Quantifying the reproductive labor of pregnancy and pregnancy loss in the demographic study of population health

Pregnancy loss remains a neglected topic within demography, overlooking the significant costs of women’s reproductive labor globally. Using data from Demographic and Health Survey reproductive calendars across 65 countries, this analysis moves beyond live birth to describe the prevalence of pregnancy loss that women across countries experience. The analysis first quantifies the substantial number of person-months that women spend being pregnant in both pregnancies that end in live birth and those that do not. It then calculates a measure of maternal cumulative prevalence of pregnancy loss, demonstrating that women’s experience of pregnancy loss is common worldwide. Next, following the methodology of the Total Fertility Rate (TFR), the analysis calculates a parallel measure called the Total Pregnancy Rate (TPR) to show the average number of pregnancies a woman would experience if she survived through the end of the reproductive years and experienced at each age the period age- specific pregnancy rates. The TPR ranges from 4% to 115% larger than the TFR across countries, with an average of 16% larger. Given that pregnancy loss is known to be undermeasured in many places, these are likely lower bound magnitudes. Finally, cross-country variation in pregnancy loss shows no discernable relationship with potential determinants of pregnancy loss such as abortion incidence rates, per capita health expenditure, rates of anemia prevalence, or TFR, demonstrating the limits of existing fertility frameworks. Counting and considering women’s reproductive labor in the form of pregnancy, whether it ends in a live birth or not, is crucial to understanding women’s and population health, and for gaining a more complete picture of the underlying costs of demographic measures of fertility.