Family planning has often been defined simply in terms of avoiding unwanted pregnancies. Expressions like unplanned, unwanted, and undesired are difficult to define in such situations, and often it is not clear to which of the prospective parents or other members of the family they refer. A pregnancy may be considered to be unwanted if either the woman, or the man, or both did not desire a child at the time of conception. The term does not imply that they will not change their minds later. All 'unplanned' pregnancies are not also 'unwanted': some pregnancies are neither planned in the sense that the couple deliberately try to achieve conception, nor unwanted in the sense that conception was clearly not desired.
In 1994, only two percent of babies in the Netherland were unplanned, compared with 28% in the 1970s. The fall was attributed to cultural acceptance of sex before marriage, expectation that couples are expected to protect themselves against pregnancy and sexually transmitted diseases, readily available contraception, mandatory and thorough sex education, reinforcement of the finer points of safe and responsible sex via the television, and legal abortion. In 1993, one in three pregnancies in the UK is said to be unplanned and teenagers have a much higher rate of unplanned pregnancy than other age groups.
In the USA in 1997, 60% of all pregnancies were unintended, a rate two to four times higher than in other industrialized countries. Most of these pregnancies result in births. In contrast to the Netherlands, in the USA, contraception is treated secretively, and its discussion is forbidden on television and in many schools. Many women with unintended pregnancies claim not to have used birth control methods because they did not want their male partners to think that they were expecting sex.
Attempts to assess the incidence of unwanted pregnancies are fraught with difficulties. Several approaches have been adopted: abortion or illegitimacy rates have been used as indices, and direct questioning of parents has also been tried. The associations found between unwanted pregnancy and morbidity and mortality are very much related to the approach adopted.
Millions of the world's people still lack access to safe and effective family planning methods. By the year 2000, some 1.6 billion women will be of childbearing age, 1.3 billion of them in developing countries.
Major efforts must be made now to ensure that all couples and individuals can exercise their basic human right to decide freely, responsibly and without coercion, the number and spacing of their children and to have the information, education and means to do so. In exercising this right, the best interests of their living and future children as well as the responsibility towards the community should be taken into account.
Unwanted high fertility adversely affects the health and welfare of individuals and families, especially among the poor; and seriously impedes social and economic progress in many countries. Women and children are the main victims of this unregulated fertility. Too many, too close, too early and too late pregnancies are a major cause of maternal, infant and childhood mortality and morbidity.