Study finds two-thirds of unplanned pregnancies in women using contraception

A survey on contraception by French researchers has found that a third of the pregnancies among women in their study were unplanned and that two-thirds of these pregnancies occurred in contraception users.

A fifth of the unplanned pregnancies happened among women using the Pill and a tenth among women using the IUD (intra-uterine device) – both theoretically highly effective medical methods of contraception, said principal investigators Dr Nathalie Bajos and Dr Nadine Job-Spira of the INSERM team at Hôpital de Bicêtre in Le Kremlin Bicêtre.

In a research paper published today (Wednesday 30 April) in Europe’s leading reproductive medicine journal Human Reproduction[1], Dr Bajos said the findings showed that the reality was that contraception was still a major problem even in a country such as France, which has the highest use of medical contraception in Europe.

One in eight of the unwanted pregnancies were among women choosing condoms and a fifth among those using natural methods, such as male withdrawal or avoiding intercourse on fertile days in the menstrual cycle. Thirty-five per cent of the unwanted pregnancies were among women using no contraception. Half of the unplanned pregnancies ended in abortion.

The study involved 1,034 women who had undergone an abortion or whose last pregnancy was unintended and 1,829 randomly selected controls taken from a representative sample of 14,704 households randomly selected from the telephone directory.

Dr Bajos said misuse was the main reason given to explain the unplanned pregnancies with 60% of the Pill users saying they had forgotten one or more pill. But over 18% said it was due to illness or taking other medication, while a fifth had no explanation or didn’t know. Over 57% of the women whose IUD had failed said they did not know what had gone wrong or had no explanation, while over 30% said the IUD was in the wrong position or fell out and more than a tenth blamed illness or medication.

Over half of the women whose unplanned pregnancy occurred while using condoms said the condom had slipped off or torn, nearly 30% had failed to use it on the occasion they got pregnant and nearly a fifth had no explanation or didn’t know what went wrong. Of those using natural methods over a quarter said they had got their dates wrong and two-thirds said their partner failed to withdraw in time. Under 7% had no explanation or didn’t know. Of the women using local methods e.g. spermicides, over half admitted not using it at the time they became pregnant and nearly a third said they had used the methods incorrectly. But 16% did not know what had gone wrong or had no explanation.

One unplanned pregnancy out of three was due to regular non-use of contraception with women giving a range of explanations. The most common reason of 12 given in the study was that they thought there was no risk of pregnancy (63.6%). But one in eight said they did not know where to go for advice.

“What this research shows most clearly is that there is often a mismatch between a woman’s contraceptive needs and the methods they use,” said Dr Bajos. “It is absolutely essential to differentiate between what are the theoretically most effective methods of contraception and what is the most practicable method for a particular woman at a particular time in a particular relationship. Theoretical effectiveness and practical suitability are not necessarily the same thing.”

She said that, for example, the Pill, whilst theoretically very effective, was not necessarily the most suitable for women having irregular intercourse or for those whose lifestyle does not make it easy to take regularly. The IUD was almost never prescribed for childless women, yet it was highly satisfactory for those with stable partners who are not exposed to the risk of sexually transmitted infections, regardless of the number of children they had. Similarly, depending on the relationships within a couple, the use of condoms and withdrawal methods may be problematic.

“There is no reason to think that what we found in our study is not more or less in line with other industrialised countries where modern contraceptive methods are available,” said Dr Bajos.

“Certainly, given the widespread use of medical contraception in countries like France, better training of family planning providers remains a major goal. When a doctor prescribes a contraceptive he or she should not think just of the theoretical perspective, but take into account the woman’s life. A woman and her doctor do not necessarily occupy the same social position and prescribers should make particular efforts to allow women to express their wishes and be attentive to their situation. The decision on the suitability of a particular method should be the result of interaction between the two.”