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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne. Today in Your Health, pregnancy - both planned and unplanned. More than half of all pregnancies in the U.S. are unintended. That's according to a survey by the Alan Guttmacher Institute. NPR's Brenda Wilson has a report on why these accidents keep happening.

BRENDA WILSON: There are many methods of contraception for preventing pregnancy, but young adults especially don't always know about them or know how to use them effectively.

Joy Migala thought she knew. She was 18, a high school senior with a new boyfriend that she was very much in love with, when she began her first sexual relationship.

Ms. JOY MIGALA: I wouldn't say that we had like any sort of extensive conversation about it. You know, it was on the radar kind of thing. And then, you know, it happened.

WILSON: They used condoms, but she decided that that was not enough.

Ms. MIGALA: Probably, I don't know, a few - two months maybe after we started having sex - and I'm fortunate that was, you know, I'm able to talk to my mother about those things. And so I was able to tell her I wanted to go and get birth control.

WILSON: Joy Migala didn't trust her memory to take a pill every day, so she chose the patch, which she had to change weekly. But after a couple of years, she decided she really didn't like it.

Ms. MIGALA: Well, I gained weight and I felt more emotional.

WILSON: So Joy went to birth control pills anyway.

Once a young woman owns up to her sexuality, the real challenge is to pick a birth control method that works for her. There are many: hormonal methods such as birth control pills, the patch, a three-month shot, a ring that's placed over the cervix. Or there are barrier methods: IUDs, the cervical cap, the diaphragm, and male and female condoms. [POST-BROADCAST CORRECTION: The IUD is not a barrier method.]

Dr. Vanessa Cullins, the medical director of Planned Parenthood of America, says different methods are suitable at different times in a woman's life.

Dr. VANESSA CULLINS (Planned Parenthood of America): During college, it might be easier to use birth control pills. Once you get out and start your career, the person might decide to go with an IUD because her childbearing goals are that she doesn't want to become pregnant for several years.

WILSON: After Joy Migala and her boyfriend had been in college for three years, the relationship unraveled. She wasn't sexually active, so she stopped taking the pill. If there wasn't a real need for a hormonal contraceptive, she didn't like putting something in her body that she says felt unnatural. But she and the boyfriend continued to see each other.

Ms. MIGALA: You know, it started off very, you know, platonic. And you know, it was fine. And there was nothing happening. And then after a couple of months of that, one night we ended up sleeping together. And I wasn't on any sort of birth control. And then a pattern was sort of set and it continued.

WILSON: Sometimes they used condoms, sometimes they didn't. She got pregnant.

Ms. MIGALA: I guess I thought that it couldn't happen to me because I was pretty good about knowing when my, like, fertile period was, you know, being -and using a condom during those times. And it was very foolish of me.

WILSON: Yes, but it's classic. Sarah Brown, the director of the National Campaign to Prevent Teen and Unplanned Pregnancy, remembers when she used to chart women's contraceptive histories.

Ms. SARAH BROWN (National Campaign to Prevent Teen and Unplanned Pregnancy): It was one of the most complicated things I've ever done. Well, I started out on this and then, well, then we broke up, so I threw the method away. But then I met this other guy. Then we used things once in a while. And then - the chaos level. It's not at all uncommon for women to get pregnant.

WILSON: It's the lesson Joy Migala learned.

Ms. MIGALA: I don't think that I fully grasped the weight of those decisions that I was making and the impact that they would ultimately have on my life.

WILSON: Sarah Brown says young people really need to think about whether they're planning to have children or not.

Ms. BROWN: If you're the middle and sort of in a fog, magical thinking, unclear, you're planning to get pregnant.

WILSON: Brenda Wilson, NPR News.

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