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The Short Version: The unintended pregnancy rate in the United States is high and accounts for nearly half of all pregnancies. Researchers at the Kinsey Institute designed the Relationship Dynamics and Social Life (RDSL) study to understand the factors that lead some young women to get pregnant unintentionally while others do not. Researchers in the program Advancing New Standards in Reproductive Health (ANSIRH) at the University of California San Francisco, wanted to learn what the consequences of undesired pregnancies were after they were carried to term. They developed the Turnaway Study, led by Dr. Diana Greene Foster, to compare the effects of being denied an abortion against those of successfully receiving one.
At the start of the Kinsey Institute’s Relationship Dynamics and Social Life (RDSL) study, 95% of the 18- and 19-year-old women reported a strong desire to avoid pregnancy in the near future. Yet by the end of the 2.5-year study, 24% of respondents reported a pregnancy at some point.
Women are most likely to encounter unintended pregnancy between ages 18 and 22. At the same time, women in this age group have many reasons to want to avoid having children. One study looked at the relationship between a woman’s age at first birth and her labor income. Women who had a child when they were under 25 had a 50% average annual income reduction over the course of their lives, according to the study by Man Yee Mallory Leung, Fane Groes, and Raul Santaeulalia-Llopis. Having children at a younger age puts a financial and emotional strain on the parent or parents, and in many cases, the child as well.
Kinsey Institute’s researchers wanted to better understand who gets pregnant and why. As part of the Relationship Dynamics and Social Life study, they interviewed the 1,003 participating women once a week for 2.5 years to learn about their relationships and what was happening in their lives.
Interviewing the women once a week gave the researchers a fuller picture of their lives than less frequent interviews could have. “With weekly interviews, we can track them as they go, instead of asking people to look back and tell us about their relationships after they dissolved, or after they became serious, to look back and tell us about the formation of those relationships,” said Dr. Jennifer Barber, Senior Researcher on the RDSL. “We capture the dynamics as they progress. So the goal of the study was to look at how those dynamics contribute to who gets pregnant and who doesn’t get pregnant.”
On the flip side, another study looked at women who had an abortion just under a clinic’s limit and those who showed up a little too late and the effects that pivotal event had on their lives. Dr. Diana Greene Foster, the Lead Researcher on The Turnaway Study, is the author of “The Turnaway Study: The Cost of Denying Women Access to Abortion.”
While the study showed that women from all walks of life seek abortions, those who are denied them face financial, social, and physical health hardships for years to come.
Women who have heterosexual sex with healthy and supportive partners still risk getting pregnant, even when they take precautions against pregnancy. But contraceptives dramatically reduce the risk of unwanted pregnancy, and when your partner supports your choice to use them — as well as your desire to avoid having children at the moment — your chance of getting pregnant diminishes.
Many women in the RDSL study found that their partners wanted them to get pregnant. “At some point during the study, 41% of the young women perceived that their partner wanted them to get pregnant, despite their own zero desire to get pregnant,” Dr. Barber said. “About one-third of the perceived pregnancy coercion was actually verbal; that is, the partner said he wanted her to get pregnant, despite her own zero desire for it.” That pressure from a partner puts a woman at a higher risk of getting pregnant despite her own desires.
It’s not uncommon for couples to disagree about whether and when to have children. But when pregnancy becomes a demand or tool for control, it can become abusive. Men either pressure or force their partners to become pregnant in these relationships. “If women don’t want a pregnancy — if they’re in a violent relationship, or if they’re in a relationship where their partner tells them that he wants them to get pregnant — they’re very likely to get pregnant,” Dr. Barber said.
Dr. Barber found a significant correlation between abuse and unwanted pregnancy. “The women in violent relationships got pregnant at about 2.5 times the rate of women in non-violent relationships,” she said.
Abusive partners often go beyond verbal pressure to facilitate pregnancy. “These partners who are controlling, violent, or disrespectful are also using this kind of contraceptive coercion to remind these women of who’s in charge,” Dr. Barber explained. “Do they really want them pregnant? I don’t think so. But do they want to, you know, dominate them in the meantime? Yes.”
While women in abusive relationships are more likely to get pregnant despite their desires, the effects of carrying out an unwanted pregnancy can be devastating for someone experiencing abuse.
“One of the main reasons women give for wanting an abortion is poor relations with the man who they became pregnant with,” Dr. Foster said. “In fact, one in twenty women reported violence from the man involved in the pregnancy. For women who are denied an abortion, ongoing contact with the man involved results in continued exposure to violence.”
The Relationship Dynamics and Social Life study found that the unintended pregnancy rate for Black women was a staggering 2.4 times higher than the rate for white women, a fact supported by other sources. This discrepancy is often explained away by a variety of factors: correlations between race and poverty, access to birth control, or even different cultural expectations about when a woman is ready to have a child.
But these explanations only address part of the issue. Black women are not just more likely to get pregnant at a young age, they’re more likely to get pregnant when they don’t want to and to remain childless when they want to be pregnant.
“Regardless of what they wanted, Black women were less likely to get what they wanted than white women,” Dr. Barber said. “There’s been this argument out there that we’re imposing a white middle-class planning paradigm on young, disadvantaged minority women, but actually, the young women have firm plans for what they want. They’re just not able to get it.”
The RDSL study didn’t address the causes of Black women’s pregnancy outcomes in an official sense, but Dr. Barber has some suspicions as to why they might be so different from those of white women’s outcomes. “Research shows that many white men are racist when it comes to dating and less likely to date Black young women,” she said. “The incarceration rate for young black men is extremely high because of structural racism. And so if they want to get pregnant, they have fewer serious partners.”
One thing was made abundantly clear from both the Relationship Dynamics and Social Life study and The Turnaway Study: Carrying an unwanted to term negatively impacts parents.
“People who are denied abortions experience years of worse economic security and poorer physical health,” Dr. Foster told me.
Carrying a pregnancy to term can come with an increased risk of physical harm, especially for women in poor relationships to begin with. Aside from the biological risks associated with going through childbirth, pregnant women face an increased risk of violence. Famously, homicide is the leading cause of death for pregnant women in the United States, usually from abusive partners.
Since so many unintended pregnancies, especially among young people, occur in abusive relationships, they have the dangerous potential to emotionally chain childbearing parents to their abusers. Even if they are able to remove themselves from that romantic relationship, they will be forever tied to their abuser through their child.
Dr. Foster said she also wants to dispel the idea that adoption is a viable option for women faced with an undesired pregnancy. Not only does it ignore the fact that going through a pregnancy can be a painful, dangerous, and traumatic experience for some, it simply isn’t a consideration for most women. “Very few women (9%) will choose to place a child for adoption if they can’t get an abortion,” Dr. Foster said.
Whether due to their beliefs or life experiences, many people find it difficult to empathize with women who get pregnant unintentionally and seek to terminate their pregnancies. But Dr. Foster said that the women who participated in the study had a wide variety of mindsets before pursuing an abortion. They came from all walks of life and political beliefs, with differing views of the procedure. The choice was emotionally different for everyone.
“We find that half of the women seeking an abortion say it is a straightforward, even easy decision; half say it is difficult,” Dr. Foster told me. “But just because a woman makes this decision easily does not mean she didn’t carefully consider her options. Instead, the choice may be clear when she considers her circumstances.”