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We examine whether changes in U.S. pregnancy, birth, and abortion rates between 2009 and 2015 reflect underlying change in the incidence of pregnancies classified by retrospectively reported pregnancy desires: pregnancies reported as having occurred at about the right time, later than wanted, too soon, or not wanted at all, and those for which individuals expressed other feelings, including uncertainty, ambivalence, or indifference. We calculate the proportionate distributions of these pregnancies and rates among U.S. women aged 15–44, as well as change over time, overall and among age groups. Characterization of desires for a past pregnancy shifted in a number of ways between 2009 and 2015, and changes across age groups were not uniform. Rates of pregnancies reported as occurring later than wanted increased among older women, while rates of pregnancies reported as occurring too soon decreased among all women. These findings shed light on previous research documenting an increasing age at first birth, increasing rates of pregnancy and childbearing among the oldest age groups, and changes in patterns of contraceptive use, particularly among young women. Our analysis explores limitations and challenges of two major sources of data on pregnancies in the United States and their measures of retrospectively reported pregnancy desires.

Introduction The impact on research findings that use pregnancy data from surveys with underreported abortions is not well-established. We estimate the percent of all pregnancies missing from women’s self-reported pregnancy histories because of abortion underreporting. Methods We obtained abortion and fetal loss data from the 2006–2015 National Survey of Family Growth (NSFG), annual counts of births from US vital statistics, and external abortion counts from the Guttmacher Institute. We estimated the completeness of abortion reporting in the NSFG as compared to the external counts, the proportion of pregnancies resolving in abortion, and the proportion of pregnancies missing in the NSFG due to missing abortions. Each measure was examined overall and by age, race/ethnicity, union status, and survey period. Results Fewer than half of abortions (40%, 95% CI 36–44) that occurred in the five calendar years preceding respondents’ interviews were reported in the NSFG. In 2006–2015, 18% of pregnancies resolved in abortion, with significant variation across demographic groups. Nearly 11% of pregnancies (95% CI 10–11) were missing from the 2006–2015 NSFG due to abortion underreporting. The extent of missing pregnancies varied across demographic groups and was highest among Black women and unmarried women (18% each); differences reflect both the patterns of abortion underreporting and the share of pregnancies ending in abortion. Discussion Incomplete reporting of pregnancy remains a fundamental shortcoming to the study of US fertility-related experiences. Efforts to improve abortion reporting are needed to strengthen the quality of pregnancy data to support maternal, child, and reproductive health research.

Despite its frequency, abortion remains a highly sensitive, stigmatized, and difficult-to-measure behavior. We present estimates of abortion underreporting for three of the most commonly used national fertility surveys in the United States: the National Survey of Family Growth, the National Longitudinal Survey of Youth 1997, and the National Longitudinal Study of Adolescent to Adult Health. Numbers of abortions reported in each survey were compared with external abortion counts obtained from a census of all U.S. abortion providers, with adjustments for comparable respondent ages and periods of each data source. We examined the influence of survey design factors, including survey mode, sampling frame, and length of recall, on abortion underreporting. We used Monte Carlo simulations to estimate potential measurement biases in relationships between abortion and other variables. Underreporting of abortion in the United States compromises the ability to study abortion—and, consequently, almost any pregnancy-related experience—using national fertility surveys. Electronic supplementary material The online version of this article (10.1007/s13524-020-00886-4) contains supplementary material, which is available to authorized users.

Objectives The Pregnancy Risk Assessment Monitoring System (PRAMS), conducted by the Centers for Disease Control and Prevention in collaboration with state health departments, is the largest state-level surveillance system that includes a question on the intention status of pregnancies leading to live birth. In 2012, the question was changed to include an additional response option describing uncertainty before the pregnancy about the desire for pregnancy. This analysis investigated how this additional response option affected women’s responses. Methods We used the change in the pregnancy intention question in 2012 as a natural experiment, taking advantage of relatively stable distributions of pregnancy intentions during short periods of time in states. Using PRAMS data from 2009-2014 (N = 222 781), we used a regression discontinuity-in-time design to test for differences in the proportion of women choosing each response option in the periods before and after the question change. Results During 2012-2014, 13%-15% of women chose the new response option, “I wasn’t sure what I wanted.” The addition of the new response option substantially affected distributions of pregnancy intentions, drawing responses away from all answer choices except “I wanted to be pregnant then.” Effects were not uniform across age, parity, or race/ethnicity or across states. Conclusions These effects could influence estimated levels and trends of the proportion of births that are characterized as intended, mistimed, or unwanted, as well as estimates of differences between demographic groups. These findings will help to inform new strategies for measuring pregnancy and childbearing desires among women.

Key Points In almost all U.S. states, pregnancies reported as occurring at the right time or being wanted sooner than they occurred comprised the largest share of pregnancies in 2017, though proportions varied widely by state. The proportion of pregnancies that were wanted later or unwanted was higher in the South and Northeast than in other regions, and the proportion of pregnancies that occurred at the right time or were wanted sooner was higher in the West and Midwest. From 2012 to 2017, the wanted-later-or-unwanted pregnancy rate fell in the majority of states. However, no clear pattern emerged for any changes in the rate of pregnancies that were reported as wanted then or sooner or in the rate of those for which individuals expressed uncertainty.

CONTEXT Contraceptive failure rates measure a woman's probability of becoming pregnant while using a contraceptive. Information about these rates enables couples to make informed contraceptive choices. Failure rates were last estimated for 2002, and social and economic changes that have occurred since then necessitate a reestimation. METHODS To estimate failure rates for the most commonly used reversible methods in the United States, data from the 2006–2010 National Survey of Family Growth were used; some 15,728 contraceptive use intervals, contributed by 6,683 women, were analyzed. Data from the Guttmacher Institute's 2008 Abortion Patient Survey were used to adjust for abortion underreporting. Kaplan-Meier methods were used to estimate the associated single-decrement probability of failure by duration of use. Failure rates were compared with those from 1995 and 2002. RESULTS Long-acting reversible contraceptives (the IUD and the implant) had the lowest failure rates of all methods (1%), while condoms and withdrawal carried the highest probabilities of failure (13% and 20%, respectively). However, the failure rate for the condom had declined significantly since 1995 (from 18%), as had the failure rate for all hormonal methods combined (from 8% to 6%). The failure rate for all reversible methods combined declined from 12% in 2002 to 10% in 2006–2010. CONCLUSIONS These broad-based declines in failure rates reverse a long-term pattern of minimal change. Future research should explore what lies behind these trends, as well as possibilities for further improvements.

Births resulting from an unintended pregnancy affect individuals differentially, and some may experience more negative consequences than others. In this study, we sought to describe the mechanisms through which the severity of effects may be mitigated or exacerbated. We conducted in-depth interviews with 35 women and 30 men, all with a youngest child born resulting from an unintended pregnancy, in two urban sites in the United States. Respondents described both negative and positive effects of the child's birth in the areas of school; work and finances; partner relationships; personal health and outlook on life trajectories. Mechanisms through which unintended pregnancies mitigated or exacerbated certain effects fell at the individual (e.g. lifestyle modification), interpersonal (e.g. partner support) and structural (e.g. workplace flexibility) levels. These qualitative findings deepen understanding of the impact of unintended childbearing on the lives of women, men and families.

An expanding body of research has investigated factors that influence fathers' involvement with their children. Generally overlooked has been the role of pregnancy intentions on men's fathering behaviors. In this study, the authors used nationally representative data from men interviewed in the 2002 and 2006-2010 National Survey of Family Growth to examine relationships between fathers' pregnancy intentions and multiple aspects of their parental involvement. Using propensity score methods to control for confounding, they found that men were less likely to live with a young child from a mistimed than intended pregnancy and that among nonresident fathers, mistimed pregnancies were associated with lower levels of visitation and consequently reduced participation in caregiving and play. Among both resident and nonresident fathers, mistimed pregnancies were also associated with lower self-appraisals of fathering quality when compared with intended pregnancies; for nonresident fathers, however, this association was moderated by other involvement.

Objective To compare, at the community level, the cost-effectiveness of oxytocin and misoprostol for the prevention of postpartum hemorrhage (PPH). Methods The present cost-effectiveness study used data collected during a randomized trial that compared the prophylactic effectiveness of misoprostol and oxytocin for the prevention of PPH in a rural setting in Senegal between June 6 and September 21 2013. The two interventions were compared, with referral to a higher level facility owing to PPH being the outcome measure. The costs and effects were calculated for two hypothetical cohorts of patients delivering during a 1-year period, with each cohort receiving one intervention. A comparison with a third hypothetical cohort receiving the current standard of care was included. A sensitivity analysis was performed to estimate the impact of variations in model assumptions. Results The cost per PPH referral averted was US$ 38.96 for misoprostol and US$ 119.15 for oxytocin. In all the scenarios modeled the misoprostol intervention dominated, except in the worst-case scenario, where the oxytocin intervention demonstrated slightly better cost-effectiveness. Conclusion The use of misoprostol for PPH prophylaxis could be cost effective and improve maternal outcomes in low-income settings.

An expanding body of research has investigated factors that influence fathers’ involvement with their children. Generally overlooked has been the role of pregnancy intentions on men’s fathering behaviors. In this study, the authors used nationally representative data from men interviewed in the 2002 and 2006–2010 National Survey of Family Growth to examine relationships between fathers’ pregnancy intentions and multiple aspects of their parental involvement. Using propensity score methods to control for confounding, they found that men were less likely to live with a young child from a mistimed than intended pregnancy and that among nonresident fathers, mistimed pregnancies were associated with lower levels of visitation and consequently reduced participation in caregiving and play. Among both resident and nonresident fathers, mistimed pregnancies were also associated with lower self-appraisals of fathering quality when compared with intended pregnancies; for nonresident fathers, however, this association was moderated by other involvement.

The premise that unintended childbearing has significant negative effects on the behavior of mothers and on the health of infants strongly influences public health policy and much of current research on reproductive behaviors. Yet, the evidence base presents mixed findings. Using data from the U.S. National Survey of Family Growth, we employ a measure of pregnancy intentions that incorporates the extent of mistiming, as well as the desire scale developed by Santelli et al. (Studies in Family Planning, 40, 87–100, 2009). Second, we examine variation in the characteristics of mothers within intention status groups. Third, we account for the association of mothers’ background characteristics with their pregnancy intentions and with the outcomes by employing propensity score weighting. We find that weighting eliminated statistical significance of many observed associations of intention status with maternal behaviors and birth outcomes, but not all. Mistimed and unwanted births were still less likely to be recognized early in pregnancy than intended ones. Fewer unwanted births received early prenatal care or were breast-fed, and unwanted births were also more likely than intended births to be of low birth weight. Relative to births at the highest level of the desire scale, all other births were significantly less likely to be recognized early in pregnancy and to receive early prenatal care.

While recently there have been renewed interest in women's childbearing intentions, the authors sought to bring needed research attention to understanding men's childbearing intentions. Nationally representative data from the 2006-2010 National Survey of Family Growth (NSFG) was used to examine pregnancy intentions and happiness for all births reported by men in the 5 years preceding the interview. We used bivariate statistical tests of associations between intention status, happiness about the pregnancy, and fathers' demographic characteristics, including joint race/ethnicity and union status subgroups. Multivariate logistic regressions were used to calculate adjusted odds ratios of a birth being intended, estimated separately by father's union status at birth. Using comparable data and measures from the male and female NSFG surveys, we tested for gender differences intentions and happiness, and examined the sensitivity of our results to potential underreporting of births by men. Nearly four out of ten of births to men were reported as unintended, with significant variation by men's demographic traits. Non-marital childbearing was more likely to be intended among Hispanic and black men. Sixty-two percent of births received a 10 on the happiness scale. Happiness about the pregnancy varied significantly by intention status. Men were significantly happier than women about the pregnancies, with no significant difference in intention status. Potential underreporting of births by men had little impact on these patterns. This study brings needed focus to men's childbearing intentions and improves our understanding of the context of their role as fathers. Men need to be included in strategies to prevent unintended pregnancy.

CONTEXT: Newly available data show large differences in rates of unintended pregnancy across states. Because key policy and program decisions that could affect these rates are made by state governments it is important to assess whether characteristics of the states are associated with this variation. METHODS: Regression analysis was used to assess the relationship between the variation in state unintended pregnancy rates in 2006 and state-level aggregate measures of demographic composition socioeconomic conditions contraceptive use and funding of and access to family planning services. RESULTS: State unintended pregnancy rates were positively associated with the proportion of resident women who were black or Hispanic. However these associations were almost entirely accounted for by differences in the age and marital status of women the proportion without health insurance and the proportion receiving Medicaid. In addition these last two measures were strongly associated with state unintended pregnancy rates after the other measures were controlled for: An increase in the proportion of women uninsured was associated with elevated unintended pregnancy rates and an increase in the proportion receiving Medicaid coverage was associated with reduced rates. CONCLUSIONS: State programs and policies should pay particular attention to increasing support for family planning services for minority groups. Findings also suggest that insurance coverage and receipt of Medicaid among women of reproductive age deserve further exploration as potentially important mechanisms for reducing state unintended pregnancy rates. Copyright (c) 2012 by the Guttmacher Institute.

OBJECTIVE: To examine characteristics of U.S. women that are associated with use of long-acting reversible contraception and changes in these characteristics between 2002 and 2006-2008. METHODS: We analyzed data from two nationally representative samples of women aged 15-44 in the National Survey of Family Growth including 7643 women in 2002 and 7356 women in 2006-2008. We conducted simple and multinomial logistic regression analyses to identify demographic and reproductive health characteristics associated with use of long-acting reversible contraception. RESULTS: Long-acting reversible contraception (intrauterine devices and subdermal implants) use among U.S. women using contraception increased from 2.4% in 2002 to 5.6% in 2006-2008. The largest increases in long-acting reversible contraception use during this time occurred among the youngest and oldest age groups non-Hispanic white and non-Hispanic African American women foreign-born women and those in the highest income group. High prevalence of long-acting reversible contraception use in 2006-2008 was seen among women who had given birth once or twice (10%) foreign-born women (8.8%) and Hispanic women (8.4%). After adjusting for key demographic and reproductive health characteristics in comparison with users of other contraceptive methods and with those not using contraception who were at risk for unintended pregnancy foreign-born women and women who experienced coitarche before age 18 were approximately twice as likely to be using long-acting reversible contraception as women without those characteristics. CONCLUSION: A more diverse population of women used long-acting reversible contraception in 2006-2008 compared with 2002. However there is likely more potential for increased uptake especially among populations historically not considered to be candidates for these methods.

CONTEXT: Births resulting from unintended pregnancies are associated with substantial maternity and infant care costs to the federal and state governments; these costs have never been estimated at the national and state levels. METHODS: The proportions of births paid for by public insurance programs in 2006 were estimated by pregnancy intention status using data from the Pregnancy Risk Assessment Monitoring System and similar state surveys or were predicted by multivariate linear regression. Public costs were calculated using state-level estimates of the number of births by intention status and of the cost of a publicly funded birth. RESULTS: In 2006 64% of births resulting from unintended pregnancies were publicly funded compared with 48% of all births and 35% of births resulting from intended pregnancies. The proportion of births resulting from unintended pregnancies that were publicly funded varied by state from 42% to 81%. Of the 2.0 million publicly funded births 51% resulted from unintended pregnancies accounting for $11.1 billion in costs-half of the total public expenditures on births. In seven states the costs for births from unintended pregnancies exceeded a half billion dollars. CONCLUSIONS: Public insurance programs are central in assisting American families in affording pregnancy and childbirth; however they pay for a disproportionately high number of births resulting from unintended pregnancy. The resulting budgetary impact warrants increased public efforts to reduce unintended pregnancy. Copyright (c) 2011 by the Guttmacher Institute.

Objective. This article assesses the comparability of contraceptive use estimates for adult women obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS), using the 2002 National Survey of Family Growth (NSFG) as a benchmark. The 2002 BRFSS uses data collection methods that are considerably different from the NSFG. Method. We compared demographic differences and national estimates of current contraceptive methods being used and reasons for nonuse. Variables were recoded in the BRFSS and NSFG systems to make the two samples comparable. Results. Women in the NSFG and BRFSS were similar in age and race/ethnicity. Compared with the NSFG, the BRFSS sample was more educated and of higher income, less likely to be cohabiting, and more likely to be married. After adjusting for differences in the coding of hysterectomy, many BRFSS estimates for current contraceptive use were statistically similar to those from the NSFG. Small but statistically significant differences were found for vasectomy (7.7% and 6.3%), the pill (21.9% and 19.6%), rhythm (1.5% and 1.0%), the diaphragm (0.5% and 0.2%), and withdrawal (0.3% and 2.7%) for the BRFSS and NSFG, respectively. Major reasons for nonuse were similar: seeking pregnancy and currently pregnant. The percentage of women who were not currently sexually active was higher in the BRFSS (16.0%) compared with the NSFG (12.5%). Conclusions. The BRFSS is a useful source of population-based data on contraceptive use for reproductive health program planning; however, planners should be cognizant that lower-income women are not fully represented in telephone surveys.

Underreporting of induced abortions in surveys is widespread, both in countries where the procedure is illegal or highly restricted and in those where it is legal. In this study, we find that fewer than one half of induced abortions performed in the United States in 1997-2001 (47 percent) were reported by women during face-to-face interviews in the 2002 National Survey of Family Growth (NSFG). Hispanic and black women and those with low income were among the least likely to report their experience of abortion. Women were also less likely to report abortions that occurred when they were in their 20s. Second-trimester abortions were more likely to be reported than first-trimester terminations. The levels of recent spontaneous abortion reported in the 2002 NSFG were consistent with the accumulated body of clinical research, although substantially more lifetime pregnancy losses were reported on self-administered surveys than in face-to-face interviews. Subsequent research should explore strategies to improve information collected on abortion, and, in the interim, research involving pregnancy outcomes should be adjusted for unreported induced abortions.

Better understanding of the impact of unintended childbearing on infant and early childhood health is needed for public health practice and policy. Data from the 2004–2008 Oklahoma Pregnancy Risk Assessment Monitoring System survey and The Oklahoma Toddler Survey 2006–2010 were used to examine associations between a four category measure of pregnancy intentions (intended, mistimed

CONTEXT: Unintended pregnancy is a key reproductive health indicator but rates have never been calculated for all 50 states. METHODS: State-level estimates of unintended pregnancy rates in 2006 were calculated using data from several sources. The proportion of births resulting from unintended pregnancies was obtained from the Pregnancy Risk Assessment Monitoring System and similar state surveys and the intention status of pregnancies ending in abortion from a national survey of abortion patients. These proportions were applied to birth and abortion counts for each state and fetal losses were estimated. Rates of unintended pregnancy were obtained by dividing relevant figures by the number of women aged 15-44 in each state. Six states and the District of Columbia had no appropriate survey data; their rates were predicted using multivariate linear regression. RESULTS: In 2006 the median state unintended pregnancy rate was 51 per 1000 women aged 15-44. Most rates fell within a range of 40-65 unintended pregnancies per 1000 women. The highest rate was in Mississippi (69); the lowest rate was in New Hampshire (36). Rates were generally highest in the South and Southwest and in states with large urban populations. In 29 states and the District of Columbia more than half of pregnancies were unintended; in nine a consistent upward trend in unintended pregnancy rates between 2002 and 2006 was apparent; no state had a consistent decline. CONCLUSIONS: These rates provide benchmarks for measuring the impact on unintended pregnancy of state policies and practices such as those governing sex education and the funding of contraceptive services. Copyright (c) 2011 by the Guttmacher Institute.

Studies of infant and child mortality have evolved to distinguish between two sets of explanatory variables-factors related to reproductive or maternal characteristics and socioeconomic factors, generally described as characteristics of the family or household. Almost all multivariate analyses include variables from each of these two sets, but there has been little consideration of the relationship between them. We examine how these two sets of variables jointly affect mortality. We test first for confounded effects by examining socioeconomic effects while excluding and then including reproductive variables in nested multivariate models. Next, we look for age-dependent effects among the explanatory variables and find that reproductive and socioeconomic factors affect mortality at differing ages of children. Finally, we examine interactive effects of the two sets of variables. We conclude that the higher mortality observed among the low status groups is not a result of greater concentration of poor reproductive patterns in those groups. Instead, higher status groups probably have more resources available for combating the negative effects of the same high-risk reproductive patterns.Data on 9185 births that occurred between 1958-73 in 26 villages in Ludhiana District in Punjab state, India were analyzed to determine how reproductive and socioeconomic factors influence child mortality. Specifically confounded, interactive, and age-dependent effects were examined. Overall, only reproductive factors were associated with neonatal mortality. These factors included maternal age (p.05 for 20 year old mothers and p.1 for 35 year old mothers) and =or 15 month birth interval (p.05). =or 15 month birth interval also affected 2-6 month old mortality (p.05) as well as mother's education ([.05). The socioeconomic factors of being a girl (p.05), lower caste Sikh (p.05), and having a low income (p.05) were all positively associated with child mortality beginning at 7 months. The nutrition, medical, and family planning interventions of the Narangwal project (1968-74) improved child survival for only =or 7 month old children born during or after 1963 (p.05). 0-36 month old children born to mothers with no education were less likely to surmount the negative effects related to a young mother, high birth order, short previous birth intervals, and a previous sibling death (p.05). The low status groups were just as likely to exhibit poor reproductive patterns as were the high status groups, but the low status groups tended to experience higher mortality because they did not have access to the resources needed to over come the negative effects of the same high risk reproductive patterns as did the high status groups.

The US abortion rate peaked soon after 1973, remained fairly constant through the 1980s, and began a steady decline to 2005. A substantial drop in the abortion rates of teenagers and women ages 20 to 24 accounts for much of the decline from 1989 to 2004. All race and ethnic groups experienced declines in abortion rates over the past 30 years, but the rate of black, and to a lesser extent Hispanic, women remains higher than that of non-Hispanic whites. The number of abortion providers has declined in recent decades, but the introduction of early medical abortion may have slowed this trend.

Background Discontinuation of contraceptive use that is not immediately followed by resumption of use of another method while a woman is at risk is a common cause of unintended pregnancy. Study design We provide new estimates of discontinuation for the pill, injectable, male condom, withdrawal and fertility-awareness–based methods, and identify socioeconomic characteristics associated with discontinuation for the pill, male condom and withdrawal. We provide new estimates of resumption of use by prior method used and identify socioeconomic characteristics associated with resumption of use. Estimates are obtained using the 2002 National Survey of Family Growth, supplemented by the 2001 Abortion Patient Survey to correct for underreporting of abortion. Results The fraction of method use segments discontinued for method-related reasons within 1 year was highest for the male condom (57%), withdrawal (54%) and fertility-awareness–based methods (53%), and lowest for the pill (33%), with the injectable in-between (44%). However, contraception was abandoned altogether in only 25% of cases. The probability of resuming use of a contraceptive was 72% in the initial month of exposure to the risk of an unintended pregnancy; this rose to 76% by the third month. Conclusion The risk of discontinuation of use of reversible methods of contraception for method-related reasons, including a change of method, is very high, but fortunately the risk of abandoning use of contraception altogether is far lower, and most spells of exposure to risk of an unintended pregnancy following discontinuation are protected from the start by a switch to another method.

Simulation models were used to compare the health consequences of birth control methods currently relied on by American women with those of using no method. The incidence of morbidity and mortality related to unintended pregnancies, live births, abortions, upper genital tract infections, tubal infertility, cardiovascular disease and reproductive cancers were estimated for hypothetical cohorts of 100,000 women aged 15-44. Women who never use any method and who never have an abortion would have an average of 18 births during their reproductive lifetime, compared with no more than five among women using any of the available birth control methods. Consequently, use of any method prevents more deaths from pregnancy and childbirth than are associated with method use. The proportion of women who would become infertile--estimated by taking into account the likelihood of developing upper genital tract infections and the probability that any pregnancies that occurred would be ectopic--is reduced substantially if women at low risk of sexually transmitted diseases use any method and if women at high risk use oral contraceptives or barrier and spermicide methods. Oral contraceptive use has a relatively small, independent effect on the risk of cardiovascular diseases, but it greatly augments that risk in combination with smoking and increased age. When ovarian, endometrial and breast cancers are considered together, there will be approximately 110 fewer diagnoses of these three cancers per 100,000 ever-users of the pill aged 15-54 than among 100,000 never-users; furthermore, prior to age 45, 100,000 ever-users will experience 10 fewer deaths from ovarian or endometrial cancers than never-users of the pill.(ABSTRACT TRUNCATED AT 250 WORDS)This study compares the risks of pregnancy, infertility, heart disease, cancer, and death associated with various contraceptive methods with the risks faced by women using no method. Estimated risks are derived from a decision-tree analysis program for a hypothetical cohort of 100,000 women. Method-specific estimates of the probability of various outcomes were obtained from published reports. Low estimates of typical use, first-year failure rates were used in the models. Tabulated data reveal that women who use no contraceptive method throughout their reproductive life (aged 15-44) and never have an abortion would have 18 births as compared to no more than five for women who use any contraceptive method. Data were also tabulated for the method-specific risks of developing upper genital tract infections, ectopic pregnancies, and tubal infertility (caused by the acquisition of a sexually transmitted disease [STD]) were calculated with method differences modeled for women at high and at low risk of acquiring a STD. The third table shows the estimated annual number of deaths per 100,000 ectopic pregnancies, live births, and induced abortions by five-year age groups. The annual pregnancy-related and method-related mortality rates per 100,000 women at risk of unintended pregnancy and at low risk of STDs was also calculated by contraceptive method. The fifth table illustrates the estimated annual incidence of and number of deaths from cardiovascular diseases per 100,000 women by smoking status, age group, and use of nonuse of oral contraceptives. OC use is also compared in a determination of the estimated annual number of ovarian, endometrial, and breast cancers diagnosed per 100,000 women by age at diagnosis. Finally, estimated deaths averted by each age group annually per 100,000 were calculated for current users of barrier and spermicide methods and of OCs and for ever-users before age 45. The conclusions drawn from these comparisons are that each contraceptive method presents different combinations of risks and benefits to women at different stages of their lives. Engaging in multiple sexual relationships, smoking, and irregular or incorrect method use are the three factors which most compromise a woman's ability to reach her reproductive and health goals.

This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.Previous estimates of 1st-year probabilities of contraceptive failure for all contraceptive methods are updated. Estimates are given for typical use (both incorrect and inconsistent use) and perfect use (correct use at every intercourse). The difference between these 2 probabilities gives a measure of how "forgiving of imperfect use" each contraceptive method is. The revisions were done because new studies "provide the 1st estimates of failure during perfect use" for the cervical cap and periodic abstinence, more complete implant evaluations are available , and the Copper T 380A (TCu 380A) is now on the US market. Other IUDs have disappeared from the same market. The previous estimate of the probability of getting pregnant while depending only on chance should be revised downward a little. The lowest expected typical, and lowest reported failure rates during the 1st year of use of many contraceptive methods and 1st-year continuation rates are given for the IUD. The estimate for "parous sponge users" has been upwardly revised. The final estimate of spermicide rates is 3%. The efficacy of the ovulation method (OM) of periodic abstinence is quite high, but the method is very unforgiving of less than perfect use. The estimates of the probability of failure of the newer methods, of sexual abstinence, symptothermal and postovulation, have been lowered. Clinical trials of implants have shown higher efficacy. Only 2 IUDs are available in the US--the TCu 380A and Progestasert. These have greater efficacy that the IUDs that were available. 1st-year failure probabilities should be revised downward. The estimate of the proportion of women who would get pregnant during 1 year of unprotected intercourse is questioned. In the National Survey of Family Growth only 43.1% of the married women who said they didn't want to get pregnant but reported no contraceptive use, did get pregnant within the 1st year. The probability estimate could be lowered from 89% to 85%.

The hypothesis that womens behaviors during pregnancy that have the potential to influence their babys health are influenced by their attitudes toward the pregnancy was examined through use of data from two US surveys: the 1988 National Maternal and Infant Health Survey (n = 9122 births) and the 1988 National Survey of Family Growth (n = 2586 births). Specifically it was explored whether women with unintended (mistimed or unwanted) pregnancies make less use of prenatal care services and conform less closely to recommended practices such as those related to smoking and weight gain than women with planned pregnancies independent of their social and demographic characteristics. Multivariate analysis indicated women with planned pregnancies were 12 percentage points more likely than women with unintended births to recognize their pregnancy in the first 6 weeks 16 percentage points more likely to have initiated prenatal care in the first 8 weeks and 8 percentage points more likely to have adhered to medical advice to quit smoking. Once the effects of social and demographic factors were controlled these differences were reduced by 49% 46% and 32% respectively. Contrary to expectations once prenatal care was initiated women with an unintended pregnancy were as likely to meet the recommended number of visits reduce alcohol consumption take vitamins and gain weight per advice as women with a planned pregnancy. These results indicate a need to pay attention to social and demographic factors that contribute to late recognition of pregnancy delayed entry into prenatal care and continued smoking during pregnancy as well as the wantedness of the pregnancy in the design of maternal-child health programs.

Results of a 1994-1995 national survey of 9,985 abortion patients reveal that women who live with a partner outside marriage or have no religious identification are 3.5-4.0 times as likely as women in the general population to have an abortion. Nonwhites, women aged 18-24, Hispanics, separated and never-married women, and those who have an annual income of less than +15,000 or who are enrolled in Medicaid are 1.6-2.2 times as likely to do so; residents of metropolitan counties have a slightly elevated likelihood of abortion. When age is controlled, women who have had a live birth are more likely to have an abortion than are those who have never had children. Catholics are as likely as women in the general population to have an abortion, while Protestants are only 69% as likely and Evangelical or born-again Christians are only 39% as likely. Since 1987, the proportion of abortions obtained by Hispanic women and the abortion rate among Hispanics relative to that for other ethnic groups have increased. The proportion of abortion patients who had been using a contraceptive during the month they became pregnant rose from 51% in 1987 to 58%. Nonuse is most common among women with low education and income, blacks, Hispanics, unemployed women and those who want more children. The proportion of abortion patients whose pregnancy is attributable to condom failure has increased from 15% to 32%, while the proportions reporting the failure of other barrier methods and spermicides have decreased.

The National Maternal and Infant Health Survey provides new data on the prevalence of unintended childbearing in the United States: Thirty-six percent of births in 1988 were mistimed and 7% were unwanted, while 57% were intended. Although the level of unintended childbearing is high in almost all socioeconomic subgroups of women, the proportion of births that were mistimed or unwanted was 50% or more among age-groups 15-17 (78%), 18-19 (68%) and 20-24 (50%), and among never-married women (73%), formerly married women (62%), black women (66%), women living below the federal poverty level (64%) or at 100-149% of the poverty level (52%), women with less than 12 years of education (58%) and women who already had two children (53%) or three or more children (60%). Multivariate analyses indicate that births to unmarried women--whether formerly married or never-married--are less likely than those to married women to be wanted and more likely to be mistimed. Poverty status has no independent effect on the odds that a birth is unwanted or on the odds that a birth to an unmarried woman is mistimed. Among currently married women, those who are poorer are more likely than women above 150% of the poverty level to have a mistimed birth. Black women are more likely than either Hispanic or white women to report a birth as unwanted and are more likely than white women to say a wanted birth was mistimed.

In 1986, the Demographic and Health Surveys project administered the first six-year calendar history of events that included women's contraceptive use and their reasons for discontinuation in experimental surveys in Peru and the Dominican Republic. In this report the experimental survey from Peru is examined to demonstrate how the calendar data can be used to calculate multiple increment-decrement life table rates of contraceptive discontinuation--including contraceptive failure, method switching, and abandonment of use--and of resumption of method use following discontinuation. These analyses reveal that nearly half of all Peruvian women who begin to use a method will stop using it within one year; 29 percent of women discontinue method use for nonpregnancy-related reasons within one year of initiating use. Women who switch methods do so frequently, and many will return to a method used previously, or move on to a third method. Women who become pregnant after abandoning contraceptive use have similar contraceptive-use patterns to women who experience a contraceptive failure.An analysis of calendar data from January 1981 to interview date in 1986 (Demographic and Health Survey) on 1065 ever married Peruvian women who had ever used a contraceptive was used to show how researcher can use these data to calculate multiple increment-decrement life table rates of contraceptive discontinuation and renewed method use after discontinuation. 46.4% of women discontinued a method within 1 year. 29% discontinued a method for nonpregnancy related reasons within 1 year of use. Women who stopped using a method were more likely to switch directly to another method than not use any method. The risk of unplanned pregnancy was therefore low for these women. Women who discontinued use of a method but not switch directly to another method likely ceased having sexual intercourse, while others either ran out of supplies, were dissatisfied with the method, or could not find acceptable alternative methods. Regardless of the reason for not switching to another method after discontinuation, these women were at an increased risk of unplanned pregnancy. Women who discontinued a method and did not directly switch to another method were just as likely to return to the abandoned method as they were to switch to another method, but were likely to become pregnant before they returned to the abandoned method or switched to another method. Contraceptive use patterns of such pregnant women matched those of women whose contraceptives failed. Both groups of women tended to return to the method that failed. The considerable amount of method switching in a population may demonstrate either that women profit from a wide range of contraceptive choices or they cannot easily obtain and are not satisfied with currently available contraceptives. Since Peru had one of the weakest family planning programs in Latin America during the 1980s, the latter 2 reasons were most likely the case.

In a 1991 study based on a nationally representative sample of more than 1,500 unmarried minors having an abortion, 61% of the respondents said that one or both of their parents (usually the mother) knew about the abortion. Only 26% of the respondents said their father knew about the abortion; furthermore, 57% of the mothers who knew about their daughter's pregnancy did not tell her father. In this study, which was conducted in states without parental involvement laws in effect, about 75% of the parents who knew about the pregnancy had been told by the daughter herself, and the great majority supported their daughter's decision to have an abortion. Among the minors whose parents found out without being told by the minor, 18% said their parents were forcing them to have an abortion and 6% reported physical violence, being forced to leave home or damage to their parents' health. Minors who did not tell their parents were disproportionately older (aged 16 or 17), white and employed. The minors' most common reasons for not telling their parents were wanting to preserve their relationship with their parents and wanting to protect the parents from stress and conflict. Of those who did not tell their parents, 30% had experienced violence in their family, feared that violence would occur or were afraid of being forced to leave home. Among minors whose parents were unaware of the pregnancy, all consulted someone other than clinic staff about the abortion; most frequently, they consulted their boyfriend (89%), an adult (52%) or a professional (22%).

SummaryContraceptive use and method mix were analysed using Philippines national survey data of 1973, 1978, and 1983. The analyses suggest that the reported decline in contraceptive prevalence between 1978 and 1983 was due to under-reporting of use in 1973 and 1983. The shifts in contraceptive method mix were also partly from under-reporting of rhythm and other methods in 1973 and 1983. Nevertheless, the determinants of method choice were similar in all three sets of data. Filipino couples were making rational choices in terms of their contraceptive goals, access, evaluation, and competence. Modifications in the directions and magnitude of the relationships in determining method choice also occurred, partly reflecting the increased use of sterilization by older, higher parity women.

This paper provides a critical review of the extensive literature on contraceptive failure. The substantive focus is on contraceptive efficacy in developed countries primarily the US. The discussion is divided into 5 main sections. In the 1st section the authors consider various concepts of contraceptive effectiveness and their measurement. In the 2nd part they examine the problem of experimental design focusing attention on methodological pitfalls particularly various forms of selection bias that snare many investigators and compromise their findings. The 3rd section provides a review organized by method of published studies of contraceptive failure. In the 4th section the authors use the results of the previous sections to construct a comparable set of failure and continuation rates; the emphasis here is on the efficacy information women (or couples) need to make an informed choice of method. The authors conclude with a set of recommendations to guide future research. (authors)