Each year, from 2015 to 2019, the world witnessed about 121 million unintended pregnancies; around 61 percent of them ended in an induced abortion. And, out of all unintended pregnancies that happen globally during the period, more than one in seven occurred in India.
What is Unintended Pregnancy?
An unintended pregnancy is typically defined as one that is not wanted or one that is unplanned. At times they are celebrated while at others they end in miscarriages and abortions.
This year’s edition of the State of World Population (SoWP) annual report by the United Nations Population Fund (UNFPA) focuses on unintended pregnancies. It has noted critical findings on the subject globally including India for which it has referenced the National Family Health Survey (NFHS-5 2018-2019) and other available studies.
The report describes unintended pregnancy as a personal issue, health issue, human rights issue, humanitarian issue and a development issue.
The Indian Context
The report notes that in India (as per studies) unintended pregnancy is associated with poor availability of maternal healthcare infrastructure leading to poorer infant and maternal health.
However, not all adolescent births result from unintended pregnancies. A majority of births among girls under the age of 18 are a result of early marriages, according to new research from the United Nations Population Division. It could classify these pregnancies as intended technically because young girls’ ability to decide when to have children and with whom is severely constrained.
The new report reveals that 13 per cent of all young women in developing countries begin childbearing. Three-quarters of girls with a first birth at age 14 and younger had a second birth before turning 20, and 40 per cent of those with two births went on to have a third birth before turning 20. Half of the world’s girls with a first birth between age 15 and 17 had a second birth before turning 20. Furthermore, more than half of the additional births (after the first birth) to adolescent mothers were rapid repeat births; that is, they occurred within 24 months of a previous birth and came with exceptionally severe health risks for girls as well as their infants.
Talking of adolescent fertility in India, the National Family Health Survey 5 (2019-21) shows that women in the 15-19 age group have 43 births per 1,000 women – a decline from 51 as reported in NFHS-4. A total of 23.3 per cent women aged 20-24 were married before they turned 18 (NFHS-5) with a decline of only 3.5 points from NFHS-4 (2015-16). As per NFHS-4, the median age at first birth was 21 years and 9.3 per cent of women aged 20-24 gave birth before the age of 18, and 27 per cent of additional births had a birth interval shorter than 24 months. NFHS 5 data on these parameters are not available yet.
Though India’s maternal mortality ratio (MMR) has improved to 103 in 2017-19, from 113 in 2016-18, according to the special bulletin on MMR released by the Registrar General of India on March 14, 2022, there is variation in MMR across various states. Seven Indian states -- Rajasthan, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Bihar, Odisha and Assam -- have 'very high' MMR meaning 130 or more maternal deaths per 100,000 live births.
Also, despite the legislative protection with the historic Medical Termination of Pregnancy Act of 1971, unsafe abortion remains the third leading cause of maternal mortality in India, and close to eight women die from causes related to unsafe abortion each day.
In India, between 2007 and 2011, 67 per cent of abortions were classified as unsafe. There was a disproportionately higher risk of unsafe abortion among the vulnerable and disadvantaged populations including young women in India. Girls aged between 15 and 19 were at the highest risk of dying from an abortion related complication.
NFHS-5 data also shows that teenage pregnancy has only marginally declined by 1 per cent -- girls in the age group of 15-19 years who were already mothers or pregnant at the time of the survey is 7.9 per cent.
More Action Needed
Andrea Wojnar, UNFPA India Representative and Bhutan Country Director states, “India has made major inroads in terms of sexual and reproductive health and rights. The population is stabilising, the number of preventable maternal deaths has reduced, and there is an increased uptake of reversible and safe modern methods for family planning. However, the 2022 State of World Population Report brings to the fore the silent crises of unintended pregnancy… with more than one in seven cases of the 121 million cases worldwide, occurring in India. In spite of safe, modern, and reversible contraceptives available, the most popular method remains female sterilisation with its acceptance at 38 per cent. Sterilisation cannot delay or space pregnancies, which is important for preventing unintended or mistimed pregnancies, especially in the young population. What is also concerning is that 67 per cent of abortions have been classified as unsafe… putting women and young girls at unnecessary risk.”
The solution lies in empowering women and girls to make affirmative decisions about sexual activity and motherhood. The report emphasises on addressing the unmet need for family planning/contraceptives and improve access to safe abortion services including medical methods.