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Biomedical subjects

J D Forrest

Publications and source records attributed to J D Forrest.

At least 37 records · Page 2Linked to original sources
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Comparing the health risks and benefits of contraceptive choices.

Simulation models were used to compare the health consequences of birth control methods currently relied on by American women with those of using no method. The incidence of morbidity and mortality related to unintended pregnancies, live births, abortions, upper genital tract infections, tubal infertility, cardiovascular disease and reproductive cancers were estimated for hypothetical cohorts of 100,000 women aged 15-44. Women who never use any method and who never have an abortion would have an average of 18 births during their reproductive lifetime, compared with no more than five among women using any of the available birth control methods. Consequently, use of any method prevents more deaths from pregnancy and childbirth than are associated with method use. The proportion of women who would become infertile--estimated by taking into account the likelihood of developing upper genital tract infections and the probability that any pregnancies that occurred would be ectopic--is reduced substantially if women at low risk of sexually transmitted diseases use any method and if women at high risk use oral contraceptives or barrier and spermicide methods. Oral contraceptive use has a relatively small, independent effect on the risk of cardiovascular diseases, but it greatly augments that risk in combination with smoking and increased age. When ovarian, endometrial and breast cancers are considered together, there will be approximately 110 fewer diagnoses of these three cancers per 100,000 ever-users of the pill aged 15-54 than among 100,000 never-users; furthermore, prior to age 45, 100,000 ever-users will experience 10 fewer deaths from ovarian or endometrial cancers than never-users of the pill.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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Public-sector savings resulting from expenditures for contraceptive services.

Almost one in four U.S. women who use a reversible method of contraception rely on a publicly funded source of care, either a family planning clinic or a private physician reimbursed by Medicaid. According to three scenarios of alternative contraceptive use patterns, if publicly funded services were not available, these women would have between 1.2 million and 2.1 million unintended pregnancies over one year--substantially more than the approximately 400,000 they currently experience. If these women relying on publicly funded services were using no method of contraception, they would be expected to have more than 3.5 million unintended pregnancies in one year. In FY 1987, federal and state governments spent $412 million on contraceptive services for women who otherwise might not have been able to obtain them. If these services had not been available, the additional public costs for medical care, welfare and supplementary nutritional programs during the first two years after a birth or for publicly funded abortions would have totaled $1.2-$2.6 billion. These savings represent an average of $4.40 saved for every dollar of public funds spent to provide contraceptive services.

Adolescent↗
PubMedDate not supplied

The impact of public-sector expenditures for contraceptive services in California.

A methodology previously used to calculate the number of unintended pregnancies averted nationally through publicly funded contraceptive services has been adapted for a state-level analysis in California. An estimated 136,800 unintended pregnancies--which would result in approximately 36,000 births, 85,100 abortions and 15,700 miscarriages--are averted each year because publicly funded contraceptive care is available from clinics and private physicians in California. Federal and state expenditures of $46 million for contraceptive services in California in FY 1989 resulted in an estimated savings of $232-$509 million in public costs for abortions, for prenatal and maternity care and for medical care, welfare and supplementary nutritional programs during the first two years after a birth. These savings represent an average of $7.70 saved for each dollar spent to provide contraceptive services. This savings/cost ratio is 75 percent higher than that previously estimated for the United States as a whole.

Abortion, Induced↗
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The sexual and reproductive behavior of American women, 1982-1988.

Comparison of 1988 data from the National Survey of Family Growth with 1982 data reveals that the proportion of U.S. women who have had sexual intercourse rose slightly, from 86 percent to 89 percent. Among teenagers, the proportion sexually active rose from 47 percent to 53 percent; most of the change is attributable to increases occurring among white and nonpoor teenagers, thus narrowing racial and income differences. Among women aged 15-44 in 1988 who have ever had intercourse, 67 percent reported that they had had two or more sexual partners in their lifetime. The proportion was highest among women aged 20-34 (about 70 percent), but 58 percent of sexually active teenage women reported having had two or more sexual partners. About 67 percent of women of reproductive age in 1988 were exposed to the risk of unintended pregnancy, up from 63 percent in 1982. Among these women, 35 percent rely on contraceptive sterilization to prevent pregnancy and 55 percent use reversible methods, while 10 percent use no method. Poor women are much more likely than nonpoor women to be using no method of contraception (15 vs. eight percent); among poor teenagers, this proportion reaches 25 percent. The level of contraceptive use at first intercourse among teenage women improved substantially between 1982 and 1988, however, rising from 48 percent to 65 percent. During 1984-1988, almost four in 10 births and almost six in 10 pregnancies among American women were unintended; most of these were mistimed, but 12 percent of births were unwanted ever.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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Contraceptive failure in the United States: revised estimates from the 1982 National Survey of Family Growth.

It is estimated that only about half of all abortions occurring during the period covered by the 1982 National Survey of Family Growth were actually reported in the survey; thus, contraceptive failure rates calculated from these data are almost certainly inaccurate. An attempt to correct for the underreporting of abortion indicates that actual 12-month use-failure rates are more than one-third higher than those calculated without taking abortion underreporting into account, with rates ranging from six percent for the pill to 14-16 percent for the condom, diaphragm and rhythm and to 26 percent for spermicides. Patterns of contraceptive failure are similar to those found in earlier studies.

Adult↗
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What public school teachers teach about preventing pregnancy, AIDS and sexually transmitted diseases.

Ninety-three percent of public school teachers in five specialties-biology, health education, home economics, physical education and school nursing--who teach grades 7-12 report that their schools offer sex education or AIDS education in some form. Almost all the teachers believe that a wide range of topics related to the prevention of pregnancy, AIDS and other sexually transmitted diseases (STDs) should be taught in the public schools, and most believe these topics should be covered by grades 7-8 at the latest. In practice, however, sex education tends not to occur until the ninth or 10th grades. Moreover, there is often a gap between what teachers think should be taught and what actually is taught. For example, virtually all the teachers say that school sex education should cover sexual decision-making, abstinence and birth control methods, but only 82-84 percent of the teachers are in schools that provide instruction in those topics. The largest gap occurs in connection with sources of birth control methods: Ninety-seven percent of teachers say that sex education classes should address where students can go to obtain a method, but only 48 percent are in schools where this is done. Forty-five percent of teachers in the five specialties currently provide sex education in some form. The messages they most want to give to their students are responsibility regarding sexual relationships and parenthood, the importance of abstinence and ways of resisting pressures to become sexually active, and information about AIDS and other STDs.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
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Public benefits and costs of government funding for abortion.

In state referenda to end public funding of abortions for poor women, one of the most successful tactics of abortion foes has been to charge that abortion funding increases the burden on taxpayers. A state-by-state analysis by The Alan Guttmacher Institute (AGI) shows that the opposite is the case. For every tax dollar spent to pay for abortions for poor women, about four dollars is saved in public medical and welfare expenditures. The savings are in public expenditures that otherwise would have to be incurred because of the babies that poor women would have borne. On the basis of earlier research, it was assumed that 20 percent of Medicaid-eligible women who could not obtain abortions would give birth. Public costs examined in the AGI analysis include Medicaid expenditures for prenatal care, delivery and postnatal care for the mother, and for newborn care, neonatal intensive care and pediatric care for the child for the first two years of life; as well as expenditures for Aid to Families with Dependent Children (AFDC), food stamps and the Special Supplemental Food Program for Women, Infants and Children (WIC) during those first two years. The benefit-to-cost ratio varies from about 9:1 in Massachusetts to 2:1 in Hawaii and Pennsylvania. The net savings for the nation as a whole over a two-year period if abortions were publicly funded in every state would total at least $339.6 million.

Abortion, Legal↗
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Why do women have abortions?

Most respondents to a survey of abortion patients in 1987 said that more than one factor had contributed to their decision to have an abortion; the mean number of reasons was nearly four. Three-quarters said that having a baby would interfere with work, school or other responsibilities, about two-thirds said they could not afford to have a child and half said they did not want to be a single parent or had relationship problems. A multivariate analysis showed young teenagers to be 32 percent more likely than women 18 or over to say they were not mature enough to raise a child and 19 percent more likely to say their parents wanted them to have an abortion. Unmarried women were 17 percent more likely than currently married women to choose abortion to prevent others from knowing they had had sex or became pregnant. Of women who had an abortion at 16 or more weeks' gestation, 71 percent attributed their delay to not having realized they were pregnant or not having known soon enough the actual gestation of their pregnancy. Almost half were delayed because of trouble in arranging the abortion, usually because they needed time to raise money. One-third did not have an abortion earlier because they were afraid to tell their partner or parents that they were pregnant. A multivariate analysis revealed that respondents under age 18 were 39 percent more likely than older women to have delayed because they were afraid to tell their parents or partner.

Abortion, Induced↗
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U.S. women's contraceptive attitudes and practice: how have they changed in the 1980s?

Between 1982 and 1987, favorable opinion of the pill increased steadily among American women (from 65 to 76 percent), and favorable opinion of the condom rose sharply (from 38 to 60 percent). Approval of the IUD dropped during the period (from 26 percent to 19 percent). During the five years, the proportion of married women aged 18-44 who were exposed to the risk of unintended pregnancy remained the same (78 percent), but the proportion among unmarried women rose significantly (from 64 percent to 69 percent). This change was primarily the result of an increase--from 68 percent to 76 percent--in the proportion of never-married women who had ever had intercourse. The overall level of contraceptive use among 18-44-year-olds who were exposed to risk remained stable over the period, at about 93 percent, but use of the most effective methods (sterilization, pill and IUD) went up, from 68 percent to 71 percent. All of the net increase in effective-method use, however, was limited to married women, among whom reliance on both sterilization and the pill increased (from 46 to 51 percent and from 17 to 22 percent, respectively). Pill use also rose among unmarried women (from 43 to 48 percent), but there was no change in the level of sterilization. The prevalence of IUD use declined among both married and unmarried women (to three percent in each case). Condom use remained steady among married women, at about 15 percent, but among the unmarried it increased markedly, from nine to 16 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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The harassment of U.S. abortion providers.

In 1985, 47 percent of abortion providers experienced antiabortion harassment. The approximately 1,250 facilities that were affected served 83 percent of all abortion patients. Nonhospital facilities performing 400 or more abortions a year were the most likely targets of antiabortion activity; 88 percent reported at least one type of harassment during the year. Picketing occurred at 80 percent of these facilities. Only six percent experienced picketing alone; the average facility was subjected to five different types of activity. Seventy-three percent of the facilities were the target of at least one illegal activity. A number of problems that made abortions more difficult or costly to provide were significantly related to the occurrence of antiabortion activity: increased expenditures for security and for legal services, loss of fire and casualty insurance, new licensing requirements and problems hiring staff. However, harassment did not appear to have affected the average number of abortions performed at large nonhospital facilities or the fee charged.

Abortion, Induced↗
PubMedDate not supplied

Family planning clinic services in U.S. counties, 1983.

Organized family planning clinics are a major source of contraceptive services for low-income women, who are less likely than higher income women to be using a contraceptive method. A 1983 study estimated that 9.5 million U.S. women with family incomes below 150 percent of poverty were at risk of unintended pregnancy, and identified a network of 5,106 clinics providing them with services. Seventy-six percent of all counties in the United States have organized clinics that offer family planning services; almost all of those without services are nonmetropolitan counties. An estimated 52 percent of low-income women at risk of unintended pregnancy were served by organized family planning clinics in 1983, while the rest either went unserved or sought care elsewhere. Ten percent of low-income women not served by clinics live in counties that have no family planning clinics, but 67 percent live in counties where existing clinics reach fewer than half of potential low-income patients. More sites may be needed, particularly in counties without clinics, to effectively serve low-income women at risk of unintended pregnancy. However, since the majority of unserved women live in counties where at least one clinic exists, coverage might be improved through increased accessibility and outreach.

Community Health Centers↗
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Abortion services in the United States, 1984 and 1985.

In 1984 and 1985, the number of abortions, the abortion rate and the abortion ratio stayed at approximately the same levels as in the previous three years. Just under 1.6 million abortions were performed, about three percent of women of reproductive age obtained an abortion, and about 30 percent of pregnancies (excluding those ending in stillbirths and miscarriages) were terminated by abortion. However, the number of abortion providers declined by five percent between 1982 and 1985, and the geographic distribution of abortion services continued to be markedly uneven. Eighty-two percent of all U.S. counties--50 percent of those classified as metropolitan and 91 percent of those classified as nonmetropolitan--lacked an abortion provider in 1985. The long-term trend away from hospital abortions persisted during the period: Eighty-seven percent of the abortions performed in 1985 were done in nonhospital facilities, an increase of five percentage points over the 1982 level. Although abortion clinics constituted only 15 percent of all providers, they were responsible for 60 percent of the procedures performed in 1985. Among all abortion facilities, only 43 percent provided services to women after the 12th week of pregnancy. Abortion clinics were far more likely to offer second-trimester procedures than were other types of abortion providers (75 percent, compared with 13-50 percent). As of mid-1986, charges for a first-trimester nonhospital abortion ranged from $75 to nearly $900. The average amount paid was $213. In 1985, only 39 percent of nonhospital abortion facilities accepted state reimbursement for abortions provided to low-income women, and only 55 percent of facilities offered some reduction in charges to such women.

Abortion Applicants↗
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The next contraceptive revolution.

The availability of modern birth control methods has wrought a veritable contraceptive revolution in both developed and developing countries over the past two decades. But concerns about safety, costly lawsuits involving current methods, as well as diverse and changing life-styles, have left the current array of contraceptives grossly inadequate to meet growing world-wide needs. Steroid implants and improved injectables, IUDs, barrier methods and sterilization devices should be widely available in the next few years. But the long-sought-after radically new methods that will constitute the next contraceptive revolution--like vaccines, a male contraceptive and a once-a-month pill--will not be developed in the foreseeable future without a massive infusion of new funds. The eight contraceptive research and development (R&D) programs that are responsible for more than half of all current product development efforts now spend about $30 million a year on contraceptive research. With an additional $23 million annually, they could considerably accelerate current research efforts and begin new ones on products that have become possible only as the result of recent scientific discoveries. Even this level of investment--representing a 75 percent increase over current expenditures by the eight groups--would probably not be sufficient to make optimum progress in the development of radically new methods. Since the pharmaceutical industry can no longer be depended upon to take the leading role that it did 20 years ago, current public-sector R&D organizations may need to expand their efforts to include most aspects of the process of contraceptive development and introduction, and new dedicated R&D centers will probably have to be established.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraception↗