The measurement and meaning of unintended pregnancy.

The concept of unintended pregnancy has been essential to demographers in seeking to understand fertility, to public health practitioners in preventing unwanted childbear-ing and to both groups in promoting a woman's ability to determine whether and when to have children. Accurate measurement of pregnancy intentions is important in understanding fertility-related behaviors, forecasting fertility, estimating unmet need for contraception, understanding the impact of pregnancy intentions on maternal and child health, designing family planning programs and evaluating their effectiveness, and creating and evaluating community-based programs that prevent unintended pregnancy. 1 Pregnancy unintendedness is a complex concept, and has been the subject of recent conceptual and method-ological critiques. 2 Pregnancy intentions are increasingly viewed as encompassing affective, cognitive, cultural and contextual dimensions. Developing a more complete understanding of pregnancy intentions should advance efforts to increase contraceptive use, to prevent unintended pregnancies and to improve the health of women and their children. To provide a scientific foundation for public health efforts to prevent unintended pregnancy, we conducted a review of unintended pregnancy between the fall of 1999 and the spring of 2001 as part of strategic planning activities within the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC). We reviewed the published and unpublished literature, consulted with experts in reproductive health and held several joint meetings with the Demographic and Behavioral Research Branch of the National Institute of Child Health and Human Development , and the Office of Population Affairs of the Department of Health and Human Services. We used standard scientific search engines, such as Medline, to find relevant articles published since 1975, and identified older references from bibliographies contained in recent articles; academic experts and federal officials helped to identify unpublished reports. This comment summarizes our findings and incorporates insights gained from the joint meetings and the strategic planning process. CURRENT DEFINITIONS AND MEASURES Conventional measures of unintended pregnancy are designed to reflect a woman's intentions before she became pregnant. 3 Unintended pregnancies are pregnancies that are reported to have been either unwanted (i.e., they occurred when no children, or no more children, were desired) or mistimed (i.e., they occurred earlier than desired). In contrast, pregnancies are described as intended if they are reported to have happened at the " right time " 4 or later than desired (because of infertility or difficulties in conceiving). A concept related to unintended pregnancy is unplanned pregnancy—one that occurred when …