One In Three Babies Is Unplanned

One in three babies is conceived by mistake, the result of missed pills and split condoms, according to a large-scale study which questions whether women have the control over their lives that modern contraception promised them.

The study by leading sexual health researchers in Edinburgh concludes that women are crossing their fingers when their contraception fails them, or when they forget to take a pill, rather than taking emergency contraception.

The figures in today’s Lancet are alarmingly similar to those in the last study of its kind 25 years ago – five years after the contraceptive pill first became available.

The paper concludes that new efforts are needed to teach women how to use contraception. Nearly 3,000 pregnant women and 900 others seeking abortions were asked about whether or not they had intended to become pregnant. They were also asked about their use of contraception and if the timing of their pregnancy was right. The survey took place at the New Royal Infirmary, Edinburgh.

Of the pregnant women nearly two-thirds were actively trying to get pregnant, one in 10 definitely did not want to get pregnant, and a quarter said they were “ambivalent”, that they had not been planning to have a baby but got pregnant anyway. The results suggest many people leave having a baby to chance.

“There’s often not a right time to have a baby so when women find themselves pregnant by mistake they often decide to go with it,” said Anna Glasier, one of the report’s authors.

Younger women were significantly more likely to report having become pregnant by accident and only 10% of those who said their pregnancies were a mistake had tried using the morning-after pill, the survey found.

Professor Glasier said: “A lot of women aren’t terribly good at using contraception, the problem mainly being with the pill and condoms. There’s something in human nature which makes us not brilliant at taking pills every day. The same is just as true for finishing a course of antibiotics. But when an accident happens lots of people just accept it.”

The authors compare the results with those from a study done 25 years ago, and report that the proportion of babies whose parents intended the pregnancy had remained almost exactly the same.

The report says: “This finding is perhaps surprising given the demographic changes. This survey needs to be repeated in other settings, and if the findings are similar elsewhere a strategy will need to be developed to improve contraceptive use. We need to find ways to raise awareness of the real risks of pregnancy associated with lack of use of contraception or with incorrect or inconsistent use.”

Of the women who were seeking abortions, only a quarter were because of unprotected sex. Most of the respondents blamed a missed pill or split condom. The results also revealed that a relatively small proportion of both groups of women had taken the morning-after pill, bought over the counter, even when they knew they had risked a pregnancy.

“Emergency contraception is unlikely to make a substantial difference to pregnancy rates,” the paper says. “Condoms and oral contraceptive pills are the most commonly used reversible methods of contraception in the UK and both rely on consistent use for effectiveness. Condom use is commonly inconsistent and compliance with oral contraception is not easy.”

One study in the US revealed that 47% of women reported missing one or more pills per cycle and 22% reported missing two or more tablets.

“We need to encourage women who clearly want to avoid pregnancy and are taking risks to use long-acting contraceptive methods [implants and intrauterine devices] that do not depend on compliance for their effectiveness,” the Lancet report says.

Kaye Wellings, a leading sexual health researcher who is about to embark on research into why women do not take the pill properly, said: “There are long-acting contraceptives available such as the coil or injection form of the pill but they are not prescribed because women don’t ask for them. Because women don’t ask for them doctors are not trained to fit them. It’s a vicious cycle.”

But she suggested that other women risked getting pregnant because of unnecessary fears about the pill. “We have got a panic culture centred around the pill – every time there’s a health scare about the pill teen pregnancies and unintended pregnancies go up. It’s easier to say the method failed rather than that you failed. In all other areas of medicine we’ve seen improved techniques and improved advice, but not in contraception.”

Simon Blake, chief executive of the Brook advisory centre, which gives sexual health advice, said young men would have to be educated about contraception if unwanted pregnancies were to be tackled. “Young men are half the problem and half the solution.”