Abortions preventable by contraceptive practice.
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Abortion, Legal↗
Biomedical subjects
J D Forrest
Publications and source records attributed to J D Forrest.
How old are U.S. fathers?
One in every six U.S. birth certificates have no information on the age of the baby's father; for more than four in 10 babies born to adolescent women, no data are available on the father's age. Information from mothers aged 15-49 who had babies in 1988 and were surveyed in the National Maternal and Infant Health Survey indicates that fathers for whom age is not reported on the birth certificate are considerably younger than other fathers. In 1988, 5% of fathers were under age 20, and 20% were aged 20-24. Fathers typically are older than mothers, especially when the mothers are teenagers. Fathers who are unmarried, black or partners of lower income women are younger than other fathers.
Adolescent↗
Intention status of U.S. births in 1988: differences by mothers' socioeconomic and demographic characteristics.
The National Maternal and Infant Health Survey provides new data on the prevalence of unintended childbearing in the United States: Thirty-six percent of births in 1988 were mistimed and 7% were unwanted, while 57% were intended. Although the level of unintended childbearing is high in almost all socioeconomic subgroups of women, the proportion of births that were mistimed or unwanted was 50% or more among age-groups 15-17 (78%), 18-19 (68%) and 20-24 (50%), and among never-married women (73%), formerly married women (62%), black women (66%), women living below the federal poverty level (64%) or at 100-149% of the poverty level (52%), women with less than 12 years of education (58%) and women who already had two children (53%) or three or more children (60%). Multivariate analyses indicate that births to unmarried women--whether formerly married or never-married--are less likely than those to married women to be wanted and more likely to be mistimed. Poverty status has no independent effect on the odds that a birth is unwanted or on the odds that a birth to an unmarried woman is mistimed. Among currently married women, those who are poorer are more likely than women above 150% of the poverty level to have a mistimed birth. Black women are more likely than either Hispanic or white women to report a birth as unwanted and are more likely than white women to say a wanted birth was mistimed.
Adolescent↗
Questions of balance: issues emerging from the introduction of the hormonal implant.
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Adolescent↗
Women's contraceptive attitudes and use in 1992.
Women aged 15-44 rate the pill, the condom, vasectomy and female sterilization most highly, according to 1992 data from an annual survey by Ortho Pharmaceutical Corporation of contraceptive attitudes and method use. The 6,955 survey respondents underrepresent women who are black or who have household annual incomes greater than $50,000, but they are similar to all American women in age, marital status and region of the country. About 74-84% of women giving an opinion view these methods favorably and 64% rate the hormonal implant favorably. The proportion of unmarried women who had had intercourse increased from 76% in 1987 to 86% in 1992. As a result, proportions of women at risk of unintended pregnancy rose from 72% to 77%. Contraceptive use also rose, from 92% to 94%. The most commonly used method is the pill (39%), followed by the condom (25%), female sterilization (19%) and vasectomy (12%). Married women exposed to the risk of unintended pregnancy are more likely to use sterilization (48%), while unmarried women are more likely to use the pill (52%) and the condom (33%). Pill use has increased since 1987, especially among married women, and condom use has increased among all women. Among unmarried women at risk of unintended pregnancy, condom use rose from 18% in 1987 to 33% in 1992. Among condom users, 40% of unmarried users and 13% of married users also use another method.
Adolescent↗
Impact of publicly funded contraceptive services on unintended pregnancies and implications for Medicaid expenditures.
Of U.S. women who use a reversible method of contraception, 24% each year obtain family planning services from a publicly funded clinic or a private doctor reimbursed by Medicaid. If these subsidized contraceptive services were not available, women who currently use them would have an estimated 1.3 million additional unplanned pregnancies annually, of which 29% would involve women aged 15-19, 67% would involve never-married women and 61% would involve women with a household income below 200% of the federal poverty level. An estimated 632,300 of these pregnancies would end in induced abortion, an increase of 40% over the current national level. Another 533,800 pregnancies would result in unintended births. Some 76,400 of these would be births to families already receiving public assistance, and 64,100 would be to families that would become eligible for public assistance because of the birth; another 197,000 would be to women whose families would not receive public assistance, but would be eligible for Medicaid coverage of pregnancy, delivery and newborn care. In FY 1987, public-sector expenditures for contraceptive services totaled an estimated $412 million. If subsidized services had not been available, the federal and state governments would have spent an additional $1.2 billion through their Medicaid programs for expenses associated with unplanned births and abortions. Thus, for every dollar spent to provide publicly funded contraceptive services, an average of $3.00 was saved in Medical costs for pregnancy-related health care and medical care for newborns.
Abortion, Induced↗
Private physicians' provision of contraceptive services.
Private physicians provide family planning services to the majority of American women. According to data from the National Ambulatory Medical Care Survey, office-based physicians received on average 13.5 million visits annually for contraceptive services during 1990-1992. Private insurance was the expected from of payment for 38% of visits, while managed care covered 22% of visits, and Medicaid or another source of public assistance subsidized 12%; 22% were self-paid and 6% covered by other sources. The majority of patients who received contraceptive services gave a reason other than general family planning or care regarding a specific contraceptive as the primary purpose for their visit, although women covered by a managed care plan or through public funding were the most likely to give general family planning needs as the main reason. Women whose visit was listed as publicly funded were less likely to have a contraceptive prescribed or provided or to obtain a Pap test than were those expected to pay with private insurance.
Adolescent↗
The family planning attitudes and experiences of low-income women.
A 1995 telephone survey of 1,852 low-income women aged 18-34 who were sexually active and at risk of unintended pregnancy found that 83% were currently practicing contraception. They were more likely to do so if they held positive attitudes toward contraceptive use, if they talked frequently about intimate matters with their partners and girlfriends and if they were very satisfied with the services they received at their last gynecologic visit. Seventy percent of current users said they were very satisfied with their method. Women whose last visit was to a clinic, who were very satisfied with the care they received and who used the pill or a long-acting method were more likely than others to report being very satisfied with their contraceptive. Women very satisfied with their gynecologic care were more likely to use oral contraceptives and to take them consistently, but were less likely to report that their partner used condoms or, if they did, used them consistently. Most women had made a medical visit for gynecologic or contraceptive care in the past year (86%), and 80% were very satisfied overall with their care at their last visit. Women were more likely to be very satisfied if the staff was courteous, helpful and respectful and made an effort to find out their needs, if their clinician's gender matched their own preference and if the facility was clean and services were organized.
Adolescent↗
Public health departments providing sexually transmitted disease services.
Results of a 1995 survey reveal that 1,437 local health departments-half of those in the country-provide sexually transmitted disease (STD) services and receive about two million client visits each year. Their clients are predominantly individuals with incomes of less than 250% of the poverty level (83%), women (60%) and non-Hispanic whites or blacks (55% and 35%, respectively); 36% of clients are younger than 20, and 30% are aged 20-24. On average, 23% of clients tested for STDs have chlamydia, 13% have gonorrhea, 3% have early-stage syphilis, 18% have some other STD and 43% have no STD. Virtually all public STD programs offer testing and treatment for gonorrhea and syphilis; only 82% test for chlamydia, but 97% provide treatment for it. Some 14% offer services only in sessions dedicated to STD care, 37% always integrate STD and other services, such as family planning, in the same clinic sessions, and 49% offer both separate and integrated sessions. STD programs that integrate services with other health care typically cover nonmetropolitan areas, have small caseloads, serve mainly women and provide a variety of contraceptives. In contrast, those that offer services only in dedicated sessions generally are in metropolitan areas and have large caseloads; most of their clients are men, and few provide contraceptive methods other than the male condom.
Adolescent↗
Understanding the impact of effective teenage pregnancy prevention programs.
A review of five rigorously evaluated adolescent pregnancy prevention programs shows that all five incorporate an emphasis on abstinence or delay of sexual initiation, training in decision-making and negotiation skills, and education on sexuality and contraception. Four of the five directly or indirectly provide access to contraceptive services. Comparisons between treatment and control groups show that all four programs that measured changes in rates of sexual initiation among adolescents had a significant effect on that outcome, reducing the proportion of adolescents who initiated sexual activity by as much as 15 percentage points; the programs were most successful when they targeted younger adolescents. Three of these four programs also significantly increased rates of contraceptive use among participants relative to controls; the most successful programs, which increased contraceptive use by as much as 22 percentage points, provided access to contraceptive services and targeted adolescents who were younger and those who were not yet sexually experienced. Two programs significantly decreased the proportion of adolescents who became pregnant; these programs were the two that were most active in providing access to contraceptive services.
Adolescent↗