Abstract

The most recent report from the National Survey of Family Growth and the National Center for Health Statistics presents disturbing and surprising information regarding intended and unintended pregnancies in the United States.¹ The authors report that in 2008, 51% of pregnancies in the United States were unintended. In addition, between 2001 and 2008, intended pregnancies decreased and unintended pregnancies increased, a shift previously unobserved. These alarming findings actually may be surprising to some, given the increasing use of more effective, long-acting reversible contraception (LARC), methods that include subdermal implants (eg, Implanon, Nexplanon) and intrauterine devices (IUDs) and systems (Paragard, Mirena, Skyla, Liletta). Indeed, the use of IUDs in the United States is estimated to have increased from 0.5% among all contraceptive users in 1995 to close to 8% in 2014.M² This increase in IUD use had given hope to many that the rate of unintended pregnancy would continue to fall and perhaps begin to show an even steeper decline. Finer and Zolna, however, have thrown a proverbial ‘‘wet blanket’’ on our ongoing efforts to reduce unintended pregnancy, but have also sounded a necessary and appreciated wake-up call.¹