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Biomedical subjects

J D Forrest

Publications and source records attributed to J D Forrest.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

The availability of reproductive health services from U.S. private physicians.

Data on the provision of seven types of reproductive health care were collected from private physicians in four specialties: general/family practitioners (GP/FPs), general surgeons, obstetrician-gynecologists and urologists. All ob-gyns, and eight in 10 GP/FPs, provide the pill, IUD or diaphragm. Over nine in 10 ob-gyns provide infertility and obstetric care and prenatal genetic screening; but only one-third or fewer of GP/FPs do so. Ob-gyns and urologists are far more likely to perform sterilizations than are GP/FPs and surgeons (nine in 10, compared with one-fifth to one-half). Although ob-gyns are the most likely to perform abortions, only four in 10 do so. Among ob-gyns who do not perform tubal sterilizations or abortions, and among urologists who do not perform vasectomies, the primary reason is moral or religious objections (reported by 59-71 percent). For GP/FPs and surgeons who do not perform the three procedures, the leading reason is that they do not perform surgery or that type of surgery; however, 34 percent of nonproviders in these specialties report moral or religious opposition to abortion. Eight in 10 ob-gyns will provide contraceptives to minors without parental consent, but only six in 10 GP/FPs will do so. One-half of doctors who perform female sterilizations, and eight in 10 of those who do vasectomies, require spousal consent. Among those who perform abortions, half require parental consent for minors. Access to private reproductive health care is quite limited for the poor, because many physicians will not accept Medicaid reimbursements or reduce their fees for low-income patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
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The need for prenatal care in the United States: evidence from the 1980 National Natality Survey.

Seventy-eight percent of U.S. mothers begin prenatal care during the first three months of pregnancy; 18 percent wait until the second three months; and five percent wait until the third trimester or receive no care at all. Patterns of prenatal care vary widely among population subgroups: Mothers younger than 18 and unmarried mothers are the least likely to obtain first-trimester care (49 percent and 56 percent, respectively), and the most likely to obtain care only in the third trimester or none at all (about 12 percent of each group). Women aged 18-19, blacks, Hispanics, poor women and women with little education also have disproportionately high levels of very late or no care (7-9 percent). Married, white, nonpoor women, in contrast, obtain the most timely prenatal care: In 1980, only two percent initiated care in the third trimester or received no care. Compared with this subgroup of women, the population as a whole has two times the risk of obtaining inadequate care. Unmarried women run the highest relative risk (five times the risk for married, white, nonpoor women), followed by teenagers, Hispanic women, women with little education, poor women and blacks (who have from three to more than four times the risk of the comparison group).

Adolescent↗
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The provision of sterilization services by private physicians.

Obstetrician-gynecologists are 4-5 times more likely to perform female sterilizations, and urologists are 2-3 times more likely to perform vasectomies, than are general surgeons or general or family practitioners. Catholics are less likely to perform either procedure than are non-Catholics. Participation in a group practice and having a practice in the North Central region of the country are associated with carrying out a larger average number of both male and female sterilizations. More than half of female sterilizations are performed as inpatient hospital procedures, and most of the remainder are done in hospitals on an outpatient basis. Two-thirds of vasectomies, on the other hand, are performed in doctors' offices, while most of the rest are performed as hospital outpatient procedures. About one vasectomy in 12, however, is performed on an inpatient basis--possibly because general anesthesia is used, or the procedure is performed along with other surgery. The average cost for an inpatient female sterilization in 1982 was $1,335. The cost for a hospital outpatient sterilization was not much less than that. The total cost of a vasectomy ranged from an average of $511 for an inpatient procedure to $240 for one performed in the office. The average cost is higher when the sterilization is performed by an obstetrician-gynecologist or a urologist than when the service is provided by a general surgeon or general/family practitioner. Fifty-eight percent of physicians performing female sterilizations accept Medicaid reimbursement, and 12 percent reduce their fees to accommodate low-income patients. The proportions for doctors who perform vasectomies are 51 percent and 12 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

Catholicism↗
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Family planning clinic services in the United States, 1983.

Almost five million women were enrolled in family planning clinics in the United States in 1983, eight percent more than in 1981. The number of family planning provider agencies declined slightly, from 2,504 to 2,462, but the number of clinic sites that could be identified increased slightly, from 5,124 to 5,174. Family planning clinics operate in three-quarters of U.S. counties; in 1975, the last time county coverage was checked, four-fifths of the counties had clinics. About one in 20 women who are exposed to the risk of unintended pregnancy and live in unserved counties are teenagers or low-income women. Nonmetropolitan counties are more likely to be without clinics than are metropolitan counties. Overall, there are 417,000 low-income women and 249,000 teenagers at risk of unintended pregnancy living in counties where there are no family planning clinics. In 1983, health departments constituted six in 10 of all family planning agencies and served two-fifths of all family planning clinic patients; Planned Parenthood affiliates accounted for fewer than one in 10 agencies and served more than one-quarter of all patients. Hospitals and all other agencies served about one-third of the total 1983 caseload. These patterns were similar to those reported for 1981. Family planning clinics continue to serve primarily low-income women: Four-fifths of the nearly five million clinic patients in 1983 had family incomes below 150 percent of the federally defined poverty level. About 1.6 million women aged 19 and younger were served, representing one-third of all clinic patients in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Abortion in the United States, 1977-1978.

There were 1.32 million legal abortions in the United States in 1977 and a projected 1.37 million in 1978, an increase of four percent between 1977 and 1978 compared with one of 12 percent between 1976 and 1977. In 1978, 29 percent of pregnant women chose to terminate their pregnancies by abortion. Almost three percent of U.S. women of reproductive age obtained an abortion in 1978. From 1967 through 1978, approximately six million women obtained almost eight million legal abortions; about one in eight U.S. women of reproductive age has had a legal abortion. The number of hospitals reporting that they provided abortion services dropped slightly from 1,695 in 1976 to 1,661 in 1977, but the number of nonhospital abortion clinics increased from 448 to 522, and the number of physicians who reported performing abortions in their offices grew from 424 to 533. Between 1976 and 1977, the average number of abortions per hospital facility decreased from 246 to 237, while the average number per nonhospital provider increased from 875 to 879. The percentage of abortions performed in hospitals declined from 35 in 1976 to 30 in 1977, while the percentage reported by free-standing clinics increased from 61 to 66; the percentage performed in physicians' offices remained at four. Ninety-five percent of abortions in 1977 occurred in metropolitan areas, where 75 percent of the women in need of abortion services live. In 1977, there were identified abortion providers in only 23 percent of U.S. counties. Nine percent (more than 118,000) of the women who obtained abortions in 1977 had to travel to another state for services, and many traveled to other, often distant, counties in their home states. One in three abortions in 1977 were obtained by teenagers, and three in four were obtained by unmarried women. Twenty-eight percent of the women estimated to be in need of abortion services in 1977, and 26 percent in 1978, were unable to obtain them. In FY 1977, before Hyde amendment restrictions on government financing of abortions for poor women, 133,000 of the estimated 427,000 Medicaid-eligible women in need of publicly funded abortion services were unable to obtain them.(ABSTRACT TRUNCATED AT 400 WORDS)

Abortion, Legal↗
PubMedDate not supplied

Abortion services in the United States, 1981 and 1982.

The U.S. abortion rate remained essentially stable in 1981 and 1982, after rising each year between 1973 and 1980. The increases had been due to widening availability of abortion services and rising unintended pregnancy rates caused by several factors, among them a shift from use of the pill and the IUD to use of less effective methods. The stabilization of the abortion rate since 1980 is the culmination of a pattern of smaller annual increases in the rate in previous years. There were 1.57 million legal abortions reported in the United States in 1982. About three percent of U.S. women of reproductive age obtained an abortion, and about 26 percent of all pregnancies were terminated by abortion during that year. There are still wide gaps in the geographic availability of abortion services. Seventy-eight percent of all U.S. counties--containing 28 percent of women aged 15-44--had no identified provider of abortion services in 1982. Only two percent of abortions were performed in nonmetropolitan counties in that year, although 26 percent of women of reproductive age live in such counties. Fully 87 percent of nonmetropolitan counties had no abortion providers at all in 1982. Despite the concentration of abortion services in urban areas, 47 percent of metropolitan counties also had no abortion service providers in 1982. Abortion services are most available, and rates are highest, in states on the East and West coasts. In 1982, 82 percent of abortions were performed in nonhospital facilities: 56 percent in clinics which specialize in abortion services, 21 percent in other kinds of clinics and five percent in physicians' offices.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMedDate not supplied

Family planning clinic services in the United States, 1981.

In the first 13 years after the federal government initiated support for family planning clinic services, there was a fivefold increase in the number of U.S. women obtaining these services from organized programs, from about 860,000 in 1968 to 4.6 million in 1981. This increase was due to the growth in the number of service providers and in the average number of clients served by each agency. Between 1968 and 1981, the number of provider agencies rose from about 1,400 separate agencies operating 1,800 clinics to 2,500 agencies administering 5,000 clinics. The average number of patients served by each agency increased from 600 to 1,800. Family planning clinics have continued to serve primarily low-income women; in 1981, four-fifths of the women served, or 3.7 million, had low incomes. In addition, an estimated 1.8 million low-income women obtained family planning services from private physicians. Thus, about 58 percent of the 9.5 million low-income women who were exposed to the risk of having an unintended pregnancy in 1981 made a contraceptive visit in that year; 39 percent went to clinics and 19 percent visited private physicians. Five million women 19 years of age or younger were at risk of unintended pregnancy in 1981; of these, 2.9 million (57 percent) obtained medically supervised family planning services--30 percent from organized programs and 27 percent from private physicians. Family planning clinic patients obtained contraceptive care from a variety of public and private health agencies in 1981.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

The costs of contraception.

The cost of contraception is one factor that affects the choice of a birth control method. An analysis of the first-year costs for the various methods, based on fees charged by private physicians and supplies purchased at drugstores, shows that the cost can be considerable and that there are large differences in cost between methods. Prescription contraceptives--the pill, IUD and diaphragm--are by far the most expensive of the reversible methods because they require medical supervision, but supplies alone are also more expensive for prescription methods than for nonprescription methods. First-year cost is highest for the pill-$172, compared with $160 for the diaphragm and $131 for the IUD. The mean of $154 for these three prescription methods is almost four times the mean first-year cost of $40 for condoms and foam. Sterilization necessitates the largest initial expenditure, and the cost of tubal ligation-$1,180-is almost five times the cost of vasectomy-$241. However, sterilization represents a one-time cost, while the other methods involve recurring expenses that may add up to more than the cost of sterilization over time. The methods that are associated with the lowest failure rates-sterilization, the pill and the IUD-are among the most expensive. To offset the costs of contraception, 4.6 million American women obtained low-cost care from subsidized family planning clinics in 1980.

Contraception↗
PubMedDate not supplied

Abortion in the United States, 1976--1977.

In 1976, about 1.2 million, and in 1977 some 1.3 million, abortions were performed in the U.S. More than half a million women were without the abortion services that they wanted. Poor, rural, young and black women were disporportionately represented among those not yet served.

Abortion, Legal↗
PubMedDate not supplied

The impact of family planning clinic programs on adolescent pregnancy.

During the 1970s, there was a decline in adolescent childbearing in the United States and, among teenagers who were sexually active, there was a decline in pregnancy rates as well. To what extent was increased enrollment by teenagers in federally funded family planning clinics responsible for these declines? Areal multivariate analysis reveals that adolescent birthrates were reduced between 1970 and 1975 as the result of enrollment by teenagers in family planning clinics, independent of the effects of other factors also affecting fertility, such as poverty status, education and urbanization. Using a model which controls for differences in adolescent sexual activity in different areas in 1970 and 1975, the analysis found that for every 10 teenage patients enrolled in family planning clinics in 1975, about one birth was averted in 1976. Other multivariate models, which did not control for differences in sexual activity, showed changes in the same direction, though of smaller dimension. Since the family planning program averts not only births but also pregnancies that result in abortions and miscarriages, an estimate was made of the total number of pregnancies averted by the program. Based on the proportion of unintended pregnancies among adolescents that resulted in live births in 1976 (36 percent), it was estimated that for every 10 teen patients enrolled in 1975, almost three pregnancies were averted in the following year. Over the 1970s, an estimated 2.6 million unintended adolescent pregnancies were averted by the program--944,000 births, 1,376,000 abortions and 326,000 miscarriages. In 1979 alone, an estimated 417,000 unintended pregnancies were prevented by the program.

Adolescent↗