The Best Intentions Unintended Pregnancy and the Well-Being of Children and Families (1995) / Chapter Skim
Currently Skimming:
Programs to Reduce Unintended Pregnancy
Programs to Reduce Unintended Pregnancy
Pages 218-249
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From page 218... ...
The chapter includes commentary on the possible economic effects of these programs, given the deep policy interest in this issue. NATIONAL PROGRAMS Although there is no national program whose primary mission is to reduce unintended pregnancy per se, several activities funded at the federal and state levels have great relevance to unintended pregnancy inasmuch as they help to fmance contraceptive services.
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From page 219... ...
The impact of Title X and Medicaid, We two largest public programs, on unintended pregnancy has not been clearly defined, although a number of studies have tried to assess the effect of "publicly supported family planning programs" (which typically Include the Title X and Medicaid programs) on various fertility Another national program relevant to unintended pregnancy is the contraceptive research and development activities of the National Institute of Child Health and Human Development.
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From page 220... ...
2This section reviews studies that have assessed the impact of publicly funded family planning services on unintended pregnancy; some of these studies are reviewed again from the perspective of economic impact in a later section of this chapter labeled "The Fiscal Impact of Family Planning Funding."
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From page 221... ...
Similarly, Anderson and Cope (1987) found that publicly funded family planning programs in the United States could be linked to lower birthrates; this analysis did not assess effects on pregnancy rates.
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From page 222... ...
and there is a strong suggestion that, as part of overall "publicly funded family planning services," they help to reduce fertility. It is unlikely that careful evaluation would find no net effect on unintended pregnancy.
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From page 223... ...
It is important, however, to begin this consideration of local programs with a clear acknowledgment that the existing array of programs at the local level those that have been evaluated and those that have not reflects a unique history and, in particular, the changing interests and ideologies of both public and private funding agencies. Historical Perspective There are few references to adolescent pregnancy in the scientific literature before 1960, although there are many references to births among unmarried women (often called "illegitimacy" at the time)
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From page 224... ...
For the sake of clarity, it should be noted that the Center for Health Promotion and Education is now the Division of Adolescent School Health at the CDC; the Center for Population Options is now Advocates for Youth; and the North Carolina Coalition on Adolescent Pregnancy is now the Adolescent Pregnancy Prevention Coalition of North Carolina.
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From page 225... ...
In sum, the existing network of programs around the country reflects a unique history, particularly the early interest in caring for pregnant adolescents, followed by changing ideologies at the federal level. Reducing unintended pregnancy has rarely been a goal of these community-based, local programs, even though their stated goals, such as reducing repeat pregnancies, are often closely related to unintended pregnancy.
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From page 226... ...
With these criteria in mind, the committee conducted a national search to learn, in general, about local programs to reduce unintended pregnancy and, in particular, to identify programs whose results had been evaluated. Letters requesting information were sent to the directors of programs receiving Title X funds and the directors of maternal and child health agencies; federal and local government programs were contacted; foundation officers were queried; the primary investigators of several leading initiatives and the project directors of many smaller initiatives were approached; notices asking for program leads appeared in newsletters of the National Association of County Health Officials and the American Public Health Association and online through the Women's Health Network; and relevant literature was reviewed through MedLine, Social Science Index, Sociological Abstracts, Psychological Abstracts, Popline, and Family Resources databases, as well as the Health Promotion and Education Database from the CDC.
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From page 227... ...
E Girls Incorporated Preventing Adolescent Pregnancy: nationwide sexuality education program divided into four age-appropriate components.
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From page 228... ...
W Teen Talk: sexuality education program based on the health belief model and social learning theory, designed to make adolescents aware of the seriousness of adolescent pregnancy and the probabilities of such a pregnancy happening to them.
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From page 229... ...
Determining the intervention "dosage," or amount of time spent in a program, is also challenging and must be carefully tracked, because some participants attend all segments of the program and some attend only a few. Similarly, the fact that unintended pregnancy prevention programs often consist of many components makes it difficult to assess the relative effectiveness of each component.
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From page 230... ...
Another problem faced in many program evaluations is that outcome measures are limited to self-reported sexual activity and contraceptive use. Such reports may be unreliable, but there are often no alternative outcome measures available, save the most conspicuous consequences such as sexually transmitted diseases (STDs)
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From page 231... ...
Success in raising the age of first intercourse, for example, is typically measured in increments of months, not years, as was the case with the Self Center. Small effects can translate into a reduced risk of unintended pregnancy at the individual level if a delay in the age of first intercourse, for example, also has the effect of increasing contraceptive use once sexual activity begins; nonetheless, the overall demographic impact of such small changes is apt to be minor.
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From page 232... ...
This program used a curriculum focusing on family values and self-esteem, pubertal development and reproduction, communication strategies and interpersonal skills about "how to say no," examination of future goals, the effects of peer and media pressures, and complications of premarital sexual activity, adolescent pregnancy, and STDs. Although the evaluation was carefully developed by using a quasiexperimental design, post-test data were gathered immediately following the 6week intervention; no follow-up data were collected at a later point.
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From page 233... ...
4. Sexuality education programs that provide information on both abstinence and contraceptive use neither encourage the onset of sexual intercourse nor increase the frequency of intercourse among adolescents.
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From page 234... ...
In addition, a recent worldwide literature review concludes that there is no support for the notion that sexuality education encourages the initiation of sexual intercourse or increased sexual activity. Even in the face of different methodologies and study locales, the aggregate effect of sexuality education is in the direction of postponing first sexual intercourse and using contraception more effectively (Grunseit and Kippax, undated)
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From page 235... ...
Some programs also increased contraceptive use among students who were sexually inexperienced at the onset of the program. They conclude that, overall, effective programs: focus specifically on reducing sexual risk-taking behaviors that might lead to unintended pregnancy or HIV or STD infection; use social learning theories as a foundation for program development;8 These theories include the Health Behavior Model, the Group Cognitive Behavior Theory, the Social Learning Theory, and the Social Inoculation Theory.
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From page 236... ...
This reluctance is due, in part, to the preponderance of programs targeting adolescents and the ongoing public debate about the appropriateness of providing sexually active, unmarried adolescents with contraceptives. Even among the evaluated programs working with adolescents who are pregnant or are already parents-a group well known to be at risk of rapid repeat, often unintended pregnancy-the direct provision of contraception is not universal.
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From page 237... ...
At the 3 year follow-up, significantly more students in schools linked to the clinics attended a clinic before beginning sexual intercourse or attended a clinic during the first months of sexual activity, a period during which unintended pregnancy is especially likely to occur. A significant delay in the initiation of sexual intercourse for young women in the intervention schools was noted; the median delay was 7 months.
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From page 238... ...
6. About half of the evaluated programs attempting to reduce rapid repeat pregnancy, especially among adolescents, have been successful.
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From page 239... ...
7. Little is known from the evaluated programs about how to influence sexual behavior or contraceptive use by changing the surrounding socioeconomic or cultural environment.
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From page 240... ...
Programs designed to change individual behaviors may never be able to achieve more than marginal success in a society whose health care system, available information and education, and overall socioeconomic and cultural environments do not uniformly support careful use of the best methods of contraception, as discussed in Chapters 5, 6, and 7. ,1~; FISCAL IMPACT OF FAMILY PLANNING FUNDING Policymakers are understandably interested in the budgetary impact of public investments in family planning programs, both those that operate at the national level and those Hat work in states and communities.
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From page 241... ...
According to the authors, "for every government dollar spent on family planning services, from $2.90 to $6.20 (an average of $4.40) is saved as a result of averting [short-term]
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From page 242... ...
These issues require, at a mirumum, consideration of the price-responsiveness of demand for contraceptive services and reproductive health services more generally. Treatment of Mistuned and Unwanted Pregnancies A recurrent theme in this report is the importance of distinguishing between pregnancies that are mistimed and those that are unwanted.
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From page 243... ...
In spite of these caveats, which suggest that the public sector benefits of family planning funding may well have been exaggerated in some studies, the weight of the evidence presented by the several studies cited earlier (i.e., Levey et al., 1988; Forrest and Singh, l990a,b; Vincent at al., 1991; Fitzgibbons, 1993; Olds et al., 1993; and Trussell et al., 1995) is that public funding of family planning services is likely to reduce net claims on public budgets.
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From page 244... ...
Although there are hundreds of programs at the community level that in some way address sexual or contraceptive behavior related to unintended pregnancy, few have been carefully evaluated, and knowledge is therefore very limited about how local programs can reduce unintended pregnancy. Those that have been evaluated illustrate several cross-cutting themes: because most of the evaluated programs target adolescents, especially adolescent girls, knowledge about how to reach adult women or men is exceedingly limited; there is insufficient evidence to determine whether abstinence-only programs have been effective in increasing the age at first intercourse; sexuality education programs that provide information on both abstinence and contraceptive use neither encourage the onset of sexual intercourse nor increase the frequency of intercourse among adolescents; in fact, programs that provide both messages appear to be effective in delaying the onset of sexual intercourse and encouraging contraceptive use, especially among younger adolescents; even though most of the evaluated programs encourage contraceptive use in some way, there is a notable reluctance to provide program participants with contraceptive methods themselves or to help participants gain access to contraceptive services at some other site; about half of the evaluated programs attempting to reduce rapid repeat pregnancy, especially among adolescents, have been successful; and little is known from the evaluated programs about how to influence sexual behavior or contraceptive use by changing the surrounding socioeconomic or cultural environment.
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From page 245... ...
Christopher FS, Roosa MW. An evaluation of an adolescent pregnancy prevention programs: Is "just say no" enough?
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From page 246... ...
Project Taking Charge: An evaluation of an adolescent pregnancy prevention program. Fam Relat.
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From page 247... ...
Lee P Failing to prevent unintended pregnancy is costly.
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From page 248... ...
Postrado LT, Nicholson HJ. Effectiveness in delaying the initiation of sexual intercourse of girls aged 12-14: Two components of the Girls Incorporated Preventing Adolescent Pregnancy Program.
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From page 249... ...
Comments on an evaluation of an abstinence-only adolescent pregnancy prevention program. Fam Relat.
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