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Abstract
Introduction Internationally comparable estimates of unintended pregnancy and abortion incidence can illuminate disparities in sexual and reproductive health and autonomy. Country-specific estimates are essential to enable international comparison, and to inform country-level policy and programming.
Methods We developed a Bayesian model which jointly estimated unintended pregnancy and abortion rates using information on contraceptive needs and use, contraceptive method mix, birth rates, the proportions of births from unintended pregnancies and abortion incidence data. Main outcomes were the estimated rates of unintended pregnancy and abortion for 150 countries and territories, reported for the 5-year period 2015–2019, as annual averages per 1000 women aged 15–49 years.
Results Estimated unintended pregnancy rates ranged from 11 (80% uncertainty interval: 9 to 13) in Montenegro to 145 (131 to 159) in Uganda per 1000 women aged 15–49 years. Between-country heterogeneity was substantial in all Sustainable Development Goal (SDG) regions, but was greatest in sub-Saharan Africa. Estimated abortion rates ranged from 5 (5 to 6) in Singapore to 80 (55 to 113) in Georgia. Variation between country estimates was similar in all SDG regions except for Europe and Northern America, where estimated abortion rates were generally lower.
Conclusion The estimates reflect variation in the degree to unintended pregnancy and abortion that are experienced in countries throughout the world. This evidence highlights the importance of investing in access to contraception and comprehensive abortion care, including in regions which may have lower rates of unintended pregnancy or abortion, respectively, as countries may differ substantially from regional averages.
- public health
Data availability statement
Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplemental information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplemental information.
Footnotes
Handling editor Seye Abimbola
Twitter @jonathanbearak, @annapopinchalk, @CynthiaBeavin, @bganatra, @otuncalp, @LeontineAlkema
Contributors JMB and LA contributed to the conceptualisation of the estimation approach. JMB developed the statistical model and conducted the data analysis with input from LA and AP. AP led data compilation and data management, with significant contributions from CB. BG, OT and A-BM led the country consultation. JMB drafted the manuscript. All coauthors convened periodically for technical exchanges about the estimation approach. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. The country consultation conducted as part of the methodology does not imply country endorsement and countries may choose to use their own data to inform national programmes and policies. JMB had full access to all the data in the study, and had final responsibility for the decision to submit for publication.
Funding UK Aid from the UK Government; Dutch Ministry of Foreign Affairs; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); the Bill & Melinda Gates Foundation INV-00844.
Disclaimer The funders of the study had no role in study design, data collection, data interpretation, analysis or the writing of the article. The corresponding author had full access to all the data in the study, and had final responsibility for the decision to submit for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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