Are all contraceptive failures unintended pregnancies? Evidence from the 1995 National Survey of Family Growth

Context: The incidence of unintended pregnancy has long been used as a primary indicator of the state of reproductive health. However, the definition-and therefore the measurement-of this indicator has been elusive. Methods: Data from the 1995 National Survey of Family Growth (NSFG) were used to compare levels of unintended pregnancy among contraceptive users based on two definitions-the standard definition based on women's reports of contraceptive failure, and the NSFG definition based on pregnancy timing (wanted then, wanted later, or not wanted then or in the future). An attitudinal scale was used to examine women's feelings about their unintended pregnancy. Results: Of pregnancies classified as contraceptive failures under the standard definition, only 68% were unintended pregnancies-94% of those ending in abortion and 60% of those ending in birth. Just 59% of women with a contraceptive failure classified as an unintended pregnancy reported feeling unhappy or very unhappy about their pregnancy, while 90% of those with a failure classified as an intended pregnancy reported being happy or very happy. Conclusions: Measures of wantedness based on women's feelings about their pregnancy may correlate more closely with important pregnancy outcomes than do traditional measures of intendedness.