High Rates Of Unintended Pregnancy Research Articles

Unmet need for publicly funded family planning in region IV

Unmet need for family planning results in higher rates of unintended pregnancies, shorter birth spacing intervals, higher abortion rates, and a greater number of pregnancies. Unmet need may be caused by lack of services, fewer contraceptive options offered, high out-of-pocket costs of methods, low understanding of options and proper use and low use of effective long-acting methods. By examining trend data in the southeast compared to national data, program decision-makers can monitor unmet need and take steps to improve service delivery that will reduce unintended pregnancies and lead ultimately to better health outcomes for women and the children they eventually may bear.

Tailoring Contraceptive Use to Patient Needs

The United States has a relatively high unintended pregnancy rate compared to other developed countries. About half of all pregnancies are unintended so, clearly, contraceptive use is not optimal for these women.1

Preventing Unintended Pregnancies and Improving Contraceptive Use Among Young Adult Women in a Rural, Midwestern State: Health Promotion Implications

Despite high rates of unintended pregnancy among women aged 18 to 30 years, little research has been conducted to understand the factors associated with their contraceptive use. Eighteen focus groups were conducted with young adult women (N = 106) who were mostly white, non-Hispanic. Results suggested that contraceptive use was negatively affected by low contraceptive knowledge; use of alcohol; a lack of planning for sex; a misperception of the likelihood of pregnancy; forgetting to use contraceptives; and concerns about side effects, cost, and confidentiality. Women liked the peace of mind that using contraceptives gave them and the benefits of regular periods from some hormonal methods. Implications for reducing unintended pregnancies through interventions are offered.

Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?

Background The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States. As health care providers are important contributors to women's contraceptive use, this study was conducted to assess provider knowledge about contraception. Study Design Bivariate and multivariate analyses were performed using data collected from a convenience sample of health care providers (physicians, nurse practitioners and physician assistants) at meetings of the professional societies of family medicine and obstetrics and gynecology. Results Younger providers were more knowledgeable, as were obstetrician/gynecologists, female providers and providers who provide intrauterine contraception in their practice. Conclusions The lack of consistent and accurate knowledge about contraception among providers has the potential to dramatically affect providers' ability to provide quality contraceptive care for their patients, which could have an impact on their ability to prevent unintended pregnancies.

Use of Dual Protection in Botswana

High rates of unintended pregnancy and of HIV and other sexually transmitted infections prompt calls for use of "dual-protection" strategies, including consistent condom use or dual-method use. This study examines the use of dual-protection strategies in a sample of 15-49-year-old men and women in Botswana in 2003. Half of sexually active respondents reported consistent condom use in the past year; 2.5 percent reported dual-method use. Multiple logistic regression analyses showed that urban residence, less than a ten-year age difference between partners, discussing HIV and contraception with one's partner, not intending to have a child in the next year, having no children, being in a relationship where one or both partners have additional concurrent partners, and supportive condom norms were associated with dual protection--that is, with consistent condom or dual-method use. In the context of high HIV prevalence, concerns about disease prevention likely influence contraception, and interventions should address childbearing desires and sexual risk simultaneously.

Abortion in adolescents: epidemiology, confidentiality, and methods

To review the epidemiology, confidentiality, and methods of abortion provision specific to adolescents. In the United States, four out of five pregnancies in teenagers are unintended and about one-third of all adolescent pregnancies end in induced abortion. Barriers such as travel and cost decrease abortion access for all women and adolescents, whose pregnancies are diagnosed later than older women, may be particularly impacted by such challenges. An increasing majority of states require parental involvement in adolescents' decisions to end their pregnancies. Recent analyses indicate that mandating parental involvement does not promote family communication; rather, such laws may actually increase the risk of harm by delaying appropriate medical care. Medication and surgical abortion are options for adolescents; both are safe and effective. There is no evidence that abortion during adolescence causes negative psychological consequences, decreased fertility, or increased risk in future pregnancies. Continued high rates of unintended pregnancy among US adolescents necessitate access to safe and timely abortion services. Unfortunately, teens encounter unique barriers in obtaining abortion care that lead to delays and preventable risk associated with later abortion.

Access and barriers to reversible contraception among recently arrested women in San Francisco

Incarcerated women typically have had limited access to health care as well as high rates of prior unintended pregnancies and low contraceptive use prior to incarceration. This study aimed to describe access to and use of reversible contraception prior to women's arrest and evaluate barriers to access among this population.

High rate of unintended pregnancy among pregnant women in a maternity hospital in Córdoba, Argentina: a pilot study

BackgroundAlthough Argentina has a new law on Reproductive Health, many barriers continue to exist regarding provision of contraceptive methods at public healthcare facilities.MethodsWe asked 212 pregnant women selected at random at the Maternity and Neonatal Hospital, Córdoba, Argentina, to participate in our descriptive study. Women were asked to complete a structured questionnaire. The objectives were to determine the rate of unintended pregnancies, reasons for not using contraception, past history of contraceptive use, and intended future use.ResultsTwo hundred women responded to the questionnaire. Forty percent of the women stated that they had never used contraception and pregnancy was declared unintended by 65%. In the unintended pregnancy group, almost 50% of women said that they had not been using a contraceptive method because they were "unaware about contraception", and 25% stated that their contraceptive method had failed. Almost 85% of women stated that they intended to use contraception after delivery.ConclusionApproximately two-thirds of all pregnancies in this sample were unintended. Although the data is limited by the small sample size, our findings suggest that our government needs to invest in counseling and in improving the availability and access to contraceptive methods.

Adolescent Gynecology

Given new developments in the field of adolescent reproductive health, this review focuses on highlighting new guidelines and practice patterns in evaluation and management of adolescent gynecologic problems. First, understanding the proper techniques for the initial examination is key to establishing a long-term relationship with this age group. Reservations about the first gynecologic examination are common, and the practitioner's goal is foremost to make the patient as comfortable as possible. Preventive health in this patient population is key, and practitioners should become comfortable with providing education about topics as diverse as sexuality, eating disorders, and dating violence. Furthermore, the frequency with which teenagers report sexual activity and the high unintended pregnancy rate in this age group makes counseling regarding effective contraception essential. Additionally, practitioners are encouraged to take the opportunity to discuss the availability of the human papillomavirus (HPV) vaccine with adolescents. In 2007, adolescents were designated as a special population, given the frequency with which they acquire and clear mild HPV-related cervical dysplasia. More conservative treatment in this population is generally favored. During their transition through puberty, disorders of menstruation become the most common complaint requiring the attention of the gynecologist. Most commonly, anovulation serves as the cause behind such abnormal bleeding. Polycystic ovarian syndrome can develop in early puberty and carry its consequences into adulthood. Infertility, diabetes, and hirsutism mark the most important components of the syndrome and require age-appropriate management. Finally, the consequences of endometriosis on the future fertility of adolescents have brought early intervention to light. Recognition and prompt treatment are advocated to prevent the future implications of this disease.

HIV Transmission by HIV‐Infected Women Using Hormonal Contraception

This letter to the editor argues that no longer recommending hormonal contraception (HC) to HIV-infected women because of concern for increased risk of transmission to uninfected sexual partners would be an unfortunate choice for providers. It states that it is imperative that HIV-infected women have access to the best contraception services as non-infected women to reduce the high rate of unintended pregnancy.

Health insurance coverage and prescription contraceptive use among young women at risk for unintended pregnancy

Background This study investigates the relationships between health insurance coverage and prescription contraceptive use among women 18–24 years of age at risk for unintended pregnancy. Study Design Data from the 2002 National Survey of Family Growth were analyzed. The sample comprised 1049 women 18–24 years of age at risk for unintended pregnancy. Multivariate logistic regression analysis was employed to examine the likelihood of prescription contraceptive use (1) between uninsured women versus ones with private insurance, Medicaid or another form of government insurance and (2) between those who had consistent versus inconsistent insurance coverage, after adjusting for a range of sociodemographic and sexual health factors. Results Twenty percent of the participants were uninsured and over 30% had inconsistent coverage. Only 55% were currently using prescription contraceptives. In multivariate analyses, young women with private insurance or Medicaid were more likely than the uninsured to use prescription contraceptives. No significant differences in prescription contraceptive use were found between other forms of government insurance and uninsurance or between consistent and inconsistent coverage. Conclusions Access to comprehensive health insurance should be considered one strategy to address the high rates of unintended pregnancy among this vulnerable population.

Condom Use Among Sexually Active Kenyan Female Adolescents at Risk for HIV-1 Infection

High rates of unintended pregnancy and HIV infection occur in sub-Saharan Africa yet few Kenyan studies have defined correlates of condom use in sexually active female adolescents. Female adolescents receiving reproductive health care and aged 15-19 were interviewed. The prevalence of ever-use of condom was 21.4% and 52 (7.3%) subjects were infected with HIV-1. Older age, higher levels of education, ever-use of hormonal contraceptives and higher numbers of sexual partners, non-consensual sex and exchange of sex for favours, were independent correlates of condom use. Condom use should be promoted in this population. Further exploration is needed on the developmental and contextual factors predisposing female adolescents to increased risk of HIV.

Changing the face of reproductive health: discussions of pregnancy and contraception with men

Studies of contraception and pregnancy have traditionally focused on women. Data regarding the perceptions of men, particularly those who live in neighborhoods with high rates of unintended pregnancy, are lacking. Yet partners play an important role in women's contraception initiation and continuation, as well as decision making surrounding pregnancy intention and/or termination. This study explores perceptions of pregnancy, pregnancy decision making and contraception use among urban males of reproductive age.

Sociodemographic, insurance, and risk profiles of maternal smokers post the 1990s: How can we reach them?

Declines in prenatal smoking rates have changed the composition of maternal smokers while public policy during the 1990s has likely made it more difficult to reach them. Medicaid expansions during the 1980s/early 1990s insured more women some time during pregnancy, but the 1996 welfare reform unexpectedly reduced enrollment in Medicaid by eligible pregnant women; overall, insurance coverage has declined since 2000. As the public sector struggles with fewer resources, it is important to understand the sociodemographic characteristics of prenatal smokers, their patterns of care, and nonsmoking risk behaviors. Targeting scarce dollars to certain settings or sub-populations can strengthen the infrastructure for tobacco policy change. We provide more current information on maternal smokers in 2002 based on the Pregnancy Risk Assessment Monitoring System (PRAMS) for 21 states. Data on urban/rural location, insurance coverage, access patterns, and nonsmoking risk behaviors (e.g., abuse) among low-income (<16,000) and other maternal smokers are included. Low-income maternal smokers are the working poor living in predominately urban areas with fewer health care resources than low-income nonsmokers. Over 50% of low-income maternal smokers are uninsured pre-pregnancy and use a clinic as their usual source of care. Regardless of income, smokers exhibit rates of nonsmoking risks that are two to three times those of nonsmokers and high rates of unintended pregnancy (68%) of low-income smokers. These characteristics likely call for a bundle of social support services beyond cessation for smokers to quit and remain smoke-free postpartum.

Contraceptive Care for Adolescents

Adolescents have a high rate of unintended pregnancy: 82% of pregnancies for women aged 15 to 19 years are unintended. The large majority of sexually active adolescent women are using some method of contraception, but few are using long-acting highly effective methods, that is, intrauterine devices and implants. Most adolescent women are relying on oral contraceptive pills and/or condoms as their most effective method, with the third most common method being depot medroxyprogesterone acetate. None of the long-acting highly effective methods are contraindicated in adolescents, and they should be considered for use and offered to young women as contraceptive options.

The multistate life table method: An application to contraceptive switching behavior

In many demographic behaviors (e.g., those relating to marriage, contraception, migration, and health), people change among multiple statuses through time, sometimes leaving and then returning to the same status. Data on such behaviors are often collected in surveys as censored event histories. The multistate life table (MSLT) can be used to properly describe, in a single analysis, these complex transitions among multiple states measured in such data, but MSLT is rarely applied in the demographic literature because practical guidance is lacking on how to compute MSLTs with such data. We provide methods for computing MSLT quantities using censored event-history data: namely, transition intensities and probabilities, "state occupancy" probabilities and standard errors, average time spent in specified states, and average number of visits to specified states. Applying these methods to contraceptive use, we find high levels of switching back and forth, particularly between barrier methods and non-use, resulting in high rates of unintended pregnancy.

Access to emergency contraception on US college campuses

College-aged women have high rates of unintended pregnancy. Little data exist regarding information given to students by student health centers (SHCs) on emergency contraception (EC), especially at crucial times such as weekends.

Contraceptive discontinuation due to method dissatisfaction in the United States

Contraceptive discontinuation contributes significantly to the high rates of unintended pregnancy in the US. This study examined contraceptive discontinuation throughout women's lives, focusing specifically on discontinuation due to dissatisfaction with the method.

IUD-related knowledge, attitudes and practices among Navajo Area Indian Health Service providers.

The IUD once accounted for about half of contraceptive use among Navajo women but is now little used in this population, which has a high rate of unintended pregnancy. Identifying barriers to use--including those stemming from providers' IUD-related knowledge, attitudes and practices--could help expand use of the method. In 2000, 107 Navajo Area Indian Health Service providers who offer contraceptive services completed a mailed survey. Responses of women's health providers and other types of providers were compared, using the Cochran-Mantel-Haenszel method. Overall, 69-78% of providers had good factual knowledge about the IUD and felt adequately prepared to insert a device or counsel women about it; considerably larger proportions of women's health providers than of others felt able to counsel about and insert IUDs. Sixty-five percent of providers (88% of women's health providers and 50% of others) currently inserted IUDs, and only 8% (none of them women's health providers) never recommended the method. The main reasons providers cited for not recommending the IUD were concerns about its safety and about side effects (mentioned by 69% and 44%, respectively); these concerns did not differ by provider type. Provider education and training should focus on insertion techniques and on the safety of available IUDs. Training should be targeted not only to women's health providers, but to family practice physicians, nurse practitioners and other providers who offer family planning counseling and services.

Patterns of contraceptive use within teenagers' first sexual relationships.

Teenagers have a high unintended pregnancy rate, in part because of inconsistent use or nonuse of contraceptives. It is important to determine how partner and relationship characteristics are related to contraceptive use and consistency within adolescents' first sexual relationships. Logistic and multinomial logistic regression analyses of data from 1,027 participants in the first two waves of the National Longitudinal Study of Adolescent Health examined the influence of relationship and partner characteristics on ever-use and consistent use of contraceptive methods during teenagers' first sexual relationships. Teenagers who had waited a longer time between the start of a relationship and first sex with that partner, discussed contraception before first having sex or used dual contraceptive methods had significantly increased odds of ever or always using contraceptives. Adolescents who had taken a virginity pledge, had an older partner, had a greater number of close friends who knew their first partner, or reported having a relationship that was not romantic but that involved holding hands, kissing and telling their partners they liked or loved them had decreased odds of contraceptive use or consistency. As relationship length increased, teenagers were more likely to ever have used a method, but less likely to always have used a method. Parents and programs should encourage teenagers to delay sexual intercourse, discuss contraception with partners before initiating sex and be vigilant about contraceptive use, particularly in long-term sexual relationships and in relationships with older partners.