Abstract
BACKGROUND: Adolescents are at high risk of unintended pregnancy due to contraceptive nonuse and inconsistent use. STUDY DESIGN: We examined associations between contraception and mistimed/unwanted birth among adolescents. For contraceptive nonusers, we analyzed factors contributing to unintended birth. RESULTS: Half of adolescents with unintended births did not use contraception at conception. Those ambivalent about pregnancy reported fewer unwanted [relative risk (RR)=0.06] compared to wanted births. Amongst contraceptive nonusers, difficulty accessing birth control was the only factor associated with more unwanted birth (RR=3.05). For Black adolescents, concerns of side effects (RR=7.03), access issues (RR=10.95) and perceived sterility (RR=3.20) were associated with unwanted birth. For younger teens, falsely perceived subfertility increased unwanted birth (RR=2.74), whereas access issues were significant for older teens (RR=3.97). CONCLUSIONS: Access issues and misconceptions around contraceptive side effects and fertility place adolescents at higher risk for unintended pregnancy, especially among younger and Black teens. Ambivalence represents an additional area for intervention.