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Report

The High Cost of Unintended Pregnancy

Emily Monea and Adam Thomas

Abstract

The high incidence of unintended pregnancy imposes costs on American society that range from
increased rates of crime and welfare participation to reduced levels of high-school completion and
labor-force participation. We focus on one of the most policy-relevant aspects of this problem by
estimating the amount spent by the government each year on medical care that is directly
associated with unintended pregnancies. We find that taxpayers spend about $12 billion annually
on publicly financed medical care for women who experience unintended pregnancies and on
infants who were conceived unintentionally. After accounting for the fact that some of these
pregnancies are merely mistimed while others are altogether unwanted, we also estimate that
taxpayers would save about half of this amount if all unintended pregnancies could be prevented.
With state and federal budgets being scoured for potential savings—and in light of the mounting
evidence showing that there are a number of cost-effective policy options for reducing unintended
pregnancies—our results suggest that policymakers should increase their investments in proven
pregnancy-prevention strategies.

Introduction

Here is a stunning but under-reported fact: nearly half of all pregnancies in the United States are
unintended. In other words, one out of every two pregnancies is to a woman who says either that
she is not yet ready to have a (or another) child or that she does not want to have a child at all.
Unintended pregnancies are particularly concentrated among individuals for whom they are likely to
be the most disruptive and who are less likely to have the resources needed to deal with the
consequences of becoming pregnant unintentionally. Among women who are teenaged, unmarried,
or low-income, the proportion of pregnancies that are unintended exceeds 60 percent.

Unintended pregnancy is also associated with an array of negative outcomes for the women and
children involved. For example, relative to women who become pregnant intentionally, women who
experience unintended pregnancies have a higher incidence of mental-health problems, have less
stable romantic relationships, experience higher rates of physical abuse, and are more likely to
have abortions or to delay the initiation of prenatal care. Children whose conception was
unintentional are also at greater risk than children who were conceived intentionally of experiencing
negative physical- and mental-health outcomes and are more likely to drop out of high school and
to engage in delinquent behavior during their teenage years.

Though most of the evidence on these relationships is correlational, some researchers have used
sophisticated research techniques in order to pin down causal relationships between pregnancy
and childbearing intentions and maternal and child outcomes. The results of these studies suggest
that, over the long run, reductions in unintended pregnancy and childbearing lead to increased
educational attainment and higher labor-force participation rates among women and to lower crime
rates and better academic, economic, and health outcomes among the affected birth cohorts.

Taken as a whole, this evidence shows that unintended pregnancy imposes substantial costs on
society. Given the current fiscal climate, it is particularly important to consider the hefty financial
burden that unintended pregnancy places on federal and state governments—a burden that is
ultimately borne by the taxpayers who foot the bill. In this brief, we present new national-level
estimates of the public costs imposed by unintended pregnancy and of the potential savings that
would accrue to taxpayers if all unintended pregnancies were prevented.

While many of the negative outcomes described above (i.e., higher crime rates and lower
educational attainment) are difficult to monetize, it is possible to develop a credible estimate of the
number of taxpayer dollars that are spent on medical care provided to women who experience
unintended pregnancies and to infants under the age of one whose births resulted from such
pregnancies. Even after we focus only on this particular category of public costs, our analysis
shows that taxpayers spend more than $12 billion each year on unintended pregnancies. We also
find that, if all unintended pregnancies were prevented, the resulting savings on medical spending
alone would equal more than three quarters of the federal FY 2010 appropriation for the Head Start
and Early Head Start programs and would be roughly equivalent to the amount that the federal
government spends each year on the Child Care and Development Fund (CCDF).

These findings should create a renewed sense of urgency among policymakers about the
importance of expanding funding for such proven cost-saving pregnancy-prevention measures as
family-planning subsidies and evidence-based interventions to discourage unprotected sex.

Authors

A

Adam Thomas

Former Brookings Expert

Visiting Associate Professor, Georgetown University; Research Fellow, Child Trends

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