An index of reproductive effiency (RE) is proposed as a social indicator that will meet the need to consider various forms of pregnancy wastage, to compare their relative costs, and to guide reproductive health policy accordingly. This article discusses conceptual and measurement aspects of RE. Conversion of wanted to unwanted pregnancies and the reverse, interpretation of abortion in relation to other pregnancy outcomes, defining the end point for the reproductive process and criteria for the events to be included as significant outcomes are conceptual issues. Measurement problems include: whether aggregation is justified, prospective and retrospective tracking of outcomes, record limitations, duplication of adversities in a single pregnancy, and selection of optimal rate for comparison. A measurement of RE for the entire United States based on the National Natality Survey of 1964-1966 is presented, showing 74.5 percent of pregnancies resulting in healthy liveborn infants. For those years, data on abortions could not be included. Within the group of reported pregnancy losses, the importance of congenital abnormalities and low-birth-weight babies is enhanced by application of economic weights based on associated medical care costs. Changing opportunities for birth timing, prenatal and infant care, and control of family size are social means of reducing adverse outcomes associated with teenage pregnancy and high-parity births, often found together with poverty. Successive increments in RE may be progressively more expensive to achieve, and cost effectiveness comparison will be necessary.

Abortion, Legal↗

PubMed1976

Reproduction and human welfare: a challenge to research.

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Costs and Cost Analysis↗

PubMed1975

An index of insurance adequacy for fertility-related health care.

Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by whether a service is a contract benefit, its market cost, and how often it is used in a given population in one year. Comprehensive coverage removes a deterrent to utilization of preventive care such as well-baby visits, prenatal care, and family planning. In a total population of women of child-bearing age, each is likely to need some fertility-related care in a given year. The method of calculating adequacy involves using best available estimates of deliveries, abortions, etc. per 1,000 women, and, within each category, of components such as cesarean section. Local or national cost data can be used to derive an average cost per service and an aggregate for a group. The method of comparing this with plan benefits depends on the way benefits are expressed. Jacksonville, Fla. medical market data were used in a trial of the method on a plan for Federal employees, which shows 70 per cent coverage of estimated expense.

Abortion, Induced↗

PubMed1975