The Best Intentions Unintended Pregnancy and the Well-Being of Children and Families (1995) / Chapter Skim
Currently Skimming:
Conclusions and Recommendations
Conclusions and Recommendations
Pages 250-272
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From page 250... ...
Unintended pregnancy is not just a problem of teenagers or unmarried women or of poor women or minorities; it affects all segments of society. For example, currently married women and those well beyond adolescence report sobering percentages of unintended pregnancy: in 1987, about 50 percent of pregnancies among women aged 20-34 were 'unintended, 40 percent of pregnancies to married women were unintended, and more than three-fourths of pregnancies to women over age 40 were IlIiintended.
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From page 251... ...
Reflecting the widespread occurrence of unintended pregnancy, abortions are obtained by women of all reproductive ages, by both married and unmarried women, and by women in all income categories; in 1992, for example, less than one-fourth of all abortions were obtained by teenagers (Centers for Disease Control and Prevention, 19941. Although abortion has few long-ter~ negative consequences for women's health, resolving an unintended pregnancy by abortion can often be a sobering and emotionally difficult experience that no woman welcomes.
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From page 252... ...
The problem of unintended pregnancy is as much one of public policies and institutional practices as it is one of individual behavior, and therefore the campaign should not try to reduce unintended pregnancies only by actions focused on individuals or couples. Although
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From page 253... ...
Should it stress contraceptive services? School-based information?
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From page 254... ...
develop and scrupulously evaluate a variety of local programs to reduce unintended pregnancy; and 5. stimulate research to (a)
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From page 255... ...
It would be particularly helpful if more people understood that the United States does not differ appreciably from many other countries in its patterns of sexual activity, but it does report higher levels of intended pregnancy. Second, abstinence cannot be counted on as the major means to reduce unintended pregnancy.
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From page 256... ...
The committee recommends that the national campaign to reduce unintended pregnancy include a wide variety of strategies for educating and informing the American public about contraception, unintended pregnancy, and reproductive health in general. These activities should be directed to more than just adolescent girls, highlighting the common occurrence of unintended pregnancy among women age 20 and over, and especially among those over age 40 for whom an unintended pregnancy may carry particular medical risks.
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From page 257... ...
However, several studies have shown that sexual activity in young adolescents can be postponed and that use of contraception can be increased once sexual activity has begun by comprehensive education that includes several messages simultaneously: the value of abstinence at young ages especially, the importance of good communication between the sexes and with parents regarding a range of interpersonal topics including sexual behavior and contraception, skills for resisting pressure to be sexually active, and the proper use of contraception once sexual activity has begun. The committee recommends that all U.S.
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From page 258... ...
Many television executives decline to advertise contraceptive products because Hey fear controversy; at the same time, Hey air advertisements Hat routinely use sexual innuendo to help sell consumer products and programs that are peppered win sexual activity of all types. The committee recommends that the electronic and print media help to educate all Americans about contraception, unintended pregnancy, and related topics of reproductive health.
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From page 259... ...
Private health insurance often does not cover contraceptive costs; the various restrictions on Medicaid eligibility make it an unreliable source of steady financing for contraception except for very poor women who already have a child; and the net decline in public investment in family planning services (especially those services supported by Title X of the Public Health Service Act) , in the face of higher costs and sicker patients, may have decreased access to care for those who depend on publicly-f~nanced services.
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From page 260... ...
The second and third elements in the recommendation above speak to the major role Mat such public financing programs as Title X and Medicaid have played in helping millions of people secure contraception, especially those who are young or poor. The Title X program in particular also has a long history of offering general health care to many low-income women, over and above family planning services, because in some communities, there are few alternative providers of primary care.
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From page 261... ...
In addition, foundations and government should fund high-quality evaluations of public programs that help to support contraceptive services, Title X and Medicaid especially. Without better data regarding their impact on unintended pregnancy or other related outcomes, they remain particularly vulnerable to attack, and it is difficult to know how best to strengthen them.
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From page 262... ...
Accordingly, the third element of the campaign to reduce unintended pregnancy should emphasize the importance of motivation in using contraception and avoiding unintended pregnancy and the potent role that social environment can play in shaping such motivation at all ages. In order to increase the careful and consistent use of contraception, the committee recommends that contraceptive services be sufficiently well funded (through adequate reimbursement rates, increased public-sector support, or both)
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From page 263... ...
Earlier recommendations offered specific suggestions for increasing knowledge about and access to contraception; all of these efforts, including augmented provider training, should give special attention to longer-acting, coitus-independent methods. On a broader level, policy leaders need to confront the likelihood that, particularly for those most impoverished, achieving major reductions in unintended pregnancies may well require that other more compelling alternatives to pregnancy and childbearing be available.
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From page 264... ...
One aspect of the committee's work that it found most distressing was how little is known about effective programming at the local level to reduce unintended pregnancy. Given all of the public concern about teenage pregnancy, nonmarital childbearing, AIDS, and high-risk sexual behavior, it is quite remarkable that, even using fairly flexible inclusion criteria, the committee was able to identify fewer than 25 programs whose effects on unintended pregnancy, broadly defined, had been carefully evaluated.
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From page 265... ...
virtually none of the evaluated programs attempt to influence the surrounding community environment shaping sexual activity and contraceptive use. The design of these new research and demonstration programs should also reflect four additional themes.
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From page 266... ...
develop new contraceptive methods for both men and women, (b) answer important questions about how best to organize contraceptive services, and (c)
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From page 267... ...
Two aspects of such research have already been mentioned: the need for better research on the effectiveness of publicly-supported programs that help to finance contraceptive services and the need for new research and demonstration programs at the community level to learn more about how to reduce unintended pregnancy. Many other important questions need answers as
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From page 268... ...
And little research has been done on couple interaction and decision-making that, for example, explores differing power relationships between the sexes and how age, income, and other status inequities affect both sexual behavior and contraceptive use, and therefore Unintended pregnancy. Finally, a new variable has entered into the contraceptive equation: concern for the prevention of STDs, including HIV and AIDS.
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From page 269... ...
There are abundant clues and some important leads, but more research is needed to understand fully why more than half of all pregnancies in the United States are unintended at the time of conception and, in particular, why it is that half of these pregnancies occur among women who did not desire to become pregnant, but were nonetheless using no method of contraception when they conceived. The committee suspects that the effectiveness of intervention programs to reduce unintended pregnancy will remain modest until the knowledge base in this area is strengthened.
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From page 270... ...
CAMPAIGN LEADERSHIP Progress toward achieving the five campaign goals outlined above would be enhanced by the existence of a readily identifiable group whose mission is to lead the suggested campaign. The committee recommends that an independent, publicprivate consortium be formed at the national level to lead the campaign to reduce unintended pregnancy.
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From page 271... ...
The national campaign to reduce unintended pregnancy will need Weir voices as well, not only because of the substance of this issue but also because children's groups have great political appeal and credibility.
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