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From page 165... ... H Robins Company, 45 Aid to Families with Dependent Children, 9, 81, 87, 113 AIDS, 7, 23 Alan Guttmacher Institute, 43, 52, 60, 61, 70, 81, 85, 88, 89, 94, 104, 111 Alza Corporation, 45 Amenorrhea, 127, 128 American Academy of Pediatrics, 107, 116 American Association of Tissue Banks, 24, 28 American Civil Liberties Union, 87 165 American College of Obstetricians and Gynecologists, 28, 47, 107-108, 116, 154-155 American Fertility Society, 28, 30, 32, 155 American Medical Association Diagnostic and Therapeutic Technology Assessment panel, 61 Amniocentesis, 134-136 Anencephaly, 135 Anorexia nervosa, 128 Artificial insemination, 3, 5, 11, 12, 23-25, 26, 28, 140, 147 Basal body temperature, 20 Benign breast tumors, 56 Biodegradable pellets, contraceptive, 65 Biomedical Ethics Board, 155, 156, 162 Birth control, see Contraception and contraceptives; and specific methods Birth control pills, 2, 57 availability of, 43, 44, 59, 60, 6, 89-90 and breast cancer, 55-56, 62 components, 56 costs, 46 development, 41 effectiveness of, 63 liability claims, 45~6 for men, 42 Read the entire page →
From page 166... ... 166 mini-pill, 63 side effects, 43~4, 55-56, 61~2, 63, 88-90 treatment of endometriosis with, 21, 65 use trends, 53, 57, S9, 76 women's attitudes toward, SS-56, 61, 78, 89-90 Birth rates from IVF, 20 for minorities and ethnic groups, 109 for unmarried women, 108-109 U.S., 53 Blacks births to unmarried women, 108 infant mortality rates, 96-97, 98, 109 pregnancy rates for adolescents, 70 prenatal care for, 10, 109, 160 Blastocyst, 17, 149, 150 Blastomeres, 17 Brain, role in reproduction, 18, 20, 21, 126-129, 144 Breast cancer, birth control pills and, SS-56, 62 Bromocriptine, 21 Catholics' 61, 152 Center for Population Options, 69, 81 Centers for Disease Control, 24 Cerebral palsy, 102, 107 Cervical cap, 41, 58, 64-65, 90 Cervical mucus, hostile reaction to sperm, 22, 23, 25 Chastity, promotion of, and teenage pregnancy, 87-88 Child care availability for teenage mothers, 80, 81-82 prenatal care accessibility and, 119 Child health, see Maternal and child health Childbearing, rates, 7 Children of teenage mothers, 69, 82-84 Children's Defense Fund, 100, 102, 108-109, 113, 116 Chlamydia, IS, 19-20 Chorionic villus sampling, 134-135, 136, 137, 140 Chromosome defects, and pregnancy outcomes, 138-139 Chronic granulomatous disease, 134 Clinics for prenatal care access to, 113-114, 119, 120, 124 hours, 119 INDEX location of, 120 malpractice insurance, 116 staff attitudes, 119-120 transportation to, 118 waiting times, 113, 119 see also In vitro fertilization clinics Clomiphene citrate, 21, 22 Cocaine, 122-123 Community health centers, 117 Conceptus, 17 Condoms adolescent attitudes on, 78 advertising, 9, 60, 92 availability of, 9, 60, 63~4, 90 effectiveness, 63-64 female, 65 historical background, 41 male, availability and effectiveness, 44, 57, 63-64 use trends, 57, 58, 60 Congenital anomalies, 103, 122 Congressional Research Service, 98 Consumer protection approaches, 34-35, 38 consensus conferences, 34 defining IVF and GIFT success rates, 30-33, 38 physician credentials, 29 protocol appropriateness, 29, 34 questions to ask an IVF clinic, 33-34 state regulation of clinics, 34 Contraceptive development barriers to, 2, 7-8, 62, 126 costs of, 49 decline in, 43, 44 52 FDA approval process and, 8, 44, 50-52 funding for, 42, 44, 49-50, S1 lawsuits and, 7, 44 46, 48-49, 62 legal rule changes and, 46-48 liability insurance costs and 48-49 time for, 65 trends in, 42-43, 49-50 WHO testing guidelines, 50-S1 Contraceptive use, 6-8 and abortion prevention, 52-53 acceptance of one's sexual behavior and' 78, 90 age and, 76 culture and, 58-S9 determinants of, 57-S9, 75-78, 90 educational goals and, 76 Read the entire page →
From page 167... ... INDEX and family planning programs, 7 hinderances to, 7, 59-62, 88-89 and maternal and child health, 54-55 patterns of, 57-58 and population growth, 41-42, 53-54 promotion of, 12 and quality of life, 54 rates of, 7, 59-60, 85 sex education and, 60-61, 76-78 and sexual behavior, 52-53, 91 social development and, 78 and teenage pregnancy, 71-72, 75-78, 85, 88 women's attitudes on, 55-56 Contraceptives acceptability and accessibility, 7-8, 47, 56-59, 71, 161 advertising, 2, 9, 45, 59, 60, 61, 84, 92, 161 choice of effective methods, 1-2, 43~4, 55-56, 60 costs, 7, 58, 72 historical background, 41-44 improving access to, 88-91 inherent attributes, 58 injectable, 43, 49, 65-66 liability insurance for, 48-49 methods not available in U.S., 7, 43, 65-66 new methods, 8, 65 perceived attributes, 58 postmarketing surveillance programs, 51 side effects, 7, 43-44, 50, 51, 66 see also Contraceptive development; Contraceptive use; Family planning; and specific methods Creams (contraceptive) , availability and effectiveness, 63, 64 Cryopreservation of eggs and embryos, 12, 37, 140-142 of sperm, 25, 37 CuFix 390, 66 Cystic fibrosis, 136, 137, 140 Danazol, 21 Depo-Provera, 43, 49, 65 Developing countries abortion rates, 53, 54 family planning programs in, 53 maternal and child health in, 54-55 population growth in, 53, 54 Diaphragms, 44, 57, 58, 63, 64, 90 167 DNA analysis adult screening, 129, 132 new techniques, 136-137 newborn screening, 129, 133 polymerase chain reaction, 140 prenatal testing techniques, 133-135 Douching, 7, 55 Down syndrome, 132, 134, 135 Duchenne muscular dystrophy, 137, 139, 140 Economic costs, of early childbearing, 81-82 Educational attainment and early childbearing, 73, 80 and prenatal care, 109 Educational goals and contraceptive use, 76 and teenage pregnancy, 73 Eggs, human chromosome abnormalities in, 26, 143-144, 149 collection for IVF, 25 development, 25, 127 donation, 12 fertilization, 15, 23-24 ovulation, 15 zone pellucida, 16 Embryos cell differentiation, 17-18 chromosome abnormalities, 130, 138-139, 150 culture medium, 142 development, early, 149-150 development, improving, 12, 142 diagnosis of genetic diseases in, 11, 139-140 ethical issues, 3-4, 10-11, 138, 143, 151-156 fertilization and incubation, 28; see also In vitro fertilization freezing for preservation of, 12, 26, 28, 37, 140-142 health of, 32, 37 human rights controversy, 11, 152 ownership of, 4, 152 preimplantation, 17, 138, 153 "primitive streak," 18 research with, 3-4, 10-12, 26, 37, 38, 126, 138, 142-143, 148-156 Endometrial cancer, 56 Endometriosis, 20, 21, 23, 25, 65 Estrogen, 56, 63, 65, 66 Read the entire page →
From page 168... ... , availability and effectiveness, 63, 64, 90 Follicle-stimulating hormone, 21, 127, 129 Food and Drug Administration, 62, 128 INDEX contraceptive testing requirements, 8, 43, 44, 50-52, 65 guidelines for screening sperm donors, 24 rules in tort liability suits, 47-48 Food stamps, 9, 81, 87 Funding for contraceptive development, 49-50, 51 for embryo research, 26, 37-38, 126, 143, 149, 150, 154 Galactosemia, 133 Gallup poll on women's attitudes toward contraception, 55, 61 Gamete intrafallopian transfer (GIFT) , 14 costs of, 6, 35 defining success, 3~33 drawbacks, 27 physician credentials for, 29 process, 5, 26-27 public policies on, 12 setting standards for, 14, 27-28 success rates, 5, 6, 14, 27, 30-33 G Read the entire page →
From page 169... ... , 26 characteristics of, 35-36 growth of, 5-6, 27, 37 questions to ask at, 33-34 Income and early childbearing, 80-81 and prenatal care, 110 Industrialized countries abortion rates in, 53, 70 adolescent pregnancies in, 70 contraceptive availability in, 71 infant mortality rates in, 96-97 time span between menarche and marriage in, 72 Infant mortality causes, 99, 109, 124 low birthweight and, 97, 99-101, 124 neonatal intensive care and, 107 poverty and, 98, 101-102, 124 169 prenatal care and, 10, 97, 105, 106, 109 rates, 1, 54-55, 96-99, 124 Infertility from damage to reproductive tract, 19-20, 45, 61, 63, 90, 160 defined, 15 from endometriosis, 20 male, 5, 2~21, 25, 37 from ovulation disorders, 20 prevalence, 4-5, 15, 37 secondary, 15 - sexually transmitted diseases and, 5, 15 tests for, 5, 19 Infertility treatment artificial insemination, 3, 5, 23-25 characteristics of patients, 36 consumer protection, 28-35, 37, 38 costs of, 35 dissemination of new technologies, 29 ethical issues, 6, 126 medical therapies for men and women, 3, 5, 21-22 new fertilization procedures, see Gamete intrafallopial transfer; In vitro fertilization physician credentials for, 29 protocols, 29, 34 public policies, 12 research needs, 37, 159-160 state regulation of, 34 sources, 5-6, 18-19 success of, 5, 22-23 surgery for varicocele, 3, 22-23 surgery for women, 3, 5, 23 Institute of Civil Justice, 46 Institute of Medicine Committee to Study Outreach for Prenatal Care, 109, 113-114, 117, 118, 120 Committee to Study the Prevention of Low Birthweight, 102, 103, 107 Intrauterine devices, 2, 41, 57 availability and effectiveness, 7-8, 43-45, 63 Cu-7, 45 CuFix 390, 66 Dalkon Shield, 45, 61 determinants of use, 58, 61 liability suits, 45, 47, 61, 66 Lippes Loop, 45 ParaGuard, 43, 45, 61, 63 Read the entire page →
From page 170... ... 70 and pelvic inflammatory disease, 19, 45, 61, 63, 90 Progestasert, 43, 45, 61, 63 and sexually transmitted diseases, 61 side effects, 44, 45, 90 IUDs, see Intrauterine devices Jellies (contraceptive) , availability and effectiveness, 64 Job opportunities, and early childbearing, 73, 80 Johns Hopkins University School of Medicine, 85, 86 Laparoscopy, 19, 21, 25, 27 Lawsuits changes in rules governing, 46-48 contraceptive-related, 41 46 deterring effects of, 47 discovery rules, 46-47 negligence standard, 46 Lesch-Nyhan syndrome, 132, 137, 139 Levonorgestrel, 64, 65 Liability coordination of regulatory system and tort system, 47-48 insurance costs, 48-49, 61 objectives of tort system, 47 see also Lawsuits; Malpractice Louis Harris survey, 61, 84 Low birthweight and congenital anomalies, 103 costs associated with, 104, 105 definition of, 97, 99 effects of, 102-105 factors contributing to, 97, 124 and family stresses, 104 and financial stresses, 104-105 and health problems, 97, 102-103, 104 and infant mortality, 97, 99-101, 124 and neurodevelopmental handicaps, 100, 102 poverty and, 101, 104 prevention of, 55, 97, 105, 106; see also Prenatal care respiratory tract problems, 103 side effects of technology, 103 substance abuse and, 122 as teenage pregnancy outcome, 79, 104-105 trends, 99-100 INDEX Lowry, 142 Luteinizing hormone, 127, 129 Maple syrup urine disease, 132 Malpractice awards, 116-117 claims, 46 insurance costs, and availability of prenatal care, 115-117 locality rule, 46 Marijuana, 122, 123 Marriage age of, relative to onset of puberty, 72-73 see also Unmarried women Maternal and child health contraception and, 5~55 current status, 98-99 poverty and, 98 research needs on, 151 sources of care, 101 substance abuse and, 122-123 teenage childbearing and, 9, 79 Maternal and Child Health Services Block grants, 117 Maternal mortality, 54-55, 56, 62, 90 Maternal serum alpha-fetoprotein screening, 135 Medicaid application procedures, and prenatal care, 112-113, 117-118, 124 continuous eligibility option, 118 and contraceptive availability, 71 expenditures relative to teenage pregnancies, 9, 81, 87 and infertility treatment, 36 physician acceptance of, 113-114, 124 prenatal care under, 101, 105-106, 111, 112-113, 117, 121, 124 reimbursement rates, 115 Medicare Catastrophic Coverage Act, 113 Menstrual cycle, 15-16, 18, 128 treatment of irregularities in, 63, 64, 65 Menstrual inducers, 43, 66 Mental retardation, 107, 129, 132 Mifepristone, 66 Migrant and Rural Health Centers, 117 Miscarriage, 8, 79, 122, 134 Morphine, 128 Morula, 149 National Bureau of Economic Research, 106 Read the entire page →
From page 171... ... INDEX National Center for Health Statistics, 4, 70, 108, 112 National Commission to Prevent Infant Mortality, 97 National Fertility Survey, 15 National Institute of Allergy and Infectious Diseases, 19 National Institutes of Health, 51, 142, 150 National Natality Survey, 110 National Research Council Panel on Adolescent Pregnancy and Childbearing, 72, 74-77, 81 National Survey of Family Growth, 4-5, 15, 36, 44 45, 57-58, 75, 110 National Survey of Young Women, 75-76 Native Americans, prenatal care for, 109 Neonatal intensive care, 100, 107 Neurodevelopmental handicaps, 100, 102-103, 122 Newborns and congenital anomalies, 103, 122 and neurodevelopmental handicaps, 100, 102-103, 122 respiratory tract problems, 103 screening for defects, 133 side effects of technology, 103 see also Low birthweight; Premature births Nonoxynol-9, 64 Norethindrone, 65 Norigest, 65 Norplant availability and effectiveness, 8, 49, 64, 90 postmarketing surveillance program, 51 Nurse-midwives, restrictions on, 115 Office of Technology Assessment, 29, 36, 42-43, 97, 101, 102, 104, 105, 108, 140, 142 Omnibus Reconciliation Act of 1987, 105, 113 Oocytes, see Eggs, human Oral contraceptives, see Birth control pills Ortho Pharmaceutical Corporation, 43, 45, 48, 49 Ovaries, 15, 19, 20, 23 cysts and cancer, 56, 63 Ovulation control of, 127 detection, 20, 25 disorders, 3, 5, 20, 127, 128, 145 process, 15 171 restoration of, 127 treatment of disorders, 21 Patient dumping, 102, 147 Peer pressure, teenage pregnancy and, 75 Pelvic inflammatory disease, 19, 45, 56, 61, 63, 90 Phenylketonuria, 129, 132, 136 Physicians acceptance of Medicaid patients, 113-114, 124 credentials, 29 inaccessibility for prenatal care, 11~115, 116 malpractice insurance costs, 115- 116 Pituitary gland, 18, 20, 21, 127 Policy issues family planning, 161 federal support of reproductive health research, 159 infertility treatment, 159-160 maternity care system improvements, 160 process for public policy, 161-162 standards, licensing, and regulation of IVF clinics, 159 teenage pregnancy and sexual activity, 161 Polymerase chain reaction, 140 Population Council, 45, 48, 50, 51, 65 Population Crisis Committee, 54 Population growth contraception and, 41-42, 53-54 in developing countries, 53, 54 Poverty and contraceptive availability, 71 and infant mortality, 98, 101-102, 124 and low birthweight, 101, 104 and prenatal care, 110 and teenage pregnancy, 69, 72, 73, 94 Preembryo, 17 Pregnancy adverse outcomes, and insurance status, 112 clinical/successful, 31, 32 complications, 55, 79 testing services, 117 tubal or ectopic, 23, 32, 56 unintended, 1, 2, 44, 53, 54, 62, 70, 88 vaccine, 42 see also Teenage pregnancy and parenthood Pregnancy Discrimination Act, 112 Read the entire page →
From page 172... ... 172 Premature births financial costs of, 2 neonatal intensive care units, 100 substance abuse and, 122 among teenagers, 79 see also Low birthweight Prenatal care attitudes about, 120-121 for blacks, Hispanics, and Native Americans, 10, 109, 160 and child care problems, 119 clinic access problems, 113-114, 119-120 cost-effectiveness of, 10, 105-107, 160 cultural and personal barriers to, 12~123 definition of good care, 10, 105, 107-108 educational attainment and, 109 financial deterrents, 110-113 homelessness, and prenatal care, 121 importance of, 9-10, 160 and infant mortality, 10, 97, 105, 106, 109 and low birthweight, 10, 97, 105, 106 and malpractice insurance costs, 115- 117 by nurse-midwives, 115 obstacles to, 98, 101, 112- 123 physician inaccessibility, 114-115 policy goals, 160 for poor women, 98, 101, 105-106, 110 populations receiving insufficient care, 107-111 programs, 117-118 research needs on, 123 studies of, 105 substance abuse, 121 - 123 for teenagers, 79, 108, 121 testing for birth defects, 133-136 and transportation problems, 118 for uninsured women, 11~111 for unmarried women, 108-109 use rates, 10, 108 for women with many children, 109-110 Progesterone, 21 Progestins, 64, 65 Progestogens, 41, 56, 63, 65, 66 Prolactin, 21 Prostaglandins, 46, 66 Puberty early onset of, and delayed marriage, 72-73 hormones controlling, 127-128 and social maturity, 2 research needs on, 92 INDEX Public assistance, teenage pregnancy and, 81-82, 87 Radio immune as say, 25 Recombinant DNA technology, 10-11, 136 Regulation of artificial insemination, 28 Religious involvement and sexual conservatism, 89, 94 and teenage pregnancy, 73-74 Reproduction brain's role in, 18, 20, 21, 126-129, 140 human process, 15-18 nutrition and, 128 research needs on, 150-151, 159 Reproductive health ethical issues, 10-12 status of Americans, 1-2 see also Contraception and contraceptives; Infertility; Prenatal care; Teenage pregnancy and parenthood Reproductive tract damage to, 19-20 see also Infertility Research needs evaluation components for intervention programs, 93 on infertility, 37 on prenatal care, 123 on reproductive health, 159 on teenage parenthood, 92-93 Respiratory distress syndrome, 103 Respiratory tract problems in premature babies, 103 Retrolental fibroplasia, 103 Rhythm method, 7 Right-to-life movement, 3-4 and contraceptive availability, 66 and contraceptive development, 7-8, 46 and embryo research, 11, 154 RU 486, 43, 66, 91 Seizure disorders, 102 Self Center program, 85-86 Self-mutilation, 132 Sex education barriers to, 2, 85 and contraceptive use, 60-61, 76-78 costs of, 87 deficiencies in programs, 85 parental role, 74 Read the entire page →
From page 173... ... INDEX in schools, 8~85 Self Center program, 85-86 and sex promotion on television, 9, 88, 92 and sexual behavior, 77, 86 and teenage pregnancies, 9, 77-78, 84-87 Sexual activity age at initiation, 43 AIDS and, 7 by children of teenage mothers, 83 contraceptive use and, 52-53, 91 family structure and, 74 sex education and, 86 and sex promotion on television, 88, 92, 94 of teenagers, 8, 70, 72-74, 85-86, 90, 93-94, 161 Sexually transmitted diseases contraceptive use and, 61, 63-65 in donor sperm, 24, 25 infertility from, 5, 15, 19-20, 160 substance abuse and, 122 Sickle cell disease, 132, 134, 13~137 Social issues, see Ethical and social issues Special Supplemental Food Program for Women, 117 Sperm biochemical interaction with zone pellucida, 21 chromosome defects in, 138 deficiencies causing infertility, 5, 2~23, 37 donated, infection-free, 6, 24, 25, 152; see also Artificial insemination fresh, and pregnancy rate, 2~25 frozen, 25, 29, 37 hostile reaction by cervical mucus, 22, 23, 25 penetration tests, 28 preparation for in vitro fertilization, 26, 28 production, maturation, and fertilization of eggs, 16-17, 23, 127, 129, 144 treatment of deficiencies in, 21, 22-23 Spermicides, 57, 63 64, 92 Spina bifida, 135 Sponges (contraceptive) , availability and effectiveness, 64 Standards for new technologies for embryo research, 154-155 for IVF and GIFT, 27-28 Sterilization, 57, 58, 63 Stillbirths, 79 Strabismus, 102 Substance abuse, and prenatal care, 121-123 173 Surgeon General, 1990 goal for high-risk women, 107 Surgery fallopian tube reconstruction, 5 for infertility in women, 5, 23 for varicocele, 22-23 Synthetic glucocorticoid hormones, 21 Syphilis, 24 Tamoxifen citrate, 22 Tay-Sachs disease, 132 Teenage pregnancy and parenthood, 8-9 and abortions, 8, 53-54, 69, 79, 91 access to contraceptives and, 88-91 age at puberty/age at marriage and, 72-73 birth rates, 8 chastity promotion and, 87-88 children of teenage mothers, 9, 69, 79, 82-84 and cognitive development in children, 82 consequences of, 2, 78-84 contraceptive use and, 71-72, 75-78, 94 economic costs of, 2, 9, 81-82, 87 and educational attainment, 80, 83 educational goals and, 73 family relationships and, 7~75 family structure and, 72-74, 83 health risks associated with, 8-9, 79, 90, 104 105, 108, 124 and income, 9, 8(~81 and job opportunities, 9, 80 peer pressure and, 75 poverty and, 69, 72, 73, 83, 89, 94 precursors of, 71-75, 94 and prenatal care, 79, 108, 121 prevention of, 77, 8~92, 94 rates, 1, 8, 53, 62, 69, 7~71, 78-79, 94, 160, I61 religious involvement and, 73-74 research needs on, 92-93, 161 scope of the problem, 7~71 sex education and, 9, 77-78, 84-87, 88 Test tube babies' 3, 25, 28; see also In vitro fertilization Thalassemia, 131, 132, 134, 136 Title V Maternal and Child Health, 112 Title XX Adolescent Family Life Act' 87 Transdermal delivery of hormones, 65 Twins identical, 17 Siamese, 18 Read the entire page →
From page 174... ... 174 Ultrasound, 20, 25, 31, 134-136 Uninsured women outcomes for infants of, 111, 124 prevalence of, 98 use of prenatal care, 2, 11~113 Unmarried women, use of prenatal care, 108-109 Upjohn Company, 46 Urinary tract infections, 64-65 U.S. Department of Health and Human Services, 3~35, 154, 162 Vaccine against pregnancy, 42 Vaginal rings, 49, 65 Vaginal suppositories, 42, 64 INDEX Varicocele, surgical treatment for, 22-23 Withdrawal, 7, 55, 57, 78 World Fertility and Contraceptive Prevalence Surveys, 54 World Health Organization, 58, 65 definition of low birthweight, 99 postmarketing surveillance program for contraceptives, 51 testing guidelines for contraceptives, 5~51 Wyeth, 43 Zona pellucida, 16, 21 Zygote, 17, 149 Read the entire page →

From page 165...

... H Robins Company, 45 Aid to Families with Dependent Children, 9, 81, 87, 113 AIDS, 7, 23 Alan Guttmacher Institute, 43, 52, 60, 61, 70, 81, 85, 88, 89, 94, 104, 111 Alza Corporation, 45 Amenorrhea, 127, 128 American Academy of Pediatrics, 107, 116 American Association of Tissue Banks, 24, 28 American Civil Liberties Union, 87 165 American College of Obstetricians and Gynecologists, 28, 47, 107-108, 116, 154-155 American Fertility Society, 28, 30, 32, 155 American Medical Association Diagnostic and Therapeutic Technology Assessment panel, 61 Amniocentesis, 134-136 Anencephaly, 135 Anorexia nervosa, 128 Artificial insemination, 3, 5, 11, 12, 23-25, 26, 28, 140, 147 Basal body temperature, 20 Benign breast tumors, 56 Biodegradable pellets, contraceptive, 65 Biomedical Ethics Board, 155, 156, 162 Birth control, see Contraception and contraceptives; and specific methods Birth control pills, 2, 57 availability of, 43, 44, 59, 60, 6, 89-90 and breast cancer, 55-56, 62 components, 56 costs, 46 development, 41 effectiveness of, 63 liability claims, 45~6 for men, 42

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From page 166...

... 166 mini-pill, 63 side effects, 43~4, 55-56, 61~2, 63, 88-90 treatment of endometriosis with, 21, 65 use trends, 53, 57, S9, 76 women's attitudes toward, SS-56, 61, 78, 89-90 Birth rates from IVF, 20 for minorities and ethnic groups, 109 for unmarried women, 108-109 U.S., 53 Blacks births to unmarried women, 108 infant mortality rates, 96-97, 98, 109 pregnancy rates for adolescents, 70 prenatal care for, 10, 109, 160 Blastocyst, 17, 149, 150 Blastomeres, 17 Brain, role in reproduction, 18, 20, 21, 126-129, 144 Breast cancer, birth control pills and, SS-56, 62 Bromocriptine, 21 Catholics' 61, 152 Center for Population Options, 69, 81 Centers for Disease Control, 24 Cerebral palsy, 102, 107 Cervical cap, 41, 58, 64-65, 90 Cervical mucus, hostile reaction to sperm, 22, 23, 25 Chastity, promotion of, and teenage pregnancy, 87-88 Child care availability for teenage mothers, 80, 81-82 prenatal care accessibility and, 119 Child health, see Maternal and child health Childbearing, rates, 7 Children of teenage mothers, 69, 82-84 Children's Defense Fund, 100, 102, 108-109, 113, 116 Chlamydia, IS, 19-20 Chorionic villus sampling, 134-135, 136, 137, 140 Chromosome defects, and pregnancy outcomes, 138-139 Chronic granulomatous disease, 134 Clinics for prenatal care access to, 113-114, 119, 120, 124 hours, 119 INDEX location of, 120 malpractice insurance, 116 staff attitudes, 119-120 transportation to, 118 waiting times, 113, 119 see also In vitro fertilization clinics Clomiphene citrate, 21, 22 Cocaine, 122-123 Community health centers, 117 Conceptus, 17 Condoms adolescent attitudes on, 78 advertising, 9, 60, 92 availability of, 9, 60, 63~4, 90 effectiveness, 63-64 female, 65 historical background, 41 male, availability and effectiveness, 44, 57, 63-64 use trends, 57, 58, 60 Congenital anomalies, 103, 122 Congressional Research Service, 98 Consumer protection approaches, 34-35, 38 consensus conferences, 34 defining IVF and GIFT success rates, 30-33, 38 physician credentials, 29 protocol appropriateness, 29, 34 questions to ask an IVF clinic, 33-34 state regulation of clinics, 34 Contraceptive development barriers to, 2, 7-8, 62, 126 costs of, 49 decline in, 43, 44 52 FDA approval process and, 8, 44, 50-52 funding for, 42, 44, 49-50, S1 lawsuits and, 7, 44 46, 48-49, 62 legal rule changes and, 46-48 liability insurance costs and 48-49 time for, 65 trends in, 42-43, 49-50 WHO testing guidelines, 50-S1 Contraceptive use, 6-8 and abortion prevention, 52-53 acceptance of one's sexual behavior and' 78, 90 age and, 76 culture and, 58-S9 determinants of, 57-S9, 75-78, 90 educational goals and, 76

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From page 167...

... INDEX and family planning programs, 7 hinderances to, 7, 59-62, 88-89 and maternal and child health, 54-55 patterns of, 57-58 and population growth, 41-42, 53-54 promotion of, 12 and quality of life, 54 rates of, 7, 59-60, 85 sex education and, 60-61, 76-78 and sexual behavior, 52-53, 91 social development and, 78 and teenage pregnancy, 71-72, 75-78, 85, 88 women's attitudes on, 55-56 Contraceptives acceptability and accessibility, 7-8, 47, 56-59, 71, 161 advertising, 2, 9, 45, 59, 60, 61, 84, 92, 161 choice of effective methods, 1-2, 43~4, 55-56, 60 costs, 7, 58, 72 historical background, 41-44 improving access to, 88-91 inherent attributes, 58 injectable, 43, 49, 65-66 liability insurance for, 48-49 methods not available in U.S., 7, 43, 65-66 new methods, 8, 65 perceived attributes, 58 postmarketing surveillance programs, 51 side effects, 7, 43-44, 50, 51, 66 see also Contraceptive development; Contraceptive use; Family planning; and specific methods Creams (contraceptive) , availability and effectiveness, 63, 64 Cryopreservation of eggs and embryos, 12, 37, 140-142 of sperm, 25, 37 CuFix 390, 66 Cystic fibrosis, 136, 137, 140 Danazol, 21 Depo-Provera, 43, 49, 65 Developing countries abortion rates, 53, 54 family planning programs in, 53 maternal and child health in, 54-55 population growth in, 53, 54 Diaphragms, 44, 57, 58, 63, 64, 90 167 DNA analysis adult screening, 129, 132 new techniques, 136-137 newborn screening, 129, 133 polymerase chain reaction, 140 prenatal testing techniques, 133-135 Douching, 7, 55 Down syndrome, 132, 134, 135 Duchenne muscular dystrophy, 137, 139, 140 Economic costs, of early childbearing, 81-82 Educational attainment and early childbearing, 73, 80 and prenatal care, 109 Educational goals and contraceptive use, 76 and teenage pregnancy, 73 Eggs, human chromosome abnormalities in, 26, 143-144, 149 collection for IVF, 25 development, 25, 127 donation, 12 fertilization, 15, 23-24 ovulation, 15 zone pellucida, 16 Embryos cell differentiation, 17-18 chromosome abnormalities, 130, 138-139, 150 culture medium, 142 development, early, 149-150 development, improving, 12, 142 diagnosis of genetic diseases in, 11, 139-140 ethical issues, 3-4, 10-11, 138, 143, 151-156 fertilization and incubation, 28; see also In vitro fertilization freezing for preservation of, 12, 26, 28, 37, 140-142 health of, 32, 37 human rights controversy, 11, 152 ownership of, 4, 152 preimplantation, 17, 138, 153 "primitive streak," 18 research with, 3-4, 10-12, 26, 37, 38, 126, 138, 142-143, 148-156 Endometrial cancer, 56 Endometriosis, 20, 21, 23, 25, 65 Estrogen, 56, 63, 65, 66

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From page 168...

... , availability and effectiveness, 63, 64, 90 Follicle-stimulating hormone, 21, 127, 129 Food and Drug Administration, 62, 128 INDEX contraceptive testing requirements, 8, 43, 44, 50-52, 65 guidelines for screening sperm donors, 24 rules in tort liability suits, 47-48 Food stamps, 9, 81, 87 Funding for contraceptive development, 49-50, 51 for embryo research, 26, 37-38, 126, 143, 149, 150, 154 Galactosemia, 133 Gallup poll on women's attitudes toward contraception, 55, 61 Gamete intrafallopian transfer (GIFT) , 14 costs of, 6, 35 defining success, 3~33 drawbacks, 27 physician credentials for, 29 process, 5, 26-27 public policies on, 12 setting standards for, 14, 27-28 success rates, 5, 6, 14, 27, 30-33 G

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From page 169...

... , 26 characteristics of, 35-36 growth of, 5-6, 27, 37 questions to ask at, 33-34 Income and early childbearing, 80-81 and prenatal care, 110 Industrialized countries abortion rates in, 53, 70 adolescent pregnancies in, 70 contraceptive availability in, 71 infant mortality rates in, 96-97 time span between menarche and marriage in, 72 Infant mortality causes, 99, 109, 124 low birthweight and, 97, 99-101, 124 neonatal intensive care and, 107 poverty and, 98, 101-102, 124 169 prenatal care and, 10, 97, 105, 106, 109 rates, 1, 54-55, 96-99, 124 Infertility from damage to reproductive tract, 19-20, 45, 61, 63, 90, 160 defined, 15 from endometriosis, 20 male, 5, 2~21, 25, 37 from ovulation disorders, 20 prevalence, 4-5, 15, 37 secondary, 15 - sexually transmitted diseases and, 5, 15 tests for, 5, 19 Infertility treatment artificial insemination, 3, 5, 23-25 characteristics of patients, 36 consumer protection, 28-35, 37, 38 costs of, 35 dissemination of new technologies, 29 ethical issues, 6, 126 medical therapies for men and women, 3, 5, 21-22 new fertilization procedures, see Gamete intrafallopial transfer; In vitro fertilization physician credentials for, 29 protocols, 29, 34 public policies, 12 research needs, 37, 159-160 state regulation of, 34 sources, 5-6, 18-19 success of, 5, 22-23 surgery for varicocele, 3, 22-23 surgery for women, 3, 5, 23 Institute of Civil Justice, 46 Institute of Medicine Committee to Study Outreach for Prenatal Care, 109, 113-114, 117, 118, 120 Committee to Study the Prevention of Low Birthweight, 102, 103, 107 Intrauterine devices, 2, 41, 57 availability and effectiveness, 7-8, 43-45, 63 Cu-7, 45 CuFix 390, 66 Dalkon Shield, 45, 61 determinants of use, 58, 61 liability suits, 45, 47, 61, 66 Lippes Loop, 45 ParaGuard, 43, 45, 61, 63

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From page 170...

... 70 and pelvic inflammatory disease, 19, 45, 61, 63, 90 Progestasert, 43, 45, 61, 63 and sexually transmitted diseases, 61 side effects, 44, 45, 90 IUDs, see Intrauterine devices Jellies (contraceptive) , availability and effectiveness, 64 Job opportunities, and early childbearing, 73, 80 Johns Hopkins University School of Medicine, 85, 86 Laparoscopy, 19, 21, 25, 27 Lawsuits changes in rules governing, 46-48 contraceptive-related, 41 46 deterring effects of, 47 discovery rules, 46-47 negligence standard, 46 Lesch-Nyhan syndrome, 132, 137, 139 Levonorgestrel, 64, 65 Liability coordination of regulatory system and tort system, 47-48 insurance costs, 48-49, 61 objectives of tort system, 47 see also Lawsuits; Malpractice Louis Harris survey, 61, 84 Low birthweight and congenital anomalies, 103 costs associated with, 104, 105 definition of, 97, 99 effects of, 102-105 factors contributing to, 97, 124 and family stresses, 104 and financial stresses, 104-105 and health problems, 97, 102-103, 104 and infant mortality, 97, 99-101, 124 and neurodevelopmental handicaps, 100, 102 poverty and, 101, 104 prevention of, 55, 97, 105, 106; see also Prenatal care respiratory tract problems, 103 side effects of technology, 103 substance abuse and, 122 as teenage pregnancy outcome, 79, 104-105 trends, 99-100 INDEX Lowry, 142 Luteinizing hormone, 127, 129 Maple syrup urine disease, 132 Malpractice awards, 116-117 claims, 46 insurance costs, and availability of prenatal care, 115-117 locality rule, 46 Marijuana, 122, 123 Marriage age of, relative to onset of puberty, 72-73 see also Unmarried women Maternal and child health contraception and, 5~55 current status, 98-99 poverty and, 98 research needs on, 151 sources of care, 101 substance abuse and, 122-123 teenage childbearing and, 9, 79 Maternal and Child Health Services Block grants, 117 Maternal mortality, 54-55, 56, 62, 90 Maternal serum alpha-fetoprotein screening, 135 Medicaid application procedures, and prenatal care, 112-113, 117-118, 124 continuous eligibility option, 118 and contraceptive availability, 71 expenditures relative to teenage pregnancies, 9, 81, 87 and infertility treatment, 36 physician acceptance of, 113-114, 124 prenatal care under, 101, 105-106, 111, 112-113, 117, 121, 124 reimbursement rates, 115 Medicare Catastrophic Coverage Act, 113 Menstrual cycle, 15-16, 18, 128 treatment of irregularities in, 63, 64, 65 Menstrual inducers, 43, 66 Mental retardation, 107, 129, 132 Mifepristone, 66 Migrant and Rural Health Centers, 117 Miscarriage, 8, 79, 122, 134 Morphine, 128 Morula, 149 National Bureau of Economic Research, 106

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From page 171...

... INDEX National Center for Health Statistics, 4, 70, 108, 112 National Commission to Prevent Infant Mortality, 97 National Fertility Survey, 15 National Institute of Allergy and Infectious Diseases, 19 National Institutes of Health, 51, 142, 150 National Natality Survey, 110 National Research Council Panel on Adolescent Pregnancy and Childbearing, 72, 74-77, 81 National Survey of Family Growth, 4-5, 15, 36, 44 45, 57-58, 75, 110 National Survey of Young Women, 75-76 Native Americans, prenatal care for, 109 Neonatal intensive care, 100, 107 Neurodevelopmental handicaps, 100, 102-103, 122 Newborns and congenital anomalies, 103, 122 and neurodevelopmental handicaps, 100, 102-103, 122 respiratory tract problems, 103 screening for defects, 133 side effects of technology, 103 see also Low birthweight; Premature births Nonoxynol-9, 64 Norethindrone, 65 Norigest, 65 Norplant availability and effectiveness, 8, 49, 64, 90 postmarketing surveillance program, 51 Nurse-midwives, restrictions on, 115 Office of Technology Assessment, 29, 36, 42-43, 97, 101, 102, 104, 105, 108, 140, 142 Omnibus Reconciliation Act of 1987, 105, 113 Oocytes, see Eggs, human Oral contraceptives, see Birth control pills Ortho Pharmaceutical Corporation, 43, 45, 48, 49 Ovaries, 15, 19, 20, 23 cysts and cancer, 56, 63 Ovulation control of, 127 detection, 20, 25 disorders, 3, 5, 20, 127, 128, 145 process, 15 171 restoration of, 127 treatment of disorders, 21 Patient dumping, 102, 147 Peer pressure, teenage pregnancy and, 75 Pelvic inflammatory disease, 19, 45, 56, 61, 63, 90 Phenylketonuria, 129, 132, 136 Physicians acceptance of Medicaid patients, 113-114, 124 credentials, 29 inaccessibility for prenatal care, 11~115, 116 malpractice insurance costs, 115- 116 Pituitary gland, 18, 20, 21, 127 Policy issues family planning, 161 federal support of reproductive health research, 159 infertility treatment, 159-160 maternity care system improvements, 160 process for public policy, 161-162 standards, licensing, and regulation of IVF clinics, 159 teenage pregnancy and sexual activity, 161 Polymerase chain reaction, 140 Population Council, 45, 48, 50, 51, 65 Population Crisis Committee, 54 Population growth contraception and, 41-42, 53-54 in developing countries, 53, 54 Poverty and contraceptive availability, 71 and infant mortality, 98, 101-102, 124 and low birthweight, 101, 104 and prenatal care, 110 and teenage pregnancy, 69, 72, 73, 94 Preembryo, 17 Pregnancy adverse outcomes, and insurance status, 112 clinical/successful, 31, 32 complications, 55, 79 testing services, 117 tubal or ectopic, 23, 32, 56 unintended, 1, 2, 44, 53, 54, 62, 70, 88 vaccine, 42 see also Teenage pregnancy and parenthood Pregnancy Discrimination Act, 112

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From page 172...

... 172 Premature births financial costs of, 2 neonatal intensive care units, 100 substance abuse and, 122 among teenagers, 79 see also Low birthweight Prenatal care attitudes about, 120-121 for blacks, Hispanics, and Native Americans, 10, 109, 160 and child care problems, 119 clinic access problems, 113-114, 119-120 cost-effectiveness of, 10, 105-107, 160 cultural and personal barriers to, 12~123 definition of good care, 10, 105, 107-108 educational attainment and, 109 financial deterrents, 110-113 homelessness, and prenatal care, 121 importance of, 9-10, 160 and infant mortality, 10, 97, 105, 106, 109 and low birthweight, 10, 97, 105, 106 and malpractice insurance costs, 115- 117 by nurse-midwives, 115 obstacles to, 98, 101, 112- 123 physician inaccessibility, 114-115 policy goals, 160 for poor women, 98, 101, 105-106, 110 populations receiving insufficient care, 107-111 programs, 117-118 research needs on, 123 studies of, 105 substance abuse, 121 - 123 for teenagers, 79, 108, 121 testing for birth defects, 133-136 and transportation problems, 118 for uninsured women, 11~111 for unmarried women, 108-109 use rates, 10, 108 for women with many children, 109-110 Progesterone, 21 Progestins, 64, 65 Progestogens, 41, 56, 63, 65, 66 Prolactin, 21 Prostaglandins, 46, 66 Puberty early onset of, and delayed marriage, 72-73 hormones controlling, 127-128 and social maturity, 2 research needs on, 92 INDEX Public assistance, teenage pregnancy and, 81-82, 87 Radio immune as say, 25 Recombinant DNA technology, 10-11, 136 Regulation of artificial insemination, 28 Religious involvement and sexual conservatism, 89, 94 and teenage pregnancy, 73-74 Reproduction brain's role in, 18, 20, 21, 126-129, 140 human process, 15-18 nutrition and, 128 research needs on, 150-151, 159 Reproductive health ethical issues, 10-12 status of Americans, 1-2 see also Contraception and contraceptives; Infertility; Prenatal care; Teenage pregnancy and parenthood Reproductive tract damage to, 19-20 see also Infertility Research needs evaluation components for intervention programs, 93 on infertility, 37 on prenatal care, 123 on reproductive health, 159 on teenage parenthood, 92-93 Respiratory distress syndrome, 103 Respiratory tract problems in premature babies, 103 Retrolental fibroplasia, 103 Rhythm method, 7 Right-to-life movement, 3-4 and contraceptive availability, 66 and contraceptive development, 7-8, 46 and embryo research, 11, 154 RU 486, 43, 66, 91 Seizure disorders, 102 Self Center program, 85-86 Self-mutilation, 132 Sex education barriers to, 2, 85 and contraceptive use, 60-61, 76-78 costs of, 87 deficiencies in programs, 85 parental role, 74

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From page 173...

... INDEX in schools, 8~85 Self Center program, 85-86 and sex promotion on television, 9, 88, 92 and sexual behavior, 77, 86 and teenage pregnancies, 9, 77-78, 84-87 Sexual activity age at initiation, 43 AIDS and, 7 by children of teenage mothers, 83 contraceptive use and, 52-53, 91 family structure and, 74 sex education and, 86 and sex promotion on television, 88, 92, 94 of teenagers, 8, 70, 72-74, 85-86, 90, 93-94, 161 Sexually transmitted diseases contraceptive use and, 61, 63-65 in donor sperm, 24, 25 infertility from, 5, 15, 19-20, 160 substance abuse and, 122 Sickle cell disease, 132, 134, 13~137 Social issues, see Ethical and social issues Special Supplemental Food Program for Women, 117 Sperm biochemical interaction with zone pellucida, 21 chromosome defects in, 138 deficiencies causing infertility, 5, 2~23, 37 donated, infection-free, 6, 24, 25, 152; see also Artificial insemination fresh, and pregnancy rate, 2~25 frozen, 25, 29, 37 hostile reaction by cervical mucus, 22, 23, 25 penetration tests, 28 preparation for in vitro fertilization, 26, 28 production, maturation, and fertilization of eggs, 16-17, 23, 127, 129, 144 treatment of deficiencies in, 21, 22-23 Spermicides, 57, 63 64, 92 Spina bifida, 135 Sponges (contraceptive) , availability and effectiveness, 64 Standards for new technologies for embryo research, 154-155 for IVF and GIFT, 27-28 Sterilization, 57, 58, 63 Stillbirths, 79 Strabismus, 102 Substance abuse, and prenatal care, 121-123 173 Surgeon General, 1990 goal for high-risk women, 107 Surgery fallopian tube reconstruction, 5 for infertility in women, 5, 23 for varicocele, 22-23 Synthetic glucocorticoid hormones, 21 Syphilis, 24 Tamoxifen citrate, 22 Tay-Sachs disease, 132 Teenage pregnancy and parenthood, 8-9 and abortions, 8, 53-54, 69, 79, 91 access to contraceptives and, 88-91 age at puberty/age at marriage and, 72-73 birth rates, 8 chastity promotion and, 87-88 children of teenage mothers, 9, 69, 79, 82-84 and cognitive development in children, 82 consequences of, 2, 78-84 contraceptive use and, 71-72, 75-78, 94 economic costs of, 2, 9, 81-82, 87 and educational attainment, 80, 83 educational goals and, 73 family relationships and, 7~75 family structure and, 72-74, 83 health risks associated with, 8-9, 79, 90, 104 105, 108, 124 and income, 9, 8(~81 and job opportunities, 9, 80 peer pressure and, 75 poverty and, 69, 72, 73, 83, 89, 94 precursors of, 71-75, 94 and prenatal care, 79, 108, 121 prevention of, 77, 8~92, 94 rates, 1, 8, 53, 62, 69, 7~71, 78-79, 94, 160, I61 religious involvement and, 73-74 research needs on, 92-93, 161 scope of the problem, 7~71 sex education and, 9, 77-78, 84-87, 88 Test tube babies' 3, 25, 28; see also In vitro fertilization Thalassemia, 131, 132, 134, 136 Title V Maternal and Child Health, 112 Title XX Adolescent Family Life Act' 87 Transdermal delivery of hormones, 65 Twins identical, 17 Siamese, 18

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From page 174...

... 174 Ultrasound, 20, 25, 31, 134-136 Uninsured women outcomes for infants of, 111, 124 prevalence of, 98 use of prenatal care, 2, 11~113 Unmarried women, use of prenatal care, 108-109 Upjohn Company, 46 Urinary tract infections, 64-65 U.S. Department of Health and Human Services, 3~35, 154, 162 Vaccine against pregnancy, 42 Vaginal rings, 49, 65 Vaginal suppositories, 42, 64 INDEX Varicocele, surgical treatment for, 22-23 Withdrawal, 7, 55, 57, 78 World Fertility and Contraceptive Prevalence Surveys, 54 World Health Organization, 58, 65 definition of low birthweight, 99 postmarketing surveillance program for contraceptives, 51 testing guidelines for contraceptives, 5~51 Wyeth, 43 Zona pellucida, 16, 21 Zygote, 17, 149

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Index Pages 165-174

Index
Pages 165-174