1 in 3 pregnancies ending in childbirth in Scotland is unintended

One in three pregnancies that end in childbirth is unintended in Scotland. Emergency contraception could prevent some of these but use is low and is therefore unlikely to have an effect on unintended pregnancy rates, according to an Article in this week's issue of The Lancet. Ways of improving use of regular contraception are needed, state the authors.

In the UK, almost 200 000 pregnancies are terminated every year. Additionally, a substantial number of births result from unintended conception. Some of these pregnancies could be prevented by emergency contraception.

In the study Anna Glasier (NHS Lothian Family Planning Service and University of Edinburgh, Edinburgh, Scotland, UK) and colleagues assessed how many pregnancies ending in either childbirth or abortion are unintended in Edinburgh, UK, and what proportion of women use emergency contraception to try and prevent pregnancy. From July 2004 to February 2005, 2908 women attending an Edinburgh hospital for antenatal care and 907 attending for abortion completed a questionnaire asking about pregnancy intention and use of emergency contraception. The researchers found that a third of pregnancies destined to end in childbirth were not clearly intended, one in ten was totally unintended, and around a quarter of women were somewhat ambivalent about their intention to become pregnant. Emergency contraception (EC) was used by 113 of women who requested abortion and 40 of those planning to continue pregnancy.

Professor Glasier concludes: "Although 98% of women who wish to avoid pregnancy use contraception in the UK, abortion rates continue to rise. Unintended pregnancies that end in childbirth, unless they occur in teenagers, are of less concern to policymakers than those that end in abortion, but they do affect the lives of the women involved. Understanding of sexual behaviour and patterns of contraceptive use is crucial for development of interventions to reduce unintended pregnancy. 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. Emergency contraception is unlikely to make a substantial difference to pregnancy rates."

In an accompanying Comment, James Trussell (Princeton University, Princeton, NJ, USA) and Elizabeth Raymond (Family Health International, Durham, NC, USA) provide a US perspective. They state: "Greater use of contraception, including emergency contraception, is clearly needed in the USA, where the situation is bleaker than in Edinburgh: half (49%) of all pregnancies are unintended, half (52%) of unintended pregnancies occur to the small minority (11%) of women not using any method of contraception, but only 13% of women obtaining abortions use emergency contraception to prevent that pregnancy. While greater use of long acting methods not requiring adherence would have the greatest effect on reducing unintended pregnancy, every little bit helps."

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EMBARGO: 00:01H (UK time) Friday November 17, 2006.

EMBARGO: In North America, 18:30H EST Thursday November 16, 2006.

Contact: Dr Anna Glasier, NHS Lothian Family Planning Service, 18 Dean Terrace, Edinburgh, SCOTLAND EH4 1NL, UK. T) 0131 315 4874 Anna.Glasier@lpct.scot.nhs.uk

Dr James Trussell, Office of Population Research, Wallace Hall, Princeton University, Princeton NJ 08544, USA. T) +1 609 258 4946 trussell@princeton.edu

Notes to editors

Please note that there is a mistake in the first line of the full Comment 'Preventing unintended pregnancy: let us count the ways' by James Trussell and Elizabeth Raymond. It reads: "In today's Lancet, Fatim Lakha and Anna Glasier report that 42% of pregnancies in women attending the New Royal Infirmary in Edinburgh, Scotland, were unintended." The figure should be 28% not 42%. Apologies, The Lancet will be publishing a Department of Error on this soon.


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