UNFPA’s efforts focus on expanding access to the information and services women and girls need to exercise their reproductive rights and choices, which underpin gender equality and enable them to exercise greater power over their lives and realize their full potential. We know the steep costs associated with unintended pregnancy — costs to an individual’s health, education and future, costs to whole health systems, workforces and societies. The question is: why has this not inspired more action to secure bodily autonomy for all? The topic of this report is a challenging one, in part because it is so common. Nearly everyone has an experience to draw upon, whether they have faced an unintended pregnancy themselves or know someone who has. For some, it is a personal crisis; for others, it is a blessing in disguise. Beyond the personal context, unintended pregnancies have societal roots and global consequences. This, therefore, is not a report about unwanted babies or happy accidents. It is not a report about motherhood. And although abortion cannot be removed from the discussion — more than 60 per cent of unintended pregnancies end in abortion — this is not a report about abortion either. Instead, this report is about the circumstances that exist before an unintended pregnancy, when a person or a couple’s agency to decide is critically undermined, and about the many impacts that follow, affecting individuals and societies over generations. We see, through original research by the authors and in new data from partner organizations, that shame, stigma, fear, poverty, gender inequality and many other factors undermine women and girls’ ability to exercise choice, to seek and obtain contraceptives, to negotiate condom use with a partner, to speak aloud and pursue their desires and ambitions. Most of all, this report raises provocative and unsettling questions about how much the world values women and girls beyond their reproductive capacities. Because recognizing the full worth of women and girls, and enabling them to contribute fully to their societies, means ensuring they have the tools, information and power to make this fundamental choice for themselves.