Accidental pregnancy and contraceptive practices in contemporary Australia.

Objectives: Australia faces the contradictory problems of high rates of unintended pregnancy and of infertility. These population patterns are well documented in demographic surveys, but little is known about how they are experienced in individual lives. The objective of this study, funded in partnership by the Australian Research Council, the Royal Women’s Hospital, The Victorian Government Department of Health, Family Planning Victoria and Melbourne IVF, was to investigate how Australians manage fertility. The aim of this paper was to describe the circumstances of unintended, mistimed, or unwanted first pregnancies in an Australian national sample of women and men of reproductive age. Design and methods: A population-based cross-sectional survey was conducted. The survey and a letter of invitation to participate were mailed to a random sample of people aged 18 to 45 extracted from the Australian Electoral Roll. Information was collected about management of fertility across the life-course, including about the circumstances of any accidental pregnancies. Responsibility for contraception and self-assessed risk of conception at the time of intercourse that led to the accidental first pregnancy were each assessed in separate single questions. Respondents were invited to endorse up to 18 fixed-choice reasons for the accidental pregnancy. Responses from women and men, and from three age cohorts (18–25; 26–40; > 40) were compared. Results: The survey was sent to 15,590 people (7795 women; 7795 men), yielding a nationally- representative sample (recruitment fraction 16%). Of the 18, reporting an accidental first pregnancy, most agreed that men and women should share responsibility for contraception. Despite the fact that all but 1% had access to affordable contraception, approximately half reported awareness of the risk of pregnancy from sexual intercourse at the time. Ninety one percent reported one or two reasons for the accidental first pregnancy; the three most common reasons were “using contraception correctly but it didn’t work”, “forgot to take or use contraception”; and “withdrawal too late” and were similar in the three age cohorts. Differences in women’s and men’s responses will be reported. Conclusions: These preliminary findings confirm that availability of contraception is insufficient to ensure that pregnancies are intended and not mistimed or unwanted. The results will contribute to a comprehensive model of the factors associated with conception at the wrong time in the lives of Australian women and men and to national gender-informed sexual and reproductive health policy and promotion.