended” merely labels her deviant from a hegemonic white cultural model of reproduction.”
With a measure developed under this hegemonic model of timed and planned pregnancies, it should be no surprise that women who are young, Black or Hispanic, low-income, unmarried, and non-college educated are more likely to have their pregnancies categorized as unintended, although rates among these groups are on the decline. Women from socially and economically disadvantaged groups have inadequate healthcare access and experience discrimination and stigma in the healthcare settings, including reproductive health services and contraception. The reproductive experiences and values of these groups of women are impacted by a range of systemic issues related to poverty, racism, and other forms of oppression, such as mass incarceration, residential segregation, availability of quality education, and economic deprivation.
Throughout U.S. history, the reproduction and childbearing practices of women who were poor, Black, Latina, Native, immigrant, young (often teen-aged), queer, and unmarried have always been devalued and placed under scrutiny through various practices and policies. The draconian control of enslaved women’s procreation for economic prosperity, removal of Native children to boarding schools through the 19th and 20th centuries, coercive and forced sterilization of poor and non-white women, denigrating images of Black motherhood, the distribution of Norplant and Depo-Provera to poor women and teenagers, and the criminilization of pregnant women are just a few examples of these reproductive restrictions. By adhering to a hegemonic model of pregnancy planning, the construct of unintended pregnancy excludes the collective reproductive experience of women.
Reproductive justice questions paradigms that value “the reduction of pregnancy in the marginalized groups...instead of honoring their reproductive autonomy.” As legal scholar and reproductive justice advocate, Dorothy Roberts, writes, “Framing birth control as a cost-reducing and problem-solving measure masks its potential for racial and class bias and coercion, as well as the systemic and structural reasons for social inequities.”
Childbearing and motherhood in the U.S. are politically and personally contentious, with assaults on women's reproductive rights intensifying in recent years and the lack of safety net support for working mothers. The very same states that make abortion services difficult to access also lack services and resources geared toward the health and well-being of mothers and children. The 2017 Evaluating Priorities report by the Center for Reproductive Rights and Ibis Reproductive Health found states that pass more abortion restrictions also have fewer policies to support women and children and poorer health and well-being outcomes. But the lack of support for mothers and children is not limited to select states; it’s a nationwide problem by which a lack of universal healthcare, paid maternity and paternity leave, and affordable childcare make motherhood an overwhelming challenge.
A 2016 National Institutes of Health study found that current measures may overestimate rates of unintended pregnancy by over 340,000 pregnancies, suggesting that improved measures may do well to capture women’s reported state of mind and actions towards birth control. Women must balance their personal desires for motherhood against the availability of social, economic, spiritual, and instrumental support in her immediate network. Pregnancy intention questions should acknowledge this reality by incorporating the role of structural support for childbearing in women’s decision to have children. Doing so would emphasize the importance of women’s access to resources that support motherhood, rather than the individual “choice” or decision-making.
Women have the right to have children how they want. The reality is that a planned pregnancy is only one model of motherhood, and it should not be the standard for everyone. Rather than categorize pregnancies as unintended or not, we should start measuring how much support parents have—and that starts with listening to mothers.
Image credit: Mother and baby, 1953. Janice Waltzer on Flickr | CC BY 2.0
