Comprehensive Management and Options for Unintended Pregnancy
Unintended pregnancies, which include pregnancies that are unplanned, mistimed, or unwanted, account for 42% of all pregnancies. Abortion care is an important healthcare service that many people may seek at different stages of their lives, and it is essential to understand the different aspects of this care, including how common it is and the methods available.
Statistics and Demographics
Unintended pregnancies are more common than many people realize. Between 2010 and 2019, the overall pregnancy rate (estimated number of pregnancies in women 15–44 years of age) declined by 12%; however, the rate of unintended pregnancies only declined from 43% to 42%. According to various health organizations, it is estimated that about one in four women will have an abortion during their lifetime. This statistic highlights how common and significant abortion care is for many individuals.
Specific populations are affected differently. Groups with the highest unintended pregnancy rates include:
- Females who are 20 to 24 years of age.
- Patients who are non-Hispanic Black.
- Those who are unmarried.
Additionally, one small survey of 41 transgender men found a rate of 24% and showed that this population has unique needs. Because most cited studies and guidelines use the term women, this article uses the same term or female to include cisgender women and patients with similar reproductive potential.
Clinical Counseling and Patient Options
Family physicians are integral in providing counseling and resources to patients with unintended pregnancies. In accordance with the American Academy of Family Physicians policy statement, counseling should remain nonjudgmental and unbiased. Options for the patient include:
- Continuing the pregnancy and parenting.
- Continuing the pregnancy and pursuing adoption.
- Having a medication or procedural abortion.
If a patient chooses to parent the infant, physicians should be equipped to offer local resources. Regarding other paths, it is important to note that physicians are not authorized to broker adoptions.
Methods of Abortion Care
Medication and procedural abortions are safe and effective for patients who choose abortion. The choice of method typically depends on how far along the pregnancy is and the individual’s health.
Medication Abortion
Also known as the abortion pill, this method involves taking two medications—mifepristone and misoprostol. The first pill (mifepristone) blocks the hormone necessary for the pregnancy to continue. The second pill (misoprostol) is taken 24-48 hours later and causes the uterus to expel the pregnancy. This method is usually used during the first 10 weeks of pregnancy.
Surgical Abortion
This procedure is often recommended for pregnancies that are beyond 10 weeks or when a medication abortion is not suitable. The most common surgical method is called aspiration or vacuum aspiration. During this procedure, a healthcare provider uses a gentle suction to remove the pregnancy tissue from the uterus. In some cases, other surgical methods, such as dilation and curettage (D&C), may be used.
Pre-Procedure Care and Future Health
Before an abortion, there are several important steps to ensure that the procedure is safe and appropriate for you. The first step is a consultation with a healthcare provider to discuss your medical history and ensure there are no contraindications. An ultrasound may be performed to determine how far along you are in your pregnancy, which helps the doctor decide whether medication or a surgical procedure is more appropriate.
One of the common concerns people have is whether having an abortion affects your future health. Fortunately, most people who have an abortion do not experience any long-term health problems. According to medical research, an abortion does not affect a person's fertility or increase the risk of future pregnancy complications, such as miscarriage or premature birth.