Unintended Pregnancies and the Bottom Line

• Employers feel the cost of unintended pregnancies directly through actual claims costs if they are self-insured or indirectly through an increase in premiums.
   
• Unintended pregnancies are more likely to result in poor pregnancy outcomes such as low birth weight, premature birth, and other costly medical complications, which lead to higher medical claims, more incidental absences, longer maternity leaves, and lost productivity. They also place stress upon women and their families.

Defining Unintended Pregnancy
Definitions and terminology for unintended pregnancy come from the National Survey of Family Growth. This federally funded survey and its precursors are the most comprehensive source of information available on pregnancy and contraceptive use among reproductive-age women in the United States. For five decades the survey has asked women a series of questions to learn about their intentions at the time they became pregnant. Definitions for intended and unintended pregnancy come from this survey.

• An intended pregnancy: wanted at the time of conception or sooner, regardless of contraception usage.
   
• An unintended pregnancy: not wanted at the time conception occurred, regardless of contraception usage
   
• There are two types of unintended pregnancies:
  • Mistimed pregnancies: those that were wanted by the woman at some time, but which occurred sooner than they were wanted.
  • Unwanted pregnancies: those that occurred when a woman did not want to have a(nother) baby ever in her life.

While a pregnancy may be unintended at the time of conception, it may result in a very much-wanted birth.

Who Has Unintended Pregnancies?

• Women of all socioeconomic, marital status and age groups contribute to the pool of unintended pregnancies.²³ Of all pregnancies in the United States, 49% are unintended.²⁴
   
• Percent of pregnancies that were unintended: 77% for women over 40, 56% for women ages 35 to 39, 42-45% for women ages 25 to 34, 61% for women ages 20 to 24, and 82% for teenagers ages 15 to 19.²⁵
   
• 31% of births result from unintended pregnancies.²⁶
   
• Approximately half of all unintended pregnancies end in abortion.²⁷

The Medical Costs of Unintended Pregnancy
The medical costs for pregnancy and childbirth can be high, especially in the case of premature delivery. The table below provides data on mean hospital charges, but this does not include all medical expenses, such as medical visits or antipartum and postpartum hospitalization. Additionally, the charges increase if the mother or infant has medical difficulties.

*Healthcare Cost and Utilization Project data from the Agency for Healthcare Quality and Research (http://www.ahrq.gov/data/hcup/)

Because one-third of births result from unintended pregnancies, employers can assume that they cover the cost of some of these births. Offering contraception as a covered benefit may help reduce unintended pregnancies and thus lower an employer’s costs for pregnancy and delivery.

Unintended Pregnancies are More Likely to Result in Low Birth Weight Babies
Women with unintended pregnancies are more likely than women with planned pregnancies to engage in behavior that is harmful to the development of their child.

• Women who have unintended pregnancies are more likely to begin prenatal care later in their pregnancies.²⁹ And research shows a link between later initiation of prenatal care and low birth weight. Less prenatal care is also associated with low birth weight babies.³⁰
   
• Women who have unintended pregnancies are more likely to smoke and drink prior to or during pregnancy than women who have planned pregnancies, which can lead to lower birth weights.³¹
   
• Caffeine consumption during pregnancy can lead to congenital malformations, slower growth of the fetus, prematurity and miscarriage.³²
   
• Stress can also lead to premature births.³³ Stress is especially a factor in unintended pregnancies where women may have economic and psychosocial concerns that place an extra burden on them during their pregnancies.

The Cost of Premature and Low Birth Weight Infants
Premature and low birth weight babies are especially costly because they are more likely to be sick and in need of medical care. The March of Dimes estimates that in 2001, hospital charges for all infants totaled $29.3 billion and that nearly half of this cost was due to premature and low birth weight infants.³⁴

According to the CDC, 1.96% of all babies are born very preterm (less than 32 weeks) and 1.46% of babies are born with a very low birth weight (less than 1,500 g).³⁶ These infants have the greatest number of health problems and incur the largest hospital costs after birth. One study found the average hospital cost for infants born under 1,500 g to be $128,250.³⁷

One recent study of birth costs among privately insured women found the cost of premature infants or those with problems at delivery to be exceedingly high. In their sample of 12,125 infants, 24% were premature or had problems. These infants accounted for 82% of the costs for infants at delivery. And almost half of the cost at delivery (45%) was due to the 4% of babies born extremely premature (this amounted to $25,615,600 out of total infant costs at delivery of $56,916,140).³⁸

*Weight and cost data from Gilbert et al “The Cost of Prematurity: Quantification by Gestational Age and Birth Weight,” 2003. Percentage of low birth weight babies from Martin et al, Births: Final Data for 2001.

Healthy Babies Require Planning

• Offering coverage of contraception will help women plan their pregnancies and have healthy babies.
   
• Planning is the key to a healthy pregnancy and a healthy baby.
  Contraceptives play a critical roll in this process because they allow a woman to appropriately space her pregnancies. She can choose to become pregnant at a time when she and her baby will be at their optimum health.
   
• Planned pregnancies enable women to receive preconception care and counseling.
  This care and counseling can identify and help manage risk factors, including chronic diseases and poor health behaviors that can lead to poor perinatal outcomes.
   
• Planning can help women prepare for pregnancy.
  For example, pregnant women should take 400 milligrams of folic acid every day to prevent birth defects in their baby’s brain and spine. However, a woman needs to start taking folic acid before she becomes pregnant because the protective effects of folic acid are greatest in the first few weeks after conception, before most women know they are pregnant. Contraception allows a women to choose when to become pregnant and therefore when to modify her diet to meet the needs of a growing child. Proper nutrition and prenatal care are important for healthy babies.