Background:
Contraceptive use in the U.S. is on the decline. In 2002, 14% of all sexually active, non-sterile women were not using contraception; this is a 40% increase in noncontracepting from 1995 to 2002. In the highest risk groups (formerly married, > 35 years of age, or in minority populations), nearly one in four at-risk women were not contracepting. The Intended/Mistimed/Unwanted construct, used by health researchers for over 30 years to describe women's pregnancy goals and intention after they have conceived, may not help to understand and reverse these trends.

Objectives:
We explore the concept of 'Readiness' to identify truly unwelcome pregnancies before they occur.

Methods:
Pregnancy readiness was defined with three variables (partner relationship, partner concordance, and type of contraception used at conception).

Results:
Among women in the 2002 National Survey of Family Growth who reported that they had given birth within the previous 5 years, more than 50 percent were defined as not having been ready for that pregnancy. Lack of pregnancy readiness was highly correlated with the mother's reporting after the birth that her pregnancy had been unwanted or that she was greatly unhappy about having been pregnant.

Conclusion and implications for practice:
These findings suggest that in a clinical setting, answers to these four questions may predict readiness for pregnancy for sexually active, fertile women: 1) How happy would you be if you were to become pregnant within the next 6 months? 2) What kind of contraception are you using? 3) What is your relationship to your sexual partner? 4) Do you and your partner agree or disagree about the desirability of your becoming pregnant? Women classified as unready should be provided intensive contraceptive counseling and more frequent follow up to help them avoid unplanned pregnancy.