About 40% of births in Los Angeles County each year are the result of unplanned pregnancies, which can endanger the health of babies, according to a study released by the county's Department of Public Health.
The figure is based primarily on a county survey completed in 2006 of more than 5,200 women ages 13 to 56 who had recently given birth. The percentage of unplanned pregnancies was about the same among women who gave birth and those who experienced stillbirths and miscarriages, according to Dr. Susie Baldwin, chief of the department's health assessment unit, which produced the study.
The study, "Healthy Women, Healthy Children," did not include women whose latest pregnancy ended in abortion. Earlier studies have shown a much higher percentage of unplanned pregnancies among such women, Baldwin said.
Although state studies show that for the same period as the county study, about 43% of births were unplanned statewide, the county numbers trouble public-health experts because women who do not realize they are pregnant are likely to delay prenatal care and may smoke or drink alcohol. Women who have had another child in the six months before an unplanned pregnancy are at even greater risk and are more likely to have a child born prematurely with a low birth weight, researchers found.
Statewide and nationally, the number of unplanned pregnancies has remained relatively unchanged in recent years, experts said, despite efforts by the U.S. Department of Health and Human Services to reduce unplanned pregnancies to 30% by this year.
"All pregnancies should be planned. An unplanned pregnancy should be a rare thing," Baldwin said.
A lack of health insurance and regular access to care may have contributed to the number of unplanned pregnancies, Baldwin said.
Researchers found that 23% of women of childbearing age lacked health insurance, and 20% said they did not have a regular source of healthcare. Those percentages were even higher among women who had recently given birth: 36% lacked insurance, 33% lacked regular healthcare.
The lack of regular care may affect women's ability to plan for a pregnancy.
About 80% of those at risk for pregnancy reported using a form of birth control the last time they had sex, although that percentage varied by ethnicity: 87% of whites compared with 81% of Asians, 80% of Latinas and 67% of African Americans.
About 82% of women who had recently given birth said they had received information about prenatal vitamins containing folic acid, but only 57% of them had taken the vitamins before becoming pregnant.
Researchers proposed developing minimum preconception-care requirements and extending Medi-Cal benefits for mothers with high-risk pregnancies for two years after a birth.
"The opportunity to impact the health of a baby starts before conception, and the health of a potential mother should be a priority long before pregnancy," said Jonathan E. Fielding, the county's public health director.
Worldwide, the rate of unintended pregnancy declined by 20% between 1995 and 2008, from 69 to 55 per 1,000 women aged 15 to 44. The decline was greater in the more-developed world, where the rate fell by 29% (from 59 to 42 per 1,000 women), than in the less-developed world, where it fell by 20% (from 71 to 57 per 1,000), according to a study by the Guttmacher Institute.