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From page 367... ... Index A Abortion access issues, 209-211, 256, 282 age variables in, 42 as consequence of unintended pregnancy, 18, 23, 50, 51, 80, 210 data sources, 25, 288, 290 denied, and subsequent child wellbeing, 73 effect of federal family planning programs on, 221-222 insurance coverage, 139 for intended pregnancies, 25 n.2 international comparisons, 42-47 marital status and, 41-42 medical risk, 51-52 neonatal mortality and, 72 number of, 2, 21, 26, 41, 51, 210 opposition movement, 208-211 percentage rates, 2, 26, 41, 45, 251 psychological issues, 53-54 public policy development, 282-285 rate of complications, 52-53 reducing need for, 80-81, 253 religious debate, 186-188 research, 211, 230, 281, 285, 288, 290 367 socioeconomic variables in, 42 sociopolitical controversy, 16, 54, 251 techniques, 52, 53, 283-284 trends, 33, 210 voting behavior and, 187-188 Abstinence, 111 as one means to prevent pregnancy, 103 efficacy, 9, 101, 255, 258, 265 in evaluated programs, 9, 232-236, 265 as pregnancy-reduction intervention, effectiveness of recommendations. 5, 255 in school-based sex education programs, 15-16, 134-135 Access to contraception, 18, 126, 127 anti-abortion movement and, 208-211 bureaucratic obstacles, 148-150 current status, 137-139, 244 in evaluated programs, 236-238 financial barriers to, 6-7, 139-145, 259-262 in health maintenance organizations, 140 individual psychological factors in, 169 Read the entire page →
From page 368... ... . Issues In researc 1 on pregnancy intendedness, 64-66, 165-166, 269-270, 288-289, 290-292 of physicians toward discussing sex and other related topics, 147 during pregnancy, shift in, 22-23 racist, birth control policy and, 198203 sexual, international comparison of, 193-194 See also Individual behavior and decision-making; Social and cultural values B Baby Boom, 194 Benefit:burden ratio, 161-162 Benefit:cost analysis, 241, 339 Block grants, 142, 218-219, 261 Breast cancer, 52 Bureau of Primary Care, 266 C Campaign to reduce unintended pregnancy, 253-271 Canada, 43, 47 Centers for Disease Control and Prevention, 25, 266 Cervical cap, 111 Child abuse and neglect later unintended pregnancy risk, 104-105 unintended pregnancy as risk factor, 1, 73-74, 81, 251 Child advocacy groups, 270-271 Child care, 74 Child health and well-being child abuse risk, 1, 73-74, 81, 251 consequences of unintended pregnancy, 12, 50, 81, 251-252 Read the entire page →
From page 369... ... INDEX developmental effects of pregnancy intendedness, 72-74, 81 effects of reducing unintended pregnancy, 79-80, 82 methodological issues in outcomes research, 64-66 outcomes research, 296 preventive public health interventions, 12 See also Fetal and neonatal health Child support, 15, 207 Clinical Laboratories Improvement Act, 143 Community level programs, 218-244 Community of Caring, 227, 311-312 Condom Mailing Program, 227, 312313 Condoms, 8, 15, 263 access to, 136, 153, 208 age patterns in use of, 115-116 as contraceptive method of choice, 103, 108 determinants of use, 174-175 in dual-method contraception, 91, 118119, 122, 258, 259-260 effectiveness of, 6, 259, 269 failure of, 99-100, 101, 172 patterns of use, 110-111, 269 race and ethnicity as factors in use of, 116 socioeconomic factors in use of, 117 use in first intercourse, 111-115, 116 user attitudes, 171-172 Congenital malformations, 60-61, 78-79 n.6 Contraceptive methods access to most effective, 138 advertising, 6, 191-192, 258-259 coitus-dependent, 101, 110-111, 122, 171 coitus-independent, 8, 101, 103, 109110, 122, 171, 258, 263, 267 dual-method, 91, 118-119, 122, 258, 259-260 effectiveness, 109, 111, 115, 122 369 emergency contraception, 128 n.1, 146, 147, 258, 283-284 failure of method, technological failure in, 99-100, 172, 255-256, 267 failure rates, 101 hormonal implants and injections, 99, 103, 109-110 individual attitudes about, 171-172, 264, 267, 268 individual changes in use of or of type used, 94-96 insurance coverage, 139-140 long-term performance, 101-102 for male use, 10, 267 pasterns of use, 103, 108-111 prescription vs. nonprescription, 135136 pricing, 144-145 professional counseling in, 8, 261, 262-263 research in, 5, 9, 10, 266-267 reversible, 92, 94, 98, 99-103, 108111,122,139,267 sexually transmitted disease prevention, 119-122, 150-151, 153 side effects, 111 sterilization, 98-99 technical development, 16 technical shortcomings, 126-127 training of health care professionals, 7, 8, 145-148, 259-260, 261-262, 263 See also Contraceptive use; specific method Contraceptive sponge, 136 Contraceptive use abortion debate and, 16 access to contraception and, 136 by adolescents, 108, 111, 115-116, 117, 129, 164-165 attitudes about contraceptive methods and, 171-172, 264, 267, 268 attitudes about fertility and, 169-170 attitudes about sexuality and, 168-169, 176 benef~t:burden models, 161-162, 176 Read the entire page →
From page 370... ... index, 339 Denmark, 136, 193 Depo-Provera, 109-110 Depression, 75 Diaphragm, 111 as contraceptive method of choice, 103 failure rate, 101 insurance coverage, 140 proper use, 130-131 Diversity cultural-ethnic, 184-185 religious and political, 185-188 Read the entire page →
From page 371... ... INDEX Divorce outcomes for children of single-parent families formed by, 63 as a result of an unintended birth, 61 Domestic violence, 75, 81 prevalence, 203 EEducational attainment adolescent childbearing and, 55-56 of children from single-parent families, 61-63 father's, 75 proper contraceptive use and, 131 Elmira Nurse Home Visiting Program, 227, 313-314 Embarrassment, 169 Emergency contraception, 128 not, 146, 147, 258, 283-284 Employment issues, 195 Evaluation of programs abstinence-based contraceptive strategies, 9, 233-236, 265 abstinence-only strategies, 9, 232-233, 265 access to contraceptive services, 9, 236-238, 265 adult interventions, 231-232 community level, 240 conclusions from, 9, 264-265 cost of, 229, 266 couples' interventions, 232 criteria, 225-226 cross-cutting themes, 231-240, 244 economic effects, methodology for measuring, 240-243, 244, 338 339, 347-363 effect on sexual behavior, 233-236 evaluated programs, 227-228, 228 240. See also specific programs family planning programs, federal, 219-222 methodological issues, 229-230 obstacles to, 229 371 outcomes, 225, 228, 244, 338, 340347 recommendations, 4, 7, 9, 254, 264-266 reduction of rapid repeat pregnancies, 9, 238-239, 265 self-reported data in, 230 social context of, 230-231 socioeconomic/cultural factors in, 239240 F Facts and Feelings, 227, 233, 314-315 Family planning, 6 black perspective, 198-203 economic effects, 241-243, 244 effect on infant mortality, 72, 81 employment issues, 195 evaluation methodology, 338-339, 351-363 federally funded programs, 142-143, 218-222 funding issues, 240-242 male role in, 206-208, 256-257, 265 managed care systems and, 13 Medicaid coverage, 139, 141 medical approach, 152-153 neonatal health and, 72 provider base, 146-147 public policy development, 12, 278285 trends, 137 See also Medicaid; Programs to reduce unintended pregnancy; Title X Family Support Act of 1988, 15 Fathers impact of unintended pregnancy on, 75-76 preconception counseling, 79 r socioeconomic consequences OT absence of, 61-63 Fetal alcohol syndrome, 70 Fetal and neonatal health abortion and subsequent pregnancy outcomes, 52 Read the entire page →
From page 372... ... 372 abortion for problems of, 25 n.2 adolescent childbearing risk, 58-59 childbearing by older women and, 6061 effect of federally funded family planning programs, 221-222 family planning and, 72 low birthweight, pregnancy intendedness and, 70 maternal substance abuse, 68-70 outcome research, 296 preconception care, 77-78 sexually transmitted disease infection and, 120 spacing of pregnancies and, 70 in unintended pregnancy, 1, 81, 250251 in unwanted pregnancy, 251 See also Child health and well-being; Prenatal care Foam, 103 Folic acid, 78 Food Stamp Program, 196 France, 43 G Gender bias, 205-208 Genetic testing, 2, 78, 82, 251 Girls Incorporated Preventing Adolescent Pregnancy, 227, 315 316 Great Britain, 43, 45 Group Cognitive Behavior Curriculum, 227, 317 Guilt, 168-169 H Head Start, 12 Health and Human Services, U.S. Department of, 3, 253 Health care professionals abortion providers, 210-211 INDEX discussion of sexual topics in primary care, 147-148, 151-152 nursing profession, 148 training for contraceptive counseling, 7, 8, 145-148, 260, 261-262, 263 Health care system accessibility to contraception through, 6, 136, 148-150, 154, 259 early intervention for contraceptive counseling, 150-152 modeling of, 349-350 reform, 12-13 See also Insurance System; Managed care Health maintenance organizations, 140 HIV/AIDS, 15, 115, 120, 268-269 sex education and, 132, 133 I Implants and injections, contraceptive, 267 insurance coverage, 140 pricing, 145 recommendations for, 258 removal, 145 welfare policy and, 200 Individual behavior and decision-making among low-income adolescents, 163165, 262 assessment of, in pregnancy surveys, 23-24 attitudes about contraceptive methods, 171-172, 267 attitudes about fertility, 169-170 attitudes about sexuality, 168-169, 176 benefit:burden models explaining contraceptive use, 161-162, 176 by child of single-parent family, 62 in contraceptive use, 4, 7-8, 18-19, 103, 120, 153, 160, 167, 176, 254, 262-264 couple and partner interactions, 174176 Read the entire page →
From page 373... ... INDEX determinants of proper contraceptive use, 131 locus of control perspective, 167 media influence, 192-193 modeling, 340-347 motivational perspective, 162-163 obstacles to research, 161 patterns of contraceptive use, 92-96 planning of sexual activity and, 170 preconception care, 77 prenatal care, 68-70 public welfare considerations in, 13-14 religious beliefs and, 187 research needs, 10, 269-270 risk of unintended pregnancy, 28-30 single-factor investigations, 166 strategic significance, 264 welfare considerations in, 196-198 Information gathering and processing, 17-18, 43 n.11 abortion data, 211, 288, 299 contraceptive use, 292-295 measures of pregnancy intendedness, 288-289, 290-292 methodological issues in outcomes research, 64-66 pregnancy prevention programs for evaluation, 226 recommendations, 266 See also Evaluation of programs; Research needs Insurance system access to contraception and, 6, 139140, 153, 259, 260 family planning programs and, 13 health care reform debate, 13 recommendations for, 6, 259, 260 Intended pregnancy abortion for, 25 n.2 definition, 22, 23, 288 as focus of prevention efforts, 255 international comparisons, 42-43 measurement of, 43 n.11 number of births, 2, 27 number of pregnancies, 26 percentage rates, 25, 31 373 International comparisons, 19, 42-47 abortion policy and practice, 43-47 access to contraception, 136-137 nonmarital childbearing, 14 n.3 sexual attitudes, 193-194 teenage pregnancy, 42-43 International Conference on Population and Development (Cairo Conference) , 19 Intrauterine devices, 129 access to, 147 insurance coverage, 140 patterns of use, 103, 109, 110 L Legal issues abortion practice, 51, 53 contraceptive use, 16, 279-280 discussion of sexual topics in medical practice and, 147 drug- and alcohol-exposed infants, 70 M Managed care, 12-13, 267-268 Marital status adolescent pregnancy trends, 56 births from unwanted pregnancy and, 38-39, 41 contraceptive use and, 96, 110-111, 115 data sources, 24 effects of unintended pregnancy on, 74 impact of income transfer programs on, 196-197 likelihood of abortion and, 41-42 never-married women, 31, 38, 41, 250 pregnancy intendedness and, 31 unintended pregnancy demographics, 34, 38, 50, 55, 250 See also Nonmarital childbearing; Single-parent families Maternal and Child Health Bureau, 266 Read the entire page →
From page 374... ... 374 Maternal health adolescent childbearing risk, 58-59 health risk for older women, 60-61 preconception care, 77-78 risks of unintended pregnancy, 74-75, 81 in unintended birth, 1, 251 McCabe Center, 227, 238, 317-318 Media contraceptive education, 127-128, 129 contraception use portrayed in, 189190, 191 contraceptive advertising in, 191, 192 influence of, on sexual behavior, 192193 recommendations, 6, 258-259 sexual attitudes and behaviors expressed in, 189-191 sexuality as topic of discussion, 15 violence and, 193 Media Project, 239-240 Medicaid, 6, 7, 12, 13, 19, 153, 218 adolescent services, 142 contraceptive coverage, 141, 196, 219, 259, 260-261 effect on unintended pregnancy rate, 7, 219, 222, 261 eligibility, 141 family planning coverage, 139, 140142, 282 male role in contraception and, 207208 spending, 141, 219 sterilization coverage, 149-150, 282 Miscarriage, 25 n.3 age-related risk, 60 Mistimed pregnancy characteristics of women, 31 child development and, 72-74 definition, 22, 288 effects of eliminating, 50-51, 309-310 low birthweight and, 70 marital status and, 34, 38, 310 maternal behavioral risks and, 68-70 maternal risk in, 81 percentage rates, 25-27 INDEX prenatal care and, 66-68 program effectiveness in preventing, economic evaluation of, 242-243 research issues, 65, 290-291 Mortality abortion, 51, 53 adolescent childbearing risk, 58-59 childbearing risk for older women, 60 infant, 70, 72, 220, 222 maternal, in unintended pregnancy, 74-75 N National Institute of Child Health and Human Development, 219 n.1, 266, 267 National Longitudinal Survey of Youth, 133 National Maternal and Infant Health Survey, 18, 24 n.1 National Survey of Families and Households, 23, 34 National Survey of Family Growth, 11, 22-25, 33-34, 64, 92, 98, 103, 165-166, 286-295 Netherlands, 43, 47 Neural tube defects, 78 New Chance, 227, 239, 319-320 Nonmarital childbearing effects of reducing unintended pregnancy, 80, 81, 309, 310 intentionality in, 38 international comparisons, 14 n.3 public policy issues, 13-14 social attitudes and, 33 n.8 trends, 13-14, 309, 310 See also Single-parent families Nonmarital pregnancy abortion outcomes, 41-42 assessing intentionality in, 38 research issues, 56 trends, 34, 38, 41 as unintended, risk of, 31, 50, 55, 250 See also Marital status Norplant, 109, 129, 140, 145, 200 Read the entire page →
From page 375... ... , 75 375 Prenatal care, 1, 250 access, 82, 256 adolescent childbearing, 59 effect of federally funded family planning programs, 221-222 obstacles to, 66 outcomes research, 296 pregnancy intendedness and, 66-68 social support network and, 68 See also Fetal and neonatal health Private sector funding for adolescent pregnancy interventions, 225 in public-private consortium for reducing unintended pregnancy, 4, 252-253 Programs to reduce unintended pregnancy access to contraceptive services, 9, 236-238, 265 contraceptive use, strategies for encouraging, 96 development of, 223-225 economic impact of, 242-244, 245 effects of funding withdrawal, 242 financing of contraceptive methods in, 6-7, 12, 259-61 focus on financial consequences, 195 goals, 3, 252, 254 in health care reform, 12-13 intervention through existing systems, 150-153 leadership, 252-253, 258-259, 270 271 male participation, 14-15, 206-208, 219, 257, 265 national programs, 218-222 noncontraceptive interventions, 8 opposition to, 255 personal motivation as factor in, 264 potential effects of, 79-80, 81, 253, 256, 308-310 public policy, evolution of, 12 recommendations for national campaign, 3-10, 252-266 research needs, 266-270 Read the entire page →
From page 376... ... diversity, 185-188 Reproductive age range, 28 Reproductive Health Screening of Male Adolescents, 227, 325-326 Research needs contraceptive use, 5, 9-10, 266-270 individual behavior and decisionmaking, 10, 269 male contraceptive behavior, 265 measures of intentionality, 23-24, 269-270, 288-289 predictors of unintended pregnancy, 81-82 program efficacy, 9 � . Read the entire page →
From page 377... ... . attitudes, 188- 189, 254-255 use of contraception at first intercourse, 96, 111-115, 116, 255 violence toward women, 203-205 See also Contraceptive use Sexually transmitted diseases, 6, 8, 14, 77, 91, 119-120, 254-255, 258259, 263, 268-269 adolescent mothers, 59 condom use and, 171-172 contraceptive counseling in treatment for, 150-151 dual-method contraception and, 118119, 258, 259 public health program spending, 143 public understanding of, 129-130 in sexual content of mass media, 191 Single-parent families adolescent pregnancy and, 56 child outcomes, 61-63 formation of, 61, 63 See also Nonmarital childbearing Six School-Based Clinics, 228, 329-330 Smoking, 68-70 Social and cultural values, 91, 211-212 abortion and, 54 childbearing decisions among lowincome adolescents, 163-164, 166, 262 contraceptive use and, 9, 16, 19, 174, 175, 183-184, 265-266, 268 in evaluated programs, 239-240 gender bias in, 205-208 international comparisons, 193-194 peer influences in contraceptive use, 174, 175 pregnancy planning, 3, 252 public policy and, 5-6, 255-256, 281 Read the entire page →
From page 378... ... Paul School-based Health Clinics, 228, 237, 330-331 Sterilization, 28, 98-99 access to, 6, 282 as contraceptive method of choice, 103, 108 gender differences, 115 insurance coverage, 139 obstacles to access, 149-150 INDEX racism and, 199-200, 201-202 sociodemographic variables, 282 n.1 Substance abuse, 33 contraceptive counseling in treatment for, 151 contraceptive use and, 172-173, 176 preconception care, 77 rape and, 203, 205 risks in pregnancy, 68-70 Success Express, 228, 232-233, 331332 Sudden infant death syndrome, 59 Summer Training and Education Program, 228, 239, 332-333 Sweden, 43 T Teenage Parent Demonstration, 228, 333-335 Teenage pregnancy abortion outcomes, 53 abstinence-focused interventions and, 15-16 adolescent fathers, 75-76 age of father, 205 age at onset of menarche and, 31 n.6 child sexual abuse and, 205 contraceptive nonuse and, 96 contraceptive use, 108, 167 decision-making among low-income adolescents, 163-165, 166, 262 development of prevention programs, 223-225 educational attainment and, 55-56 effect of federal family planning programs on, 221 family planning trends, 137 income transfer programs and, 197198 intentionality in, 38, 288-289 international comparisons, 42-43 involuntary sexual activity in, 204 marital status trends, 56 medical issues, 58-59 Read the entire page →
From page 379... ... INDEX percentage of unintended pregnancies, 31, 252 rapid repeat, 238-239 risk for child of single-parent family, 62 sex education and, 133-135 socioeconomic outcomes, 55-58, 195 socioeconomic risk factors, 28 trends, 11-12, 13, 14 understanding of reproductive biology and, 129 unintended, percentage rate, 250 Teen Outreach Project, 228, 335-336 Teen Talk, 228, 235, 336-337 Title X, 12, 19, 142, 207-208, 209, 218 access to contraception in, 6, 7, 259262 effect on unintended pregnancy rate, 219, 222 funding, 278 in health care reform debate, 13 origins and development, 278, 279 prospects for, 278-279 role of, 138, 219 spending, 219 utilization, 219 Title XX, 142 U Unintended pregnancy benefits of reducing, 4, 79-80, 81, 253, 254 consequences of, 1, 250-251 data sources, 22, 23-25 definition, 11, 22 demographic trends, 2, 11-12, 18, 3334-41, 250 extent of, 1, 2, 11, 25, 26-27, 92, 250 interrelationship of factors in, 2-3, 8, 10, 19, 211-212, 253 methodological issues in outcomes research, 64-66 methodological issues in research on determinants, 268 379 number of abortions for, 2, 21, 41, 251 percentage rates, 25-27, 28-31, 45 risk factors, 28-30, 45, 55 trends in births from unintended pregnancies, 33-41, 47 types of, 22 United Nations, 19, 206 Unwanted pregnancy child development and, 72-74 definition, 22, 288 effects of eliminating, 50-51, 70, 81, 308-309 fetal health risk, 1, 251 likelihood of abortion for, 41-42 low birthweight and, 70 maternal behavioral risks and, 68-70 prenatal care and, 66-68, 81 program effectiveness in preventing, economic evaluation of, 242-243 research issues, 65, 290-291 trends in births from unwanted pregnancies, 38-41, 47 V Vasectomy, 98, 115 Violence, 193, 203 anti-abortion, 209, 211 domestic, 75, 81, 203 unintended pregnancy and, 203-205 W Welfare system adolescent childbearing outcomes, 56 alcohol- and drug-exposed infants, 70 benefit:burden models in evaluation of, 162 child support payment and, 15 contraceptive services, perception of racism in, 198-203 marital status and, 196-197 Read the entire page →
From page 380... ... 380 pregnancy prevention programs and, evaluation of, 240-241, 242, 243244, 245 reform efforts, 13-14 unintended pregnancy trends and, 196198 See also Title X Withdrawal method, 103, 111, 115 Women over 40 years old, 1-2, 5, 250, 256-257 abortion utilization, 42 contraceptive use, 94, 108 medical risk in childbearing, 60-61 INDEX percentage of unintended pregnancies, 31 program outreach for, 266 socioeconomic issues in childbearing, 60 Women's issues, 11, 271 child care, 74 gender bias, 205-208 violence against women, 203-205 y Year 2000 objectives, 3, 253 Read the entire page →

From page 367...

... Index A Abortion access issues, 209-211, 256, 282 age variables in, 42 as consequence of unintended pregnancy, 18, 23, 50, 51, 80, 210 data sources, 25, 288, 290 denied, and subsequent child wellbeing, 73 effect of federal family planning programs on, 221-222 insurance coverage, 139 for intended pregnancies, 25 n.2 international comparisons, 42-47 marital status and, 41-42 medical risk, 51-52 neonatal mortality and, 72 number of, 2, 21, 26, 41, 51, 210 opposition movement, 208-211 percentage rates, 2, 26, 41, 45, 251 psychological issues, 53-54 public policy development, 282-285 rate of complications, 52-53 reducing need for, 80-81, 253 religious debate, 186-188 research, 211, 230, 281, 285, 288, 290 367 socioeconomic variables in, 42 sociopolitical controversy, 16, 54, 251 techniques, 52, 53, 283-284 trends, 33, 210 voting behavior and, 187-188 Abstinence, 111 as one means to prevent pregnancy, 103 efficacy, 9, 101, 255, 258, 265 in evaluated programs, 9, 232-236, 265 as pregnancy-reduction intervention, effectiveness of recommendations. 5, 255 in school-based sex education programs, 15-16, 134-135 Access to contraception, 18, 126, 127 anti-abortion movement and, 208-211 bureaucratic obstacles, 148-150 current status, 137-139, 244 in evaluated programs, 236-238 financial barriers to, 6-7, 139-145, 259-262 in health maintenance organizations, 140 individual psychological factors in, 169

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From page 368...

... . Issues In researc 1 on pregnancy intendedness, 64-66, 165-166, 269-270, 288-289, 290-292 of physicians toward discussing sex and other related topics, 147 during pregnancy, shift in, 22-23 racist, birth control policy and, 198203 sexual, international comparison of, 193-194 See also Individual behavior and decision-making; Social and cultural values B Baby Boom, 194 Benefit:burden ratio, 161-162 Benefit:cost analysis, 241, 339 Block grants, 142, 218-219, 261 Breast cancer, 52 Bureau of Primary Care, 266 C Campaign to reduce unintended pregnancy, 253-271 Canada, 43, 47 Centers for Disease Control and Prevention, 25, 266 Cervical cap, 111 Child abuse and neglect later unintended pregnancy risk, 104-105 unintended pregnancy as risk factor, 1, 73-74, 81, 251 Child advocacy groups, 270-271 Child care, 74 Child health and well-being child abuse risk, 1, 73-74, 81, 251 consequences of unintended pregnancy, 12, 50, 81, 251-252

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From page 369...

... INDEX developmental effects of pregnancy intendedness, 72-74, 81 effects of reducing unintended pregnancy, 79-80, 82 methodological issues in outcomes research, 64-66 outcomes research, 296 preventive public health interventions, 12 See also Fetal and neonatal health Child support, 15, 207 Clinical Laboratories Improvement Act, 143 Community level programs, 218-244 Community of Caring, 227, 311-312 Condom Mailing Program, 227, 312313 Condoms, 8, 15, 263 access to, 136, 153, 208 age patterns in use of, 115-116 as contraceptive method of choice, 103, 108 determinants of use, 174-175 in dual-method contraception, 91, 118119, 122, 258, 259-260 effectiveness of, 6, 259, 269 failure of, 99-100, 101, 172 patterns of use, 110-111, 269 race and ethnicity as factors in use of, 116 socioeconomic factors in use of, 117 use in first intercourse, 111-115, 116 user attitudes, 171-172 Congenital malformations, 60-61, 78-79 n.6 Contraceptive methods access to most effective, 138 advertising, 6, 191-192, 258-259 coitus-dependent, 101, 110-111, 122, 171 coitus-independent, 8, 101, 103, 109110, 122, 171, 258, 263, 267 dual-method, 91, 118-119, 122, 258, 259-260 effectiveness, 109, 111, 115, 122 369 emergency contraception, 128 n.1, 146, 147, 258, 283-284 failure of method, technological failure in, 99-100, 172, 255-256, 267 failure rates, 101 hormonal implants and injections, 99, 103, 109-110 individual attitudes about, 171-172, 264, 267, 268 individual changes in use of or of type used, 94-96 insurance coverage, 139-140 long-term performance, 101-102 for male use, 10, 267 pasterns of use, 103, 108-111 prescription vs. nonprescription, 135136 pricing, 144-145 professional counseling in, 8, 261, 262-263 research in, 5, 9, 10, 266-267 reversible, 92, 94, 98, 99-103, 108111,122,139,267 sexually transmitted disease prevention, 119-122, 150-151, 153 side effects, 111 sterilization, 98-99 technical development, 16 technical shortcomings, 126-127 training of health care professionals, 7, 8, 145-148, 259-260, 261-262, 263 See also Contraceptive use; specific method Contraceptive sponge, 136 Contraceptive use abortion debate and, 16 access to contraception and, 136 by adolescents, 108, 111, 115-116, 117, 129, 164-165 attitudes about contraceptive methods and, 171-172, 264, 267, 268 attitudes about fertility and, 169-170 attitudes about sexuality and, 168-169, 176 benef~t:burden models, 161-162, 176

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From page 370...

... index, 339 Denmark, 136, 193 Depo-Provera, 109-110 Depression, 75 Diaphragm, 111 as contraceptive method of choice, 103 failure rate, 101 insurance coverage, 140 proper use, 130-131 Diversity cultural-ethnic, 184-185 religious and political, 185-188

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From page 371...

... INDEX Divorce outcomes for children of single-parent families formed by, 63 as a result of an unintended birth, 61 Domestic violence, 75, 81 prevalence, 203 EEducational attainment adolescent childbearing and, 55-56 of children from single-parent families, 61-63 father's, 75 proper contraceptive use and, 131 Elmira Nurse Home Visiting Program, 227, 313-314 Embarrassment, 169 Emergency contraception, 128 not, 146, 147, 258, 283-284 Employment issues, 195 Evaluation of programs abstinence-based contraceptive strategies, 9, 233-236, 265 abstinence-only strategies, 9, 232-233, 265 access to contraceptive services, 9, 236-238, 265 adult interventions, 231-232 community level, 240 conclusions from, 9, 264-265 cost of, 229, 266 couples' interventions, 232 criteria, 225-226 cross-cutting themes, 231-240, 244 economic effects, methodology for measuring, 240-243, 244, 338 339, 347-363 effect on sexual behavior, 233-236 evaluated programs, 227-228, 228 240. See also specific programs family planning programs, federal, 219-222 methodological issues, 229-230 obstacles to, 229 371 outcomes, 225, 228, 244, 338, 340347 recommendations, 4, 7, 9, 254, 264-266 reduction of rapid repeat pregnancies, 9, 238-239, 265 self-reported data in, 230 social context of, 230-231 socioeconomic/cultural factors in, 239240 F Facts and Feelings, 227, 233, 314-315 Family planning, 6 black perspective, 198-203 economic effects, 241-243, 244 effect on infant mortality, 72, 81 employment issues, 195 evaluation methodology, 338-339, 351-363 federally funded programs, 142-143, 218-222 funding issues, 240-242 male role in, 206-208, 256-257, 265 managed care systems and, 13 Medicaid coverage, 139, 141 medical approach, 152-153 neonatal health and, 72 provider base, 146-147 public policy development, 12, 278285 trends, 137 See also Medicaid; Programs to reduce unintended pregnancy; Title X Family Support Act of 1988, 15 Fathers impact of unintended pregnancy on, 75-76 preconception counseling, 79 r socioeconomic consequences OT absence of, 61-63 Fetal alcohol syndrome, 70 Fetal and neonatal health abortion and subsequent pregnancy outcomes, 52

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From page 372...

... 372 abortion for problems of, 25 n.2 adolescent childbearing risk, 58-59 childbearing by older women and, 6061 effect of federally funded family planning programs, 221-222 family planning and, 72 low birthweight, pregnancy intendedness and, 70 maternal substance abuse, 68-70 outcome research, 296 preconception care, 77-78 sexually transmitted disease infection and, 120 spacing of pregnancies and, 70 in unintended pregnancy, 1, 81, 250251 in unwanted pregnancy, 251 See also Child health and well-being; Prenatal care Foam, 103 Folic acid, 78 Food Stamp Program, 196 France, 43 G Gender bias, 205-208 Genetic testing, 2, 78, 82, 251 Girls Incorporated Preventing Adolescent Pregnancy, 227, 315 316 Great Britain, 43, 45 Group Cognitive Behavior Curriculum, 227, 317 Guilt, 168-169 H Head Start, 12 Health and Human Services, U.S. Department of, 3, 253 Health care professionals abortion providers, 210-211 INDEX discussion of sexual topics in primary care, 147-148, 151-152 nursing profession, 148 training for contraceptive counseling, 7, 8, 145-148, 260, 261-262, 263 Health care system accessibility to contraception through, 6, 136, 148-150, 154, 259 early intervention for contraceptive counseling, 150-152 modeling of, 349-350 reform, 12-13 See also Insurance System; Managed care Health maintenance organizations, 140 HIV/AIDS, 15, 115, 120, 268-269 sex education and, 132, 133 I Implants and injections, contraceptive, 267 insurance coverage, 140 pricing, 145 recommendations for, 258 removal, 145 welfare policy and, 200 Individual behavior and decision-making among low-income adolescents, 163165, 262 assessment of, in pregnancy surveys, 23-24 attitudes about contraceptive methods, 171-172, 267 attitudes about fertility, 169-170 attitudes about sexuality, 168-169, 176 benefit:burden models explaining contraceptive use, 161-162, 176 by child of single-parent family, 62 in contraceptive use, 4, 7-8, 18-19, 103, 120, 153, 160, 167, 176, 254, 262-264 couple and partner interactions, 174176

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From page 373...

... INDEX determinants of proper contraceptive use, 131 locus of control perspective, 167 media influence, 192-193 modeling, 340-347 motivational perspective, 162-163 obstacles to research, 161 patterns of contraceptive use, 92-96 planning of sexual activity and, 170 preconception care, 77 prenatal care, 68-70 public welfare considerations in, 13-14 religious beliefs and, 187 research needs, 10, 269-270 risk of unintended pregnancy, 28-30 single-factor investigations, 166 strategic significance, 264 welfare considerations in, 196-198 Information gathering and processing, 17-18, 43 n.11 abortion data, 211, 288, 299 contraceptive use, 292-295 measures of pregnancy intendedness, 288-289, 290-292 methodological issues in outcomes research, 64-66 pregnancy prevention programs for evaluation, 226 recommendations, 266 See also Evaluation of programs; Research needs Insurance system access to contraception and, 6, 139140, 153, 259, 260 family planning programs and, 13 health care reform debate, 13 recommendations for, 6, 259, 260 Intended pregnancy abortion for, 25 n.2 definition, 22, 23, 288 as focus of prevention efforts, 255 international comparisons, 42-43 measurement of, 43 n.11 number of births, 2, 27 number of pregnancies, 26 percentage rates, 25, 31 373 International comparisons, 19, 42-47 abortion policy and practice, 43-47 access to contraception, 136-137 nonmarital childbearing, 14 n.3 sexual attitudes, 193-194 teenage pregnancy, 42-43 International Conference on Population and Development (Cairo Conference) , 19 Intrauterine devices, 129 access to, 147 insurance coverage, 140 patterns of use, 103, 109, 110 L Legal issues abortion practice, 51, 53 contraceptive use, 16, 279-280 discussion of sexual topics in medical practice and, 147 drug- and alcohol-exposed infants, 70 M Managed care, 12-13, 267-268 Marital status adolescent pregnancy trends, 56 births from unwanted pregnancy and, 38-39, 41 contraceptive use and, 96, 110-111, 115 data sources, 24 effects of unintended pregnancy on, 74 impact of income transfer programs on, 196-197 likelihood of abortion and, 41-42 never-married women, 31, 38, 41, 250 pregnancy intendedness and, 31 unintended pregnancy demographics, 34, 38, 50, 55, 250 See also Nonmarital childbearing; Single-parent families Maternal and Child Health Bureau, 266

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From page 374...

... 374 Maternal health adolescent childbearing risk, 58-59 health risk for older women, 60-61 preconception care, 77-78 risks of unintended pregnancy, 74-75, 81 in unintended birth, 1, 251 McCabe Center, 227, 238, 317-318 Media contraceptive education, 127-128, 129 contraception use portrayed in, 189190, 191 contraceptive advertising in, 191, 192 influence of, on sexual behavior, 192193 recommendations, 6, 258-259 sexual attitudes and behaviors expressed in, 189-191 sexuality as topic of discussion, 15 violence and, 193 Media Project, 239-240 Medicaid, 6, 7, 12, 13, 19, 153, 218 adolescent services, 142 contraceptive coverage, 141, 196, 219, 259, 260-261 effect on unintended pregnancy rate, 7, 219, 222, 261 eligibility, 141 family planning coverage, 139, 140142, 282 male role in contraception and, 207208 spending, 141, 219 sterilization coverage, 149-150, 282 Miscarriage, 25 n.3 age-related risk, 60 Mistimed pregnancy characteristics of women, 31 child development and, 72-74 definition, 22, 288 effects of eliminating, 50-51, 309-310 low birthweight and, 70 marital status and, 34, 38, 310 maternal behavioral risks and, 68-70 maternal risk in, 81 percentage rates, 25-27 INDEX prenatal care and, 66-68 program effectiveness in preventing, economic evaluation of, 242-243 research issues, 65, 290-291 Mortality abortion, 51, 53 adolescent childbearing risk, 58-59 childbearing risk for older women, 60 infant, 70, 72, 220, 222 maternal, in unintended pregnancy, 74-75 N National Institute of Child Health and Human Development, 219 n.1, 266, 267 National Longitudinal Survey of Youth, 133 National Maternal and Infant Health Survey, 18, 24 n.1 National Survey of Families and Households, 23, 34 National Survey of Family Growth, 11, 22-25, 33-34, 64, 92, 98, 103, 165-166, 286-295 Netherlands, 43, 47 Neural tube defects, 78 New Chance, 227, 239, 319-320 Nonmarital childbearing effects of reducing unintended pregnancy, 80, 81, 309, 310 intentionality in, 38 international comparisons, 14 n.3 public policy issues, 13-14 social attitudes and, 33 n.8 trends, 13-14, 309, 310 See also Single-parent families Nonmarital pregnancy abortion outcomes, 41-42 assessing intentionality in, 38 research issues, 56 trends, 34, 38, 41 as unintended, risk of, 31, 50, 55, 250 See also Marital status Norplant, 109, 129, 140, 145, 200

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From page 375...

... , 75 375 Prenatal care, 1, 250 access, 82, 256 adolescent childbearing, 59 effect of federally funded family planning programs, 221-222 obstacles to, 66 outcomes research, 296 pregnancy intendedness and, 66-68 social support network and, 68 See also Fetal and neonatal health Private sector funding for adolescent pregnancy interventions, 225 in public-private consortium for reducing unintended pregnancy, 4, 252-253 Programs to reduce unintended pregnancy access to contraceptive services, 9, 236-238, 265 contraceptive use, strategies for encouraging, 96 development of, 223-225 economic impact of, 242-244, 245 effects of funding withdrawal, 242 financing of contraceptive methods in, 6-7, 12, 259-61 focus on financial consequences, 195 goals, 3, 252, 254 in health care reform, 12-13 intervention through existing systems, 150-153 leadership, 252-253, 258-259, 270 271 male participation, 14-15, 206-208, 219, 257, 265 national programs, 218-222 noncontraceptive interventions, 8 opposition to, 255 personal motivation as factor in, 264 potential effects of, 79-80, 81, 253, 256, 308-310 public policy, evolution of, 12 recommendations for national campaign, 3-10, 252-266 research needs, 266-270

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From page 376...

... diversity, 185-188 Reproductive age range, 28 Reproductive Health Screening of Male Adolescents, 227, 325-326 Research needs contraceptive use, 5, 9-10, 266-270 individual behavior and decisionmaking, 10, 269 male contraceptive behavior, 265 measures of intentionality, 23-24, 269-270, 288-289 predictors of unintended pregnancy, 81-82 program efficacy, 9 � .

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From page 377...

... . attitudes, 188- 189, 254-255 use of contraception at first intercourse, 96, 111-115, 116, 255 violence toward women, 203-205 See also Contraceptive use Sexually transmitted diseases, 6, 8, 14, 77, 91, 119-120, 254-255, 258259, 263, 268-269 adolescent mothers, 59 condom use and, 171-172 contraceptive counseling in treatment for, 150-151 dual-method contraception and, 118119, 258, 259 public health program spending, 143 public understanding of, 129-130 in sexual content of mass media, 191 Single-parent families adolescent pregnancy and, 56 child outcomes, 61-63 formation of, 61, 63 See also Nonmarital childbearing Six School-Based Clinics, 228, 329-330 Smoking, 68-70 Social and cultural values, 91, 211-212 abortion and, 54 childbearing decisions among lowincome adolescents, 163-164, 166, 262 contraceptive use and, 9, 16, 19, 174, 175, 183-184, 265-266, 268 in evaluated programs, 239-240 gender bias in, 205-208 international comparisons, 193-194 peer influences in contraceptive use, 174, 175 pregnancy planning, 3, 252 public policy and, 5-6, 255-256, 281

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From page 378...

... Paul School-based Health Clinics, 228, 237, 330-331 Sterilization, 28, 98-99 access to, 6, 282 as contraceptive method of choice, 103, 108 gender differences, 115 insurance coverage, 139 obstacles to access, 149-150 INDEX racism and, 199-200, 201-202 sociodemographic variables, 282 n.1 Substance abuse, 33 contraceptive counseling in treatment for, 151 contraceptive use and, 172-173, 176 preconception care, 77 rape and, 203, 205 risks in pregnancy, 68-70 Success Express, 228, 232-233, 331332 Sudden infant death syndrome, 59 Summer Training and Education Program, 228, 239, 332-333 Sweden, 43 T Teenage Parent Demonstration, 228, 333-335 Teenage pregnancy abortion outcomes, 53 abstinence-focused interventions and, 15-16 adolescent fathers, 75-76 age of father, 205 age at onset of menarche and, 31 n.6 child sexual abuse and, 205 contraceptive nonuse and, 96 contraceptive use, 108, 167 decision-making among low-income adolescents, 163-165, 166, 262 development of prevention programs, 223-225 educational attainment and, 55-56 effect of federal family planning programs on, 221 family planning trends, 137 income transfer programs and, 197198 intentionality in, 38, 288-289 international comparisons, 42-43 involuntary sexual activity in, 204 marital status trends, 56 medical issues, 58-59

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From page 379...

... INDEX percentage of unintended pregnancies, 31, 252 rapid repeat, 238-239 risk for child of single-parent family, 62 sex education and, 133-135 socioeconomic outcomes, 55-58, 195 socioeconomic risk factors, 28 trends, 11-12, 13, 14 understanding of reproductive biology and, 129 unintended, percentage rate, 250 Teen Outreach Project, 228, 335-336 Teen Talk, 228, 235, 336-337 Title X, 12, 19, 142, 207-208, 209, 218 access to contraception in, 6, 7, 259262 effect on unintended pregnancy rate, 219, 222 funding, 278 in health care reform debate, 13 origins and development, 278, 279 prospects for, 278-279 role of, 138, 219 spending, 219 utilization, 219 Title XX, 142 U Unintended pregnancy benefits of reducing, 4, 79-80, 81, 253, 254 consequences of, 1, 250-251 data sources, 22, 23-25 definition, 11, 22 demographic trends, 2, 11-12, 18, 3334-41, 250 extent of, 1, 2, 11, 25, 26-27, 92, 250 interrelationship of factors in, 2-3, 8, 10, 19, 211-212, 253 methodological issues in outcomes research, 64-66 methodological issues in research on determinants, 268 379 number of abortions for, 2, 21, 41, 251 percentage rates, 25-27, 28-31, 45 risk factors, 28-30, 45, 55 trends in births from unintended pregnancies, 33-41, 47 types of, 22 United Nations, 19, 206 Unwanted pregnancy child development and, 72-74 definition, 22, 288 effects of eliminating, 50-51, 70, 81, 308-309 fetal health risk, 1, 251 likelihood of abortion for, 41-42 low birthweight and, 70 maternal behavioral risks and, 68-70 prenatal care and, 66-68, 81 program effectiveness in preventing, economic evaluation of, 242-243 research issues, 65, 290-291 trends in births from unwanted pregnancies, 38-41, 47 V Vasectomy, 98, 115 Violence, 193, 203 anti-abortion, 209, 211 domestic, 75, 81, 203 unintended pregnancy and, 203-205 W Welfare system adolescent childbearing outcomes, 56 alcohol- and drug-exposed infants, 70 benefit:burden models in evaluation of, 162 child support payment and, 15 contraceptive services, perception of racism in, 198-203 marital status and, 196-197

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From page 380...

... 380 pregnancy prevention programs and, evaluation of, 240-241, 242, 243244, 245 reform efforts, 13-14 unintended pregnancy trends and, 196198 See also Title X Withdrawal method, 103, 111, 115 Women over 40 years old, 1-2, 5, 250, 256-257 abortion utilization, 42 contraceptive use, 94, 108 medical risk in childbearing, 60-61 INDEX percentage of unintended pregnancies, 31 program outreach for, 266 socioeconomic issues in childbearing, 60 Women's issues, 11, 271 child care, 74 gender bias, 205-208 violence against women, 203-205 y Year 2000 objectives, 3, 253

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Index Pages 367-380

Index
Pages 367-380