Megan Nichole Poole and Alana Cattapan show that there is an important and ongoing need for accurate, up-to-date information about rates of unintended pregnancy in Canada.
The 2021 Canadian federal budget promised $7.6 million (CAD) over five years for a national sexual and reproductive health survey. This is a significant development, as it will hopefully fill critical gaps in knowledge related to sexual health, contraception, conception, pregnancy, birth, and postpartum experiences, along with “data on race, household income, and sexual orientation.”
This announcement is particularly welcome for those interested in unintended pregnancy (sometimes described as “unplanned”) because contemporary knowledge on the topic is inconsistent and often unclear. Accurate information about rates of unintended pregnancies is important because women are led to believe that they may become pregnant at any time. Public health campaigns focusing on “preconception care” are well-intentioned in working to inform “women of childbearing age” about how to achieve a healthy pregnancy in case they might be pregnant. These campaigns have historically asked women to refrain from drinking alcohol, drugs, and smoking, and to adjust their diet and exercise regimes if engaged in unprotected sex. And while there is no contesting the importance of both healthy pregnancies and healthy babies, the disproportionate attention directed towards women’s bodies before and in the earliest stages of pregnancy have long been justified in the name of addressing high rates of unintended pregnancy.
Reported rates of unintended pregnancy in Canada vary widely. The Society of Obstetrician and Gynaecologists of Canada reports that 50% of all Canadian pregnancies are unintended, repeating this number in a range of educational literature. Relevant research also suggests that “up to 40% of pregnancies in Canada are unintended.” The Public Health Agency of Canada’s Family-Centred Maternity and Newborn Care, a guidebook for potential patients and health care providers, frequently cites a similar number but relies instead on American data, stating that “while no national data exists for Canada, the most recent US data show that 49% of pregnancies are, in fact, unplanned.”
Aside from variation in estimated rates, the data are often misreported or reported in unclear ways, particularly in popular media. When the Society of Obstetricians and Gynaecologists conducted a study on contraception use in 2016, an article in the Ottawa Citizen reported that “61% of Canadian women have an unintended pregnancy,” failing to note that this was the rate of unintended pregnancy among the 32.5% of respondents who had ever been pregnant. Other reporting suggested that “one in five Canadian women had an unintended pregnancy in 2016,” rather than stating that among women surveyed, one in five had experienced an unintended pregnancy at some point in their lives. What stems from this unclear reporting is an understanding that unintended pregnancy very frequently occurs, and is likely to occur for most women, rather than among a subset of the population.
Further, focusing on the number of pregnancies that are unintended, rather than the women who experience them, puts the emphasis in the wrong place. The likelihood of experiencing unintended pregnancy varies widely among different sectors of the population. In an analysis of the 2005-2006 Canadian Maternity Experiences Survey, women who were “under 20 years of age, immigrated to Canada, had an equivalent of a high school education or less, no partner, experienced violence or abuse and had one or more previous pregnancies” were more likely than other women to report that their most recent pregnancy was unintended. If the number of women who experience unintended pregnancy is closer to 20% (or one in five) over the course of their lifetimes, rather than 50% or more as has been reported, then attention should be paid to who comprises that 20%. Sexual and reproductive health information and resources should be directed to populations where unintended, and more importantly, unwanted, pregnancy most frequently occurs.
The announcement in the 2021 budget of a national sexual and reproductive health survey is welcome news. There is significant need for routinely collected data on reproductive health that can inform evidence-based policies and public health campaigns. It is imperative that Canadians receive clear and reliable information about rates of unintended pregnancy—without sensationalism—and about the precautions they can take with their bodies and behaviours if they intend to carry an unintended pregnancy to term if it occurs.
Megan Nichole Poole is an anthropologist living on Prince Edward Island, and a Research Assistant in the Department of Political Science at the University of Waterloo.