Beyond the numbers: What’s it like to have an unplanned pregnancy?

There’s a lot at stake for women’s health in the Republican plan to replace the Affordable Care Act, which eliminated out-of-pocket costs for birth control and has been highly successful in breaking down barriers to affordable family planning. The cost-sharing changes alone are saving individual women hundreds of dollars each year on their choice of contraception.

So far, the Republican replacement proposal, known as the American Health Care Act, doesn’t impact the Obama-era contraception coverage provisions, nor does it touch other women’s health benefits, such as designating maternity care an essential health benefit. But it does attempt to cut off funding to Planned Parenthood, which serves millions of women and men every year; restrict insurance coverage of abortion; and roll back Medicaid funding, which experts predict will disproportionately impact low-income women. (It is important to note, however, that on the issue of contraceptive coverage and other essential health benefits important to women, Health and Human Services Secretary Tom Price does have the power to change the rules governing those benefits through the agency’s rulemaking process. In turn, it’s probably too early to say the ACA’s contraceptive benefits are safe.)

All these potential policy changes come with very real impacts to women’s health and economic security. The Urban Institute released a new health policy brief this month that illuminates those impacts and helps us gain a deeper understanding of the role of family planning in women’s lives. Part of a multiyear project known as “Beyond Birth Control: Family Planning and Women’s Lives,” the new brief focuses on prevalence and perceptions of unplanned births. It’s based on data from the Urban Institute’s Survey of Family Planning and Women’s Lives, a nationally representative survey of nearly 2,000 women of reproductive age. Among the brief’s key findings, significant numbers of U.S. women experience an unplanned birth in their lifetimes, and such experiences have serious impacts on their lives and opportunities.

Researchers found that more than one-third of women surveyed in 2016 — or more than 36 percent — said they had experienced at least one unplanned birth. Among women who already had children, that rate was more than six in 10, or 62 percent. Marital status underscored the greatest difference in unplanned birth numbers, with married women having the lowest prevalence. Still, about half of married women reported an unplanned birth. Majorities of women said an unplanned birth would negatively affect their education, job, income and mental health. More than 40 percent said an unplanned birth would have a negative impact on their physical health. Brief authors Emily Johnston, Brigette Courtot, Jacob Fass, Sarah Benatar, Adele Shartzer and Genevieve Kenney report:

Women’s responses in follow-up interviews reinforced the negative reported perceptions of the effect an unplanned birth would have on a woman’s education, job, and income. For example, one 21- year-old woman said, “Kids are expensive, and I wouldn’t be able to finish my degree and get the high- paying job that I want. It would definitely change my future plans in a bad way.” When discussing the effect an unplanned birth would have on her life compared with that of her partner, a 28-year-old woman said, “Unfair as it is, it probably wouldn’t affect his career or education as much as it would affect mine.” One 35-year-old respondent expressed concerns about her mental health and stated, “Emotionally and financially we would be better prepared to have another child in a year, but we would make it work if it happened.”

Among 26 survey respondents participating in follow-up interviews, about half had a positive or neutral reaction to the idea of an unplanned pregnancy. However, women pretty much agreed that an unplanned pregnancy would have significant financial and emotional costs. Some women said having another baby would mean big new expenditures, like a new house, new car and additional childcare. Several said a new baby would result in them quitting their jobs. Quotes from respondents:

•Being a mom, I know that babies change things and you change your plans. We’ve always just managed to just change our work hours around so that someone was always home with the children. That may be a factor. — 44-year-old married woman

• I would be extremely scared and very upset and worried about my future. As a female I’m applying for grad school, and it would put a kink in my educational plans and financial plans in the long term. — 28- year-old single woman

• I wouldn’t be depressed, but I would be overwhelmed because I have a lot of goals to accomplish before that happens. — 22-year-old woman living with a partner

Among women who had experienced an unplanned birth, more than half agreed that it positively impacted their motivation to achieve their goals. Nearly half said it had a negative impact on their income and 40 percent said an unplanned birth negatively impacted their mental health. Hispanic and black women were more likely to report mostly positive effects than white women. The brief concludes:

Women’s concerns about the negative effects of unplanned births underscore the importance of access to reproductive health and family planning services, which allow women to plan their pregnancies and prevent unplanned births. For women who experience an unplanned birth, access to targeted services and supports could reduce the negative impact of an unplanned birth on a woman’s life.

The future of the Affordable Care Act is unsure. But every one of the 62 percent of women of reproductive age who use contraception — and the many, many more who’ll need it in the future — will be impacted by its fate.

Download a copy of the new policy brief at the Urban Institute.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.