Reproductive, maternal, neonatal, child, adolescent health (RMNCAH)
Rationale:
SDG 3.1 - To prevent maternal mortality and morbidity from unsafe abortion, health systems need to meet population abortion care needs.
SDG Target 3.7 Ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
Definition:
Unintended pregnancy rate estimate – country specific
Associated terms:
Unplanned birth, unintended pregnancy, unwanted pregnancy, unplanned pregnancy, pregnancy intention; universal access to sexual and reproductive health-care services, family planning, contraception
Disaggregation:
None
Method of measurement
Bayesian estimation. Model described briefly above, and in the online protocol:
Bearak, J.M., Popinchalk, A., Sedgh, G. et al. Pregnancies, abortions, and pregnancy intentions: a protocol for modeling and reporting global, regional and country estimates. Reprod Health 16, 36 (2019). https://doi.org/10.1186/s12978-019-0682-0
M&E Framework:
Abortion Care Guideline Monitoring and Evaluation Framework
Method of estimation:
A Bayesian model was used to jointly estimate 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.
Method of estimation of global and regional aggregates:
Model-estimated unintended pregnancy rates were sorted within Sustainable Development Goal (SDG) regions, annually per 1000 women aged 15–49 years in 2015–2019, with 80% and 95% uncertainty intervals. Northern America is an SDG region and contrasts with North America, with Mexico in Latin America and the Caribbean. Regional averages were computed from 195 countries and territories.
Preferred data sources:
Bearak JM, Popinchalk A, Beavin C, et al. Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019.BMJ Global Health 2022;7:e007151.
Unit of Measure:
Rate per 1000 women of reproductive age
Unit Multiplier:
Not applicable
Expected frequency of data dissemination:
The expectation is to generate estimates every 5 years.
Expected frequency of data collection:
Input data are from multiple sources including national health information systems, population-based surveys and others. Some of these data are collected throughout the year and reported annually as official statistics. Other input data are collected on a less regular basis.
A dichotomous measure of pregnancy intentions may not fully capture individuals’ feelings about their pregnancies. However, questions designed to measure this construct have been asked in hundreds of nationally representative surveys fielded regularly for decades in dozens of countries, and our use of this measure enables international comparison. To address the potential for response bias, we used a 1-year recall period, modelled bias terms when this was not possible and refrained from subcategorising unintended births into those which were conceived when no more children were desired and those which were conceived sooner than desired. Our estimates may still be conservative, and to address the potential for this to vary by country, we modelled non-sampling error for these data. Additionally, we note that while unintended pregnancies are useful for contextualising abortions, these may also occur following intended pregnancies.
Limited data resulted in sizeable UIs around the unintended pregnancy and abortion incidence estimates for several countries and it is important to consider these, and the posterior probabilities of differences, when interpreting the estimates. We also note that while the variation we found suggests inequality in the ability to determine whether and when to have children, the ability to have children when one desires is one among several aspects of reproductive autonomy
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