Guttmacher Institute Research Articles

The Consequences of Abortion and Contraception Policies on Young Women's Reproductive Choices, Schooling and Labor Supply

I specify a dynamic life-cycle model of abortion, contraceptive use, schooling, and labor supply decisions of US women. I structurally estimate the model, allowing for abortion misreporting, using data from the NLSY97, aggregate abortion provider data from the Guttmacher Institute, and information on mandatory counseling restrictions at the state level. I simulate a series of policies and find that eliminating access to abortion services increases contraceptive use but decreases women’s schooling and lifetime earnings. I also find that providing free contraception would increase contraceptive use and decrease abortion rates substantially, while also leading to an increase in women’s schooling.

Career Adaptability, Resiliency and Perceived Obstacles to Career Development of Adolescent Mothers

Career adaptability, resiliency and perceived obstacles to career development of adolescent mothers were examined using a proposed conceptual framework that combined resiliency and career adaptability. The goals of this study were to gauge the current state of the career development and resiliency of adolescent mothers, including areas of strength and weakness, and to better understand the interactions between the three components of career adaptability (i.e., planfulness, exploration, decision-making), resiliency and perceived obstacles. Adolescent mothers were similar to nonparenting peers on the planfulness and decision-making dimensions of career adaptability, yet lower on career exploration. While adolescent mothers' traits of personal resiliency and emotional reactivity were comparable to those of their peers, their relational resiliency was lower. Based on the findings of the study, proposed strategies to further the three components of career adaptability and the resiliency of adolescent mothers are suggested.Keywords: adolescent mothers, career development, career adaptability, resiliency, decision-makingIn the United States, becoming a parent during adolescence has been described as a premature and nonnormative life event that can present lifelong challenges and growth opportunities in the career development of adolescent mothers (Gruber, 2012; Zachry, 2005). Taylor (2009) reported the most prevalent negative outcomes associated with adolescent parenthood as lowered high school graduation rates, limited educational opportunities after high school, and difficulty achieving stable work and financial independence. These are important career development considerations for this population given the national statistics on adolescent motherhood, previous research findings on the impact of parenting programs on the long-term career outcomes for adolescent mothers, and the viability of the proposed theoretical framework of the integration of career adaptability and resiliency (Barto, Lambert, & Brott, in press).The national statistics on adolescent mothers indicate a disparity between racial groups with 8.3% of Latina, 6.5% of African American and 2.7% of Caucasian (non-Hispanic) adolescent females becoming mothers (Guttmacher Institute, 2010). Race and ethnicity may influence how an adolescent pregnancy is perceived by the adolescent mother and those around her, further contributing to the mother's obstacles to and opportunities for career development (McAdoo, 2007; Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002). Support from families has been shown to be a positive factor in furthering the career development of adolescent mothers (Brosh, Weigel, & Evans, 2009). Although both African American and Latino families may be disappointed by adolescent pregnancies, these families tend to discourage pregnancy termination or adoption, instead offering assistance to adolescent mothers (McAdoo, 2007; Santiago-Rivera et al, 2002). Conversely, Caucasian adolescent mothers have the highest rates of formal adoptions outside the family; thus, family support for attempting to combine motherhood and career development may be lower for Caucasian adolescent mothers than for adolescent mothers in other racial or ethnic groups (Low, Moely, & Willis, 1989).Adolescent mothers typically report more challenges with life planning when compared to nonparenting peers (Spear, 2004). Related issues can be viewed through the lens of obstacles to and opportunities for career development for adolescent mothers. These obstacles may include completing an education, finding employment and experiencing increased financial strain. Conversely, becoming a mother during adolescence may stimulate resiliency and growth opportunities in the working role (Zachry, 2005). These opportunities could foster the desire to provide financially for self and child, positive attitudes toward the future after becoming a mother (Brubaker & Wright, 2006), and a greater sense of maturity and purpose about the future (Rosengard, Pollock, Weitzen, Meers, & Phipps, 2006). …

Atualização das estimativas da magnitude do aborto induzido, taxas por mil mulheres e razões por 100 nascimentos vivos do aborto induzido por faixa etária e grandes regiões. Brasil, 1995 a 2013

IntroductionEstimates of induced abortion in Brazil were inaccurate until the early 1990, varying between 300 million and 3.3 million clandestine abortions. In 2000, were estimated 22.3 abortions induced by 1000 women in Brazil, using the methodology proposed by the Alan Guttmacher Institute. ObjectiveUpdate estimates of induced abortion in Brazil during the period of 1995 to 2013. MethodThe primary data source was the number of hospitalizations for abortion registered in the Hospital Information System of the Unified Health System, disaggregated by region and age group. The number of induced abortions has been estimated by interval upper limit, multiplying by five the number of hospitalizations, and by lower bound, by multiplying by four the number of hospitalizations. It was considered under percentage record of 12.5% and the proportion of miscarriages of 25%. ResultsBetween 1995 and 2013, the hospitalizations of women from 10 to 49 years by complications from abortion decreased by 27% and the estimate of the annual number of induced abortions declined 26%. It was observed decline of upper limit of induced abortion ratio of 27/1000 women for 16/1000. The same was noticed for the lower bound of 21/12/1000 to 1000. In the two regions with the highest number of hospitalizations for complications of abortion, Northeast and Southeast, showed significant reduction in the number of cases of 35% and 27% respectively. Found a great reduction in the risk of induced abortion, of 43% between 15 and 29 years, 49% between 20 and 29 years old, 26% between 30 and 39 years and 50% of 40 to 49 years. The estimation of induced abortions decreased from 864,628 to 687,347 (lower limit), and from 1,086,708 to 865,160 (upper limit). ConclusionBoth the reason of abortion per 100 live births and the rate of induced abortions per thousand women aged 15 to 49 years in Brazil showed decrease in the studied period.

Induced abortions and unintended pregnancies in pakistan.

During the past decade, unmet need for family planning has remained high in Pakistan and gains in contraceptive prevalence have been small. Drawing upon data from a 2012 national study on postabortion-care complications and a methodology developed by the Guttmacher Institute for estimating abortion incidence, we estimate that there were 2.2 million abortions in Pakistan in 2012, an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 per 1,000 women in 2002. After taking into consideration the earlier study's underestimation of abortion incidence, we conclude that the abortion rate has likely increased substantially between 2002 and 2012. Varying contraceptive-use patterns and abortion rates are found among the provinces, with higher abortion rates in Baluchistan and Sindh than in Khyber Pakhtunkhwa and Punjab. This suggests that strategies for coping with the other wise uniformly high unintended pregnancy rates will differ among provinces. The need for an accelerated and fortified family planning program is greater than ever, as is the need to implement strategies to improve the quality and coverage of postabortion services.

Offline: Making it happen for women and girls

It was not a matter of forgetting. “There were forces within the UN that didn't want to include contraception.” Dr Babatunde Osotimehin is the Executive Director of the United Nations Population Fund (UNFPA) and doesn't mince his words. He was speaking last week at the launch of the Guttmacher Institute's signature report, Adding It Up. Sexual and reproductive health and rights were “deliberately” dropped by the UN back in 2000, he argued. Those forces are still active today. And they are “more nimble in pushing back”. It's not an argument about evidence. It's “ideological”. Equity and human rights were absent from the Millennium Development Goals. This mistake cannot be allowed to happen again. In the same week that Ban Ki-moon published his Synthesis Report on the post-2015 agenda, it was essential, Dr Babatunde said, that governments invested more in their people. That investment includes spending on health systems. If health systems had been stronger, the Ebola crisis could have been avoided. There are reasons for concern. Women's and children's health is almost invisible in the 17 draft Sustainable Development Goals (SDGs), produced by an Open Working Group of the United Nations during the summer. This invisibility has now been endorsed by Mr Ban. The UN Secretary-General welcomed their “ground-breaking work”. Women living in the most vulnerable circumstances may not see this outcome as quite such a “ground-breaking” result.

Do State-Based Policies Have an Impact on Teen Birth Rates and Teen Abortion Rates in the United States?

ObjectivesThe United States has one of the highest teen birth rates among developed countries. Interstate birth rates and abortion rates vary widely, as do policies on abortion and sex education. The objective of our study is to assess whether US state-level policies regarding abortion and sexual education are associated with different teen birth and teen abortion rates. MethodsWe carried out a state-level (N = 51 [50 states plus the District of Columbia]) retrospective observational cross-sectional study, using data imported from the National Vital Statistics System. State policies were obtained from the Guttmacher Institute. We used descriptive statistics and regression analysis to study the association of different state policies with teen birth and teen abortion rates. ResultsThe state-level mean birth rates, when stratifying between policies protective and nonprotective of teen births, were not statistically different—for sex education policies, 39.8 of 1000 vs 45.1 of 1000 (P = .2187); for mandatory parents' consent to abortion 45 of 1000, vs 38 of 1000 when the minor could consent (P = .0721); and for deterrents to abortion, 45.4 of 1000 vs 37.4 of 1000 (P = .0448). Political affiliation (35.1 of 1000 vs 49.6 of 1000, P < .0001) and ethnic distribution of the population were the only variables associated with a difference between mean teen births. Lower teen abortion rates were, however, associated with restrictive abortion policies, specifically lower in states with financial barriers, deterrents to abortion, and requirement for parental consent. ConclusionWhile teen birth rates do not appear to be influenced by state-level sex education policies, state-level policies that restrict abortion appear to be associated with lower state teen abortion rates.

Making the Most of the Affordable Care Act's Contraceptive Coverage Mandate for Privately-Insured Women

Under the Patient Protection and Affordable Care Act of 2010 (ACA), most women of reproductive age with private health insurance have, or will soon have, first-dollar coverage of contraception and contraceptive counseling. The need for contraceptive coverage is great, because most American families want two children, resulting in the average woman spending three decades of her reproductive life trying to avoid pregnancy (Guttmacher Institute, 2012; Finer & Philbin, 2014). Contraceptive coverage without cost sharing is a sea change in women’s health insurance. This policy change has the potential to dramatically shift contraceptive use patterns, to reduce the U.S. unintended pregnancy ratedwhich stands at approximately half of all pregnancies (Finer & Zolna, 2014)dand to improve the health of women and families. In this commentary, we argue that realizing the potential of this policy change requires more action on the part of public health practitioners, insurers, health care providers, and researchers than is currently evident, andwe offer some suggestions for making the most of first-dollar contraceptive coverage.

Hubris and the HHS Mandate

Hubris and the HHS Mandate

Ann Starrs: enabling women to fulfil their potential

Ann Starrs: enabling women to fulfil their potential

Meeting demand for family planning within a generation: the post-2015 agenda

Expanding access to family planning has been a key aim of health and development programming for almost 50 years. During that time, important gains have been made in addressing unmet need for family planning, increasing contraceptive prevalence, and preventing unintended pregnancies. Over the past two decades, however, the pace of these gains has slowed, especially in several countries in sub-Saharan Africa and south Asia. 1 Singh S Darroch JE Adding it up: costs and benefits of contraceptive services—estimates for 2012. Guttmacher Institute and United Nations Population Fund, New York2012 Google Scholar , 2 Darroch JE Singh S Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. Lancet. 2013; 381: 1756-1762 Summary Full Text Full Text PDF PubMed Scopus (177) Google Scholar , 3 Alkema L Kantorova V Menozzi C Biddlecom A National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet. 2013; 381: 1642-1652 Summary Full Text Full Text PDF PubMed Scopus (318) Google Scholar Meanwhile, an ever growing body of research shows the wider beneficial effect of family planning on improving maternal and child health and survival, increasing economic wellbeing of individuals, families, communities, and nations, fostering environmental sustainability, and empowering women. 4 Cleland J Bernstein S Ezeh A Faundes A Glasier A Innis J Family planning: the unfinished agenda. Lancet. 2006; 368: 1810-1827 Summary Full Text Full Text PDF PubMed Scopus (586) Google Scholar , 5 Ahmed S Li Q Liu L Tsui AO Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012; 380: 111-125 Summary Full Text Full Text PDF PubMed Scopus (386) Google Scholar , 6 Rutstein S Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the Demographic and Health Surveys. Int J Gynecol Obstet. 2005; 89: S7-24 Summary Full Text Full Text PDF PubMed Scopus (302) Google Scholar , 7 Glasier A Gulmezoglu AM Schmid GP Moreno CG Van Look PF Sexual and reproductive health: a matter of life and death. Lancet. 2006; 368: 1595-1607 Summary Full Text Full Text PDF PubMed Scopus (384) Google Scholar , 8 UNFPAFamily planning and the environment: stabilizing population would help sustain the planet. United Nations, New York2008 Google Scholar

The Need for a National Abortion Reporting Requirement: Why Both Sides Should Be in Support of Better Data

This paper focuses on the status of abortion reporting in the United States and how current data is inadequate. Looking to the two primary collectors of abortion statistics, the CDC and the Guttmacher Institute, this article highlights how both institutions suffer deficiencies and delays with their information gathering and how this is ultimately bad for society. Next, the paper discusses the Supreme Court's treatment of state abortion reporting statutes and how under today's Court, such legislation would likely pass constitutional muster as long as patient confidentiality was maintained. Finally, I discuss potential avenues through which better data can be achieved by Congress, characterized as the command option (legislative mandate), and the bribe option (conditional spending), respectively. I conclude that the bribe option is superior as it avoids concerns of anti-commandeering and allows the states to voluntarily cooperate with federal policy rather than passively resist it.

Five-year trends in medication abortion: a view from planned parenthood

National estimates demonstrate that while abortions are declining in the United States, the proportion of medication abortions is increasing. The Guttmacher Institute’s abortion provider census found that 23% of nonhospital abortions in 2011 were medication abortions. When looking only at abortions performed within 9 weeks of gestation, the proportion is higher.

The sexual double standard and gender differences in attitudes toward casual sex among U.S. university students

AbstractBACKGROUNDA significant portion of premarital sexual activity is casual rather than in relationships, and commentators disagree on whether this is what women prefer.OBJECTIVEWe examine gender differences in attitudes toward casual sex. We also assess whether there is a double standard whereby women are judged more harshly for casual sex.METHODSWe use a large online survey of U.S. university students to examine gender differences with regard to attitudes and reports of sexual behavior.RESULTSWhile distributions overlap, the average man looks more favorably on casual sex than the average woman. Both sexes show substantial openness to relationships. We find evidence of a double standard: men are more judgmental toward women than toward men who have casual sex. Men appear to over-report and/or women to under-report intercourse and fellatio, suggesting that men see these acts as enhancing and/or women see them as diminishing their status.CONCLUSIONSWomen face more negative judgment than men when they are known to engage in casual sex, and they also report less interest in casual sex than men. Our analysis does not permit us to assess whether the double standard we find evidence of explains why women have less interest in casual sex, but we hypothesize that this is the case.1. IntroductionIn the United States today, average age at first intercourse is 17, first marriages are typically in the mid-20s, and premarital sex is ubiquitous (Guttmacher Institute 2013). Numerous other affluent nations also have late marriage and substantial premarital sex (Schalet 2011; Darroch et al. 2001; Hubert et al. 2004). For U.S. cohorts born before World War II, much of premarital heterosexual activity was between partners engaged to be married, but later cohorts were more likely to have had sex in relationships that didn't lead to marriage (Klassen et al. 1989). More recently premarital sexual activity is often in contexts even more casual than a girlfriend-boyfriend relationship (Manning et al. 2006; Bogle 2008; Armstrong et al. 2012). It is likely that these changes, common to affluent Western nations, arose from structural and cultural changes that promoted secularization and individualism, and which manifest in casual sex among young adults, as well as the rise of childbearing within cohabitation (Surkyn and Lesthaeghe 2004). In the U.S., the rise of casual sex has been dubbed the culture.Commentators disagree on whether the casual sex entailed on hookups is good for women and whether it is what women want. Regarding the U.S. college scene, Bogle (2008) calls the disagreement over whether relationships or hookups are preferable a war of the sexes that women have lost. (For similar views see Glenn and Marquardt 2001; Regnerus and Uecker 2011; Regnerus 2012). These authors posit the conventional wisdom that men want casual sex more than women, while women are more desirous of relationships and limiting sex to relationships. Evolutionary psychologists argue that men's greater interest in casual sex is hard-wired (Buss 1989; Baumeister et al. 2001). Many social scientists, on the other hand, see such gender differences in preferences for casual sex as resulting from a socially enforced double standard: girls and women are judged harshly if they are seen as too sexual (Crawford and Popp 2003; Miller 2008; Armstrong et al. 2012), while boys and men more often receive accolades (Pascoe 2007). Other journalists and social scientists question the claim that women are more interested in relationships than men. They argue that many college women participate enthusiastically in the hookup culture, and that it is better for women's autonomy, education, and careers to avoid relationships till well into their 20s (Rosin 2012:17-46; Hamilton and Armstrong 2009).We use a large dataset on U.S. college students to examine whether there is evidence for a double standard and for gender differences in attitudes toward casual sex. …

528: Prevalence of hepatitis B infection by test for HBsAg and HBV DNA during pregnancy and risk of perinatal vertical transmission: a multicenter, prospective study

OBJECTIVE: 1) To examine trends in black-white disparities in infant deaths due to congenital anomalies in the United States, and 2) To explore whether state funding of pregnancy termination for women on Medicaid is associated with rates of infant death due to anomalies. STUDY DESIGN: We used US vital statistics records from 1983-2004. Data on state funding of pregnancy termination under Medicaid was obtained from the Guttmacher Institute. Poisson regression was used to examine rates of infant death due to congenital anomalies by race and year, adjusting for maternal age. Trends in racial disparities were examined by including an interaction term between year and race, then calculating adjusted risk differences (RD) and rate ratios (IRR) at various years. The association between state Medicaid coverage of pregnancy termination for fetal indications and mortality rates in recent years (2001-2004) was examined using a Poisson model. RESULTS: Infant deaths due to anomalies decreased by 3% per year between 1983 and 2004, from 257 to 136 per 100,000 live births. During this time, the gap between blacks and whites widened steadily (Figure). In 1983, the adjusted RD was 20.5 per 100,000 (95% CI [13.8, 27.2], IRR1⁄41.08 [1.06, 1.11]); by 2004, this had grown to 36.2 per 100,000 ([31.5, 40.9], IRR1⁄41.27 [1.24, 1.31]). Black women were more likely to live in states without Medicaid coverage of pregnancy termination (68 vs 59%) and these states had higher rates of infant death due to anomalies (22.0/100,000 higher [15.4, 28.5], IRR1⁄41.19 [1.16, 1.23]). CONCLUSION: Infant deaths due to anomalies are more common among blacks than whites, and this disparity has increased steadily over time. Rates are higher when pregnancy termination for fetal indications is not covered under Medicaid. There is a need to better understand whether differences in access to, or uptake of, pregnancy termination of anomalous fetuses has contributed to the growing black-white gap in infant deaths due to anomalies.

Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy

ObjectiveMedicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers. Study DesignWe constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively. ResultsWith the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved. ConclusionA revised Medicaid sterilization policy could potentially honor women’s reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds. ImplicationCompared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year.

Knowledge of State-level Abortion Laws and Regulations Among Reproductive Health Care Providers

ObjectiveTo assess the accuracy of knowledge of state-level abortion laws and regulations among clinicians who provide reproductive health care. MethodsMembers of several reproductive health professional organizations completed a self-administered survey. Respondents were asked if laws and regulations were present in their state. Responses were graded according to the Guttmacher Institute's monthly publication State Policies in Brief: An Overview of Abortion Laws. ResultsThree hundred forty-one surveys were completed. Fifty-nine respondents met exclusion criteria and were excluded. Of the remaining 282, most (80.1%) were physicians, and over half (55.0%) reported currently providing abortion services. Most (86.5%) considered themselves to be informed about abortion laws and regulations in their state. Knowledge of laws and regulations involving spousal involvement, mandatory waiting periods, and availability of private insurance coverage was high (77.0%–86.2%). Receiving reminders of state abortion laws and regulations was associated with significantly more accurate knowledge of parental notification and spousal consent laws, mandatory waiting periods, and availability of Medicaid and private insurance coverage (all p < .05). Receiving reminders and being a provider of abortion services were independent predictors of better knowledge of state abortion laws and regulations among clinicians who provide reproductive health care. ConclusionClinicians who provide reproductive health care had highly accurate knowledge of some abortion laws and regulations, but less accurate knowledge of others. Reminders of laws and regulations may increase knowledge among clinicians. Given the importance of accurate information, evaluation of mechanisms to increase knowledge of abortion laws and regulations may be warranted.

Significant and Non-significant Associations Between Technology Use and Sexual Risk: A Need for More Empirical Attention

Significant and Non-significant Associations Between Technology Use and Sexual Risk: A Need for More Empirical Attention

English

Illegal and unsafe abortions are not uncommon. Various different types of retained foreign bodies used in cases of septic abortions have been reported earlier. We present this case report to highlights an unusual and rare complication of a retained red rubber catheter used for illegally induced abortion. INTRODUCTION: Between 1995 and 2008, the rate of unsafe abortion worldwide remained essentially unchanged, at 14 abortions per 1,000 women aged 15–44. According to latest global abortion figures released by WHO and Guttmacher institute, New York, India contributes to most of abortions in south and central Asia (6.5 million out of 10.5 million) and 2 out of 3 abortions in India are unsafe1. The estimated annual number of deaths from unsafe abortion declined from 56,000 in 2003 to 47,000 in 2008. Complications from unsafe abortion accounted for an estimated 13% of all maternal deaths worldwide in both years2. We present here one such case of illegal abortion which presented with an unusual and rare complication. CASE REPORT: A 25 year old female, P2L2A1 reported to our gynaecology outpatient clinic with complaints of dull aching pain and lump in left lower abdomen which had been gradually increasing in size for last five months following an induced abortion. She also had progressive constipation and amenorrhea for the same period. She had two uneventful full term normal vaginal deliveries and last child birth was 10 months back. Five months following the second delivery, she had consulted a local midwife in her village for persisting amenorrhea and was diagnosed as three months of pregnancy. She underwent termination of pregnancy by that local midwife. About 1015 days following the procedure, she developed low grade fever, pain abdomen and a progressively increasing abdominal lump in left lower abdomen with constipation.

Community Health Centers' Role in Family Planning

Community Health Centers' Role in Family Planning Ruth Lesnewski, MD (bio), Lisa Maldonado, MA, MPH (bio), and Linda Prine, MD (bio) Whenever I see a woman who has an unintended pregnancy, I make a point of looking through her chart to see if she had a recent office visit. About 75% of the time, I find she did have a visit within the previous three months, but contraception was not addressed. —Family physician and medical director of a federally qualified health center Federally qualified health centers, also known as community health centers (CHCs), care for our nation's neediest populations. By latest count, 1,128 federally qualified health centers operate more than 8,500 sites serving 20.2 million men, women, and children.1 These numbers are expected to grow with expanded funding via the Patient Protection and Affordable Care Act. Community health centers are charged with providing a wide scope of preventive health services to people of all ages—including prenatal care, immunizations, cancer screening, and family planning.2 Community health centers form an integral part of the communities they serve. In some areas, these health centers offer the only medical resources available for miles around. Community health centers have demonstrated excellent outcomes in reproductive health. Community health center patients are less likely to have pre-term births or low-birthweight babies,3 and are more likely to obtain Pap tests and mammograms than other low-income patients.4 However, CHCs' effectiveness at providing family planning services is unclear. A 2001 study5 by the Guttmacher Institute found that only 60% of CHC sites provided contraception. Community health centers provided contraception to about 28% of their female patients of reproductive age. More recent studies by Guttmacher and others found that while most publicly funded clinics offered oral contraceptives, CHCs were less likely to provide the most effective contraceptive methods (namely the IUD and implant) and were not as likely to follow evidence-based contraceptive practices such as quick start (that is, same-day initiation of contraception).6 The role of CHCs in caring for our nation's most underserved populations is unquestioned. Community health centers serve one in five low-income women7 and are also more likely than other publicly funded family planning providers to serve men, special [End Page 429] needs groups, minorities, and patients with limited English proficiency.6 Yet, CHCs can do more to prevent unintended pregnancy in the United States. The Impact of Unintended Pregnancy We know a lot about unintended pregnancy in the United States. We know that most families in the United States want two children. We know that most people want to plan childbearing and avoid unintended pregnancies.8 One way of looking at this is that most women spend about 75% of their reproductive years trying to avoid pregnancy.9 We also know that nearly half of all pregnancies in the United States are unintended.10 Our rate of unintended pregnancy is far higher than that of most other developed nations. We know that poor and low-income women, the very women CHCs serve, are much more likely to experience an unintended pregnancy than other women.11 Unintended pregnancy can have lasting consequences. In 2001, the latest year of available data, 3.1 million unintended pregnancies in the U.S. resulted in 1.3 million abortions, 400,000 miscarriages, and 1.4 million births. Women with unintended pregnancies are less likely than women with intended pregnancies to initiate prenatal care promptly,12 to quit smoking cigarettes,2,13 to consume adequate amounts of folic acid,14 and to breastfeed their infants.15 Teens who have a child are less likely than others to graduate from high school or complete college.16 Children born of unintended pregnancies are more likely to have a premature birth, to die in the first year of life, to suffer abuse, and to fail in school.17 Consistent use of effective contraception can make a difference. Most women who experience unintended pregnancies are not using contraception at all or are using it inconsistently during the month of their conception.18 Teen pregnancy rates have dropped to all-time lows as a result of increased access to...

The Komen–Planned Parenthood Controversy: Bringing the Politics of Breast Cancer Advocacy to the Forefront

In the midst of the many political attacks against Planned Parenthood and abortion rights over the past year (Guttmacher Institute, 2012b), the news that Komen for the Cure was halting future funding to Planned Parenthood for breast cancer screening and breast health education still managed to create shock waves among women’s health advocates and the general public. Within hours of the news breaking, social media sites erupted with the sounds of outrage and significant pressure was placed on Komen to reverse its decision (Gates, 2012; Lynch, 2012b; Preston & Harris, 2012). As the national interest in the controversy grew, news outlets began to focus on the socially conservative employee within Komen who was seen as engineering a new policy to provide cover for the defunding of Planned Parenthood (Lynch, 2012a). Unable to withstand the pressure or fearful of growing public backlash, Komen reversed its decisions and amended its policy to allow Planned Parenthood to continue to be eligible for new awards (Belluck, Preston, & Harris, 2012). Soon the media coverage declined and the world of online pundits turned to trying to assess the damage done to the Komen brand and the implications of the debate for Washington politics (Cohen, 2012; Sauer, 2012; Sutton, 2012). What remained unaddressed in the media frenzy surrounding the Komen–Planned Parenthood faceoff was the reality that breast cancer, and Komen’s approach to breast cancer advocacy, have a history of politicization (King, 2006;