The best intentions : unintended pregnancy and the well-being of children and families / Committee on Unintended Pregnancy, Division of Health Promotion and Disease Prevention, Institute of Medicine ; Sarah S. Brown and Leon Eisenberg, editors.

Format:

Book

Contributor:

Brown, Sarah S.

Eisenberg, Leon, 1922-2009.

Institute of Medicine (U.S.). Committee on Unintended Pregnancy.

Language:

English

Subjects (All):

Unwanted pregnancy--Government policy--United States.

Unwanted pregnancy.

Birth control--Government policy--United States.

Birth control.

Birth control clinics--Utilization--United States.

Birth control clinics.

Physical Description:

ix, 380 p. : ill.

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1995.

Language Note:

English

Summary:

Experts estimate that nearly 60 percent of all U.S. pregnancies-and 81 percent of pregnancies among adolescents-are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted. Now, current issues-health care and welfare reform, and the new international focus on population-are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts. This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs. The Best Intentions explores problematic definitions-"unintended" versus "unwanted" versus "mistimed"-and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear. Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care." The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals.

Contents:

The Best Intentions

Copyright

Acknowledgments

Contents

The Best Intentions

Summary

COMMITTEE RECOMMENDATIONS

The Campaign to Reduce Unintended Pregnancy

Campaign Leadership

1 Introduction

FOCUS OF THIS REPORT

STUDY METHODS AND REPORT ORGANIZATION

2 Demography of Unintended Pregnancy

TERMINOLOGY

PERCENTAGE RATES OF UNINTENDED PREGNANCY

WOMEN AT RISK OF UNINTENED PREGNANCY

WOMEN WHO HAVE UNINTENDED PREGNANCIES

TRENDS IN UNINTENDED PREGNANCY

Overall Trends for All Women

Trends Among Currently Married Women

Trends Among Never-Married Women

Trends in Births Unwanted at Conception

THE ROLE OF ABORTION

Factors That Affect Who Obtains an Abortion

INTERNATIONAL COMPARISONS

U.S. Abortion Rates Versus Other Western Democracies

CONCLUSION

REFERENCES

3 Consequences of Unintended Pregnancy

ABORTION AS A CONSEQUENCE OF UNINTENDED PREGNANCY

Medical Complications

Rates of Complications

Psychological Issues

Political Issues

MATERNAL DEMOGRAPHIC STATUS

Adolescent Childbearing: Socioeconomic Issues

Adolescent Childbearing: Medical Issues

Childbearing at Older Ages: Socioeconomic and Medical Issues

Childbearing by Single Women

THE EFFECTS OF INTENDEDNESS

Methodological Concerns

Prenatal Care

Behavioral Risks in Pregnancy

Low Birthweight

Infant Mortality

Poor Child Health and Development

Consequences for the Parents

Mothers

Fathers

PRECONCEPTION CARE

THE DEMOGRAPHIC IMPLICATIONS OF REDUCING UNINTENDED PREGNANCY

4 Patterns of Contraceptive Use

PATTERNS OF CONTRACEPTIVE USE AND UNINTENDED PREGNANCY

Unintended Pregnancy Among Women Using No Contraception (Group C)

Unintended Pregnancy Among Women Using Contraception (Groups A and B)

Contraceptive Sterilization.

Reversible Contraception

Current Choices Among Reversible Methods

Reversible Contraceptive Methods: Types and Trends

CONTRACEPTIVE USE AMONG MEN

Use of Male Methods of Contraception at First Intercourse

Use of Male Methods by Married Men

Age and Condom Use

Race, Ethnicity, and Condom Use

Socioeconomic Status and Condom Use

USE OF DUAL CONTRACEPTIVE METHODS

SEXUALLY TRANSMITTED DISEASES

5 Basic Requirements: Contraceptive Knowledge and Access

KNOWLEDGE, SKILLS, AND SCHOOL-BASED EDUCATION

Contraceptive Knowledge

Contraceptive Skills

School-Based Education and Information

ACCESS TO CONTRACEPTION

Data on Overall Access

Financial Barriers

Private Insurance

Health Maintenance Organizations

Public Sector Programs

Contraceptive Pricing

The Provider Base for Contraception

Bureaucratic Hurdles

MISSED OPPORTUNITIES

6 Personal and Interpersonal Determinants of Contraceptive Use

A COMMENT ON AVAILABLE DATA

UNDERLYING THEMES

SINGLE FACTOR INVESTIGATIONS

Personality Characteristics

Attitudes and Feelings About Sexuality and Fertility

Attitudes and Feelings About Contraceptive Methods

Substance Abuse, Peer Influences and Family Relationships

Alcohol and Substance Use

Parents and Peers

Partner and Couple Issues

7 Socioeconomic and Cultural Influences on Contraceptive Use

DIVERSITY IN U.S. CULTURE

Cultural and Ethnic Diversity

Religious and Political Diversity

CONFLICTING VIEWS ABOUT SEXUALITY

The Media

International Comparisons

ECONOMIC INFLUENCES ON FERTILITY

AFDC and Other Transfer Programs

Potential Influences

Empirical Findings

RACISM

Race, Welfare, and Birth Control

Genocide

VIOLENCE

GENDER BIAS

OPPOSITION TO ABORTION.

CONCLUSION

8 Programs to Reduce Unintended Pregnancy

NATIONAL PROGRAMS

LOCAL PROGRAMS

Historical Perspective

Program Search and Selection

Evaluated Programs

A Comment on Program Evaluation

Cost

Methodological Issues

Social Environment

CROSS-CUTTING THEMES

THE FISCAL IMPACT OF FAMILY PLANNING FUNDING

Program Reactions to Funding Withdrawal

Treatment of Mistimed and Unwanted Pregnancies

Program Eligibility Versus Participation

Incomplete Accounting for Public Revenue Effects

REFERENCES10

9 Conclusions and Recommendations

A NEW SOCIAL NORM

THE CAMPAIGN TO REDUCE UNINTENDED PREGNANCY

Campaign Goal 1: Improve knowledge about contraception, unintended pregnancy, and reproductive health.

Campaign Goal 2: Increase access to contraception.

Campaign Goal 3: Explicitly address the major roles that feelings, attitudes, and motivation play ...

Campaign Goal 4: Develop and scrupulously evaluate a variety of local programs to reduce unintende ...

Campaign Goal 5: Stimulate research to (a) develop new contraceptive methods for both men and wome ...

CAMPAIGN LEADERSHIP

Appendixes

A Commissioned and Contributed Papers

B The Political Storms over Family Planning: Supplement to Chapters 1 and 7

Historical Background

Conclusion

C The National Survey of Family Growth: Principal Source of Statistics on Unintended Pregnancy: Supplement to Chapter 2

Definitions and Measurement Issues

NSFG Plans for the Future

Improving Abortion Reporting

Clarifying Questions on Unwanted and Mistimed Pregnancies

Measuring Ambivalence about Pregnancy

Improving Questions on Unplanned Pregnancies and Use of Contraception

D Tables of Odds Ratios: Supplement to Chapter 3.

E Technical Notes on the Recalculation Exercise: Supplement to Chapter 3

Births Unwanted at Conception

Births Mistimed at Conception

F Summaries of Evaluated Programs: Supplement to Chapter 8

Community of Caring

Primary Reference:

Condom Mailing Program

Elmira Nurse Home Visiting Program

Primary References:

Facts and Feelings

Girls Incorporated Preventing Adolescent Pregnancy

Group Cognitive Behavior Curriculum

McCabe Center

New Chance

The Ounce of Prevention Fund's Parents Too Soon Program

Postponing Sexual Involvement

Project Redirection

Project Taking Charge

Reducing the Risk

Reproductive Health Screening of Male Adolescents

School/Community Program for Sexual Risk Reduction Among Teens

Self Center

Six School-Based Clinics

St. Paul School-Based Health Clinics

Success Express

Summer Training and Education Program

Teenage Parent Demonstration

Teen Outreach Program

Teen Talk

G Assessing Program Effectiveness and Cost-Effectiveness: Supplement to Chapter 8

Assessing Program Effectiveness

Assessing Cost-Effectiveness

Cost-Effectiveness in Family Planning

Dimensions of Cost-Effectiveness

Translating Service Statistics into Measures of Contraceptive Protection

Predicting Net Program Effects Without Individual Data

Estimating the Cost Functions

Conclusions.

REFERENCES

Index.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references and index.

ISBN:

0-309-17654-9

1-280-19330-1

9786610193301

0-309-55637-6

0-585-09841-7

OCLC:

923267653