Poor women in America are increasingly likely to have unwanted pregnancies, whereas relatively affluent women are succeeding more and more in getting pregnant only when they want to, according to a study analyzing federal statistics.
As a result of the growing disparity, women living in poverty are now almost four times more likely to become pregnant unintentionally than women of greater means, the study found.
Based on nationwide data collected by the National Center for Health Statistics and other sources, the researchers found that from 1994 through 2001, the rate of unplanned pregnancies increased by almost 30 percent for women below the federal poverty line -- now defined as $16,000 annually for a family of three. For women in families comfortably above poverty, the rate of unplanned pregnancies fell by 20 percent during the same period.
The abortion rate also rose among poor women while declining among the more affluent.
"Clearly, something is changing, and it doesn't bode well in terms of unplanned pregnancies and abortions for poor women, in particular," said Heather Boonstra, one of the authors of the report.
Asked what was driving the trends, the authors noted that some state and federal reproductive health programs have been cut or made more restrictive in recent years. State and federal programs have increasingly focused on abstinence rather than contraception, and some analysts have argued that the shift is leading to less use of contraceptives and more unintended pregnancies.
Many social conservatives say, however, that contraceptives have limitations and that the only way a woman can ensure she will not have an unintended pregnancy is to refrain from sexual intercourse until she is ready to have a child.
Leslee Unruh, president and founder of the Abstinence Clearinghouse, a South Dakota-based nonprofit that seeks to educate about abstinence programs, said the growing number of unintended pregnancies among poorer women shows that traditional sex education programs are failing.
"Programs for poor women are often so condescending, even degrading," she said. "They teach how to put on a condom rather than how to take control of their lives."
The finding of a growing divide between poor and more affluent women with respect to unintended pregnancies was contained in a larger report on pregnancy and abortion by the Guttmacher Institute.
Decline in abortion rate
The report, released yesterday, found that the overall abortion rate has declined steadily for years and that a higher percentage of women with unintended pregnancies are carrying them to birth. It also found that women who have abortions are doing so earlier in their pregnancies -- when it is safer for the woman -- than in the past.
But as with unintended pregnancies generally, the trend lines for poor and more affluent women have been diverging. Among the poor, the proportion of unintended pregnancies that resulted in live births increased by almost 50 percent between 1994 and 2001, while it declined for women in families whose income was at least twice the poverty level. Poor women who had abortions did so on average six days later in their pregnancies than women of greater means.
"We're seeing greater disparities when it comes to education and race, as well," said Lawrence Finer, research director of the institute, a nonprofit group that does research, policy analysis and public education on sexual and reproductive health issues. He was lead author of a study that will appear in the June edition of the peer-reviewed Perspectives on Sexual and Reproductive Health, published by Guttmacher, that was released earlier to be included in the broader report.
Finer's study found there were 6.4 million pregnancies in the United States in 2001, resulting in about 4 million births. There were 1.3 million abortions and 1.1 million miscarriages. The pregnancies were almost evenly divided between intended and unintended, and the unintended ones led to almost even numbers of births and abortions.
Contraceptive use
The authors said the growing disparities between richer and poorer women appeared to be the result of greater contraceptive use by the more affluent. The health statistics center, which is part of the Centers for Disease Control and Prevention, reported in 2004 that after decades of increasing contraceptive use, the trend stalled in the late 1990s and began to decline after that. The decline occurred almost entirely in poorer women.
The overall pregnancy rate for women of child-bearing age declined slightly from 1994 to 2001, as did the abortion rate. Black and Hispanic women were considerably more likely to become pregnant than white women, and black women had by far the highest percentage of unintended pregnancies and abortions.
In 1994, the study found, 87 women of every 1,000 living below the poverty line had unintended pregnancies. In 2001, that number had risen to 112 of 1,000 women.
For women earning between $16,000 and $32,000 a year, the number of unintended pregnancies increased from 65 per 1,000 in 1994 to 81 per 1,000 in 2001. But for women in families earning more than $32,000, the number of unplanned pregnancies declined from 37 to 29 per 1,000 women.