Contraception

In England and Wales, about 30% of all pregnancies are unintended, and around 20% of all pregnancies end in abortion.[1]Office for National Statistics. Conception statistics: conceptions in England and Wales 2016. Mar 2018 [internet publication]. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/bulletins/conceptionstatistics/2016 [2]National Institute for Health and Care Excellence. Long-acting reversible contraception. Jul 2019 [internet publication]. https://www.nice.org.uk/guidance/cg30 ​ In the US, which has one of the highest rates of unintended pregnancy in the developed world, about half of all pregnancies are unintended. Of these, approximately 40% end in abortion.[3]Hatcher R. Contraceptive technology. 21st ed. New York: Ardent Media; 2018. http://www.contraceptivetechnology.org/the-book [4]Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med. 2016 Mar 3;374(9):843-52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861155 http://www.ncbi.nlm.nih.gov/pubmed/26962904?tool=bestpractice.com

The abortion rate in the US decreased by 21% between 2010 and 2019. In 2019, there were 11.4 abortions per 1000 women aged 15 to 44 years.[5]Kortsmit K, Mandel MG, Reeves JA, et al. Abortion surveillance - United States, 2019. MMWR Surveill Summ. 2021 Nov 26;70(9):1-29. https://www.cdc.gov/mmwr/volumes/70/ss/ss7009a1.htm http://www.ncbi.nlm.nih.gov/pubmed/34818321?tool=bestpractice.com Although the overall abortion rate in the US has declined, this is not seen across all population groups, with higher rates of unintended pregnancy and abortion in disadvantaged groups.[4]Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med. 2016 Mar 3;374(9):843-52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861155 http://www.ncbi.nlm.nih.gov/pubmed/26962904?tool=bestpractice.com [6]Jones RK, Jerman J. Population group abortion rates and lifetime incidence of abortion: United States, 2008-2014. Am J Public Health. 2017 Dec;107(12):1904-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678377 http://www.ncbi.nlm.nih.gov/pubmed/29048970?tool=bestpractice.com ​ This disparity suggests that there is limited access to contraception for some women and adolescents, and points to the importance of addressing birth control with all patients at risk of unintended pregnancy. To improve women's contraceptive options and their choices of place to access contraception, the World Health Organization recommends self-care interventions (e.g., self-injectable contraception and the over-the-counter availability of oral contraception).[7]World Health Organization. WHO guideline on self-care interventions for health and well-being​, 2022 revision. Jun 2022 [internet publication]. https://www.who.int/publications/i/item/9789240052192

Availability of contraceptives differs between regions, and local guidelines should always be consulted.