High prevalence of unplanned pregnancy warrants primary and secondary prevention efforts Among the most important decisions that individuals and couples face during their reproductive years is if and when to have a child, and how many children to have. Ideally, pregnancy occurs if and when it is desired. However, reproductive outcomes commonly occur that are contrary to plans and desires. Infertility affects 15-25% of couples worldwide, while four of every 10 pregnancies that occur globally are considered to be unintended.1 2 In the linked study (doi:10.1136/bmj.d4473), Carson and colleagues assess cognitive abilities (verbal, non-verbal, and spatial) in children of women who considered their pregnancies to be unplanned, mistimed, and planned, as well as women who were subfertile, needed ovulation induction, or had assisted reproductive technology.3 Many studies have linked unintended pregnancies with negative health and social outcomes for mothers and children, including delayed and insufficient antenatal care, lower likelihood and shorter duration of breast feeding, and higher rates of depression and anxiety among mothers.4 …