National Survey Of Family Growth Research Articles

Women with endometriosis in the United States: National Survey of Family Growth, 2011–2019

ObjectiveEndometriosis is a chronic often painful disease associated with infertility, which often leads to diminished quality of life. Therefore, we sought to identify the characteristics of women with endometriosis, focusing on variables that reflect quality of life, and to report the association between infertility and endometriosis Material and methodsWe conducted a cross-sectional study of a nationally representative sample of U.S. women, using data from National Survey of Family Growth, for the period 2011–2019. ResultsOur analytical sample consisted of 17,619 women aged 20–44 years. Several characteristics differed between women with and without endometriosis but the association between endometriosis and some of these characteristics (age, marital status, body mass index, smoking and diabetes) were attenuated in the adjusted logistic regression analysis. There was no significant association between endometriosis and poverty, education or employment. The rate of functional impairment induced by pain associated with endometriosis was 67.50% in the weighted sample of women aged 15–49 years (2017–2019). The weighted prevalence of endometriosis was 6.40% and the weighted prevalence of infertility among women with endometriosis was 7.37%. Compared to fecund women, infertile women had 3.61 times higher odds of having endometriosis (95% CI 2.44–5.35). ConclusionIn the U.S., women with endometriosis demonstrated different characteristics and had a high rate of functional impairment. Various demographic, socioeconomic and reproductive factors were associated with endometriosis. Further longitudinal population-based studies are warranted to examine endometriosis and its association with infertility.

Demographic Correlates of Endometriosis Diagnosis Among United States Women Aged 15-50

To compare demographic characteristics for women with and without a diagnosis of endometriosis. Data were collected from the National Survey of Family Growth - a publicly available survey designed and administered by the Centers for Disease Control, which uses a nationally-representative sample of the United States population. Univariate data were reported as survey-weighted percentages and means, and were analyzed using chi-square, t-tests, and logistic regression. Analyses accounted for complex survey design. United States PARTICIPANTS: Interviews were conducted with 6,141 female respondents, aged 15-50, between 2017 and 2019. Data were collected through in-person interviews. Nationally, 5.7% reported a diagnosis of endometriosis (95% CI 4.6-6.9%). Those with endometriosis were older, with a mean age of 39 (95% CI 38.1-39.9), compared to 31.7 (95% CI 31.2-32.2) among those without (p < 0.0005). Endometriosis diagnosis was significantly associated with race. Compared to non-Hispanic White women, Hispanic women had an adjusted odds ratio (aOR) of 0.37 (95% CI 0.21-0.65) for diagnosis of endometriosis, and non-Hispanic Black women had an aOR of 0.54 (95% CI 0.35-0.84). We also observed a difference in diagnosis by health insurance: compared to those with private insurance or Medi-Gap coverage, those with Medicare or military insurance had an aOR for endometriosis diagnosis of 2.49 (95% CI 1.36-4.55). Finally, compared to those with less than a high school education, those who had completed high school or greater had an aOR for endometriosis diagnosis of 2.84 (95% CI 1.15-6.99). These disparities in endometriosis diagnosis suggest that intersecting barriers may preclude certain groups from accessing timely endometriosis diagnosis and management. Further studies are warranted to explore these hypothesis-generating data, and to identify and address specific barriers to equitable endometriosis diagnosis and management.

Social Determinants of Health and Patient-Reported Difficult Removal of Long-Acting Reversible Contraception [ID 2683430

INTRODUCTION: Lack of access to high-quality reproductive health care has been reported by persons negatively affected by social determinants of health (SDH). The inability to discontinue a contraceptive method when desired can deleteriously affect a person’s reproductive autonomy. The objective of this study is to evaluate the association of SDH with participant-reported difficult long-acting reversible contraception (LARC) removal. METHODS: A retrospective cross-sectional analysis of data from the 2017–2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. RESULTS: Seven hundred fifty-four respondents reported wanting to have their LARC removed. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). 105 (11%) reported difficult LARC removal. After adjusting for age, race, education, geographic location, parity, and body mass index, persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficult LARC removal compared to respondents without any SDH (2.11 [95% CI: 1.21, 3.69]). Transportation barriers demonstrated the largest aOR of 2.90 [95% CI: 1.07, 7.87]. CONCLUSION: Social determinants of health are unique risk factors that can negatively affect reproductive justice. Social determinants of health are associated with participant-reported difficult LARC removal. Consideration of SDH at the time of contraceptive selection may be a critical step in addressing equitable and safe access to contraceptives with attention to method discontinuation.

Does the approach used to measure sexual identity affect estimates of health disparities differently by race? A randomized experiment from the National Survey of Family Growth

The inclusion of “something else” as a response option for survey questions about sexual identity has been shown to significantly moderate estimated differences between sexual identity subgroups in the distributions of various health outcomes in national health surveys, specifically for substance use/misuse and reproductive health. This moderation effect may be larger depending on the respondent's race, possibly due to the intersectionality of multiple minority identities and compounding minority stressors. To test this hypothesis, we conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (2015–2019) [n = 18,903 (8510 males, 10,393 females)] in the United States, where respondents were randomly assigned to receive either a four-category version of the sexual identity question that included “something else” as a response option along with lesbian/gay, bisexual, and heterosexual, or a three-category version that omitted “something else.” We focused on model-based estimates of distributions of health outcomes across subgroups defined by both race and sexual identity and tested the race moderation hypothesis using three-way interactions involving sexual identity, question type received (four-category vs. three-category), and race (Black, White, and other). Based on this randomized experiment, we found evidence of significant differences between the four-category and three-category question versions of sexual identity, in terms of the associations between sexual identity and several health outcomes, along with moderation of these differences by the respondent's race. For some outcomes, such as wanting a child or another child, the magnitudes of the estimated sexual identity differences among racial minority individuals, specifically between bisexual and heterosexual women, were sensitive to the measurement of sexual identity. These results further suggest a need for improved sexual minority measurement, especially among racial minorities. These differences were also mostly found among women, suggesting further intersectionality of groups exposed to specific stressors.

The demand for male contraception: Estimating the potential market for users of novel male contraceptive methods using United States National Survey of Family Growth data

ObjectiveTo estimate the potential market for novel male contraceptives (NMCs) using United States National Survey of Family Growth (NSFG) data, 2015–2017. Study designWe described the market for NMCs via secondary analysis of the 2015–2017 NSFG’s weighted male respondent data, utilizing surrogate markers for contraceptive switching (NSFG) and contraceptive discontinuation data from the Contraceptive CHOICE project. Potential NMC users included men relying on: (1) no methods or less effective methods but who reported that they would be “very upset” if they got someone pregnant, (2) permanent methods but who reported that they might still want more children, (3) a female partner’s method that she might discontinue in the next year, (4) a male method even when his partner uses her own contraceptive. ResultsOf 3340 respondents—representing 55,890,830 sexually active, reproductive-age men—23.2% used no contraception at last intercourse, 15.8% condoms, 5.1% withdrawal, and 5.1% vasectomy. Among respondents relying solely on condoms, withdrawal, or no method, 19.7%, 3.8%, and 4.4% would be “very upset” if they got someone pregnant. For permanent contraceptive users, 17.3%−20.5% wanted another child. For men reliant on their partner’s long-acting reversible or combined hormonal contraceptive, 12–17% and 45–51% of partners might discontinue their method. These data conservatively suggest that 13% or more than 7 million men would potentially use NMCs, rising to 15.5 million with less restrictive contraceptive switching criteria. ConclusionAdjusting for pregnancy attitudes and likelihood of contraceptive switching, a substantial portion (between 7–15.5 million) of reproductive age men in the US are potential NMC users. ImplicationsThe population of potential novel male contraceptive users extends beyond just users of condoms, withdrawal and vasectomy and should include couples practicing dual-partner contraception and female partners using contraceptive methods that they may become dissatisfied with and discontinue.

Trends in Vaginal Intercourse Experience and Timing among Adolescent Men in the United States: A Descriptive Analysis by Race/Ethnicity

Recent reports of declining prevalence of vaginal intercourse (VI) experience among adolescent men are largely silent on differences by race and ethnicity. This visualization illustrates trends by race/ethnicity in VI experience, average age at first VI, and age-specific cumulative probabilities of VI experience for young men, using retrospective data from multiple rounds of the National Survey of Family Growth covering 2006 to 2019. The authors find that although VI engagement is declining universally, the decline is substantially more pronounced among Black men than among their White and Hispanic peers. Although young Black men continue to engage in VI at higher rates and earlier ages, recent trends are narrowing long-standing racial/ethnic differences.

Educational experiences and American young adults' childbearing goals: A research note

AbstractObjectiveThis research note describes the relationship between young adults' educational experiences and childbearing goals in the United States.BackgroundIn the United States, education is associated with later childbearing and fewer children, but the relationship between education and fertility desires and intentions is less well‐understood. This article contributes to the research literature by illustrating variation in prospective fertility goals by education, focusing on the early life course in order to understand young adults' goals before they have been shaped by parenting and extensive workforce experiences.MethodThis analysis uses data from the National Surveys of Family Growth (1995–2019), a nationally representative survey, to study fertility desires and intentions among childless US men and women ages 19–24. Predicted probabilities demonstrating differences in fertility goals by educational experiences, from three sets of multivariable analyses (logistic regression predicting fertility desires and intentions, separately, and negative binomial regression predicting intended parity), are shown.ResultsMen and women with a bachelor's degree and those enrolled in college do not have lower fertility goals than those without a degree and not enrolled; if anything, more educated individuals are slightly more likely to desire (for men only) and intend children and to have slightly larger intended family size.ConclusionsEducation gaps in fertility in the United States are not attributable to differences in early‐life fertility goals.

Usual Source of Care and Contraceptive Use.

A high proportion of people in the United States at risk of unintended pregnancy also have limited primary care access. We pooled data for analyses from separate 2015-2017 and 2017-2019 waves of the National Survey of Family Growth. Multivariable logistic regression was used to estimate associations between the usual source of health care and self-reported use of a comprehensive range of contraceptive options, as well as alignment between patient preference and the current method. Compared with having a private doctor or Health Maintenance Organization, not having a usual source of care was associated with lower odds of using short-term hormonal methods (OR=0.54, 95% CI: 0.40-0.73, for an 11 percentage point lower rate); higher odds of using time-based methods (OR=1.47, 95% CI: 1.10-1.97, for a 6 percentage point higher rate); and higher odds of preferring a contraceptive method other than the one most recently used (OR=1.39, 95% CI: 1.01-1.90, for a 6 percentage point higher probability). Reliance on an emergency department as a usual source of care was not associated with contraceptive use or satisfaction with the method used. Reliance on urgent care was associated only with higher odds of using time-based methods (OR=1.60, 95% CI: 1.03-2.50, for a 7 percentage point higher rate). Clinic-based usual care was not associated with any differences in contraceptive use but was associated with preferring a contraceptive method other than the one most recently used (OR=1.65, 95% CI: 1.21-2.25, for an 8 percentage point higher probability). All sources of usual care can improve contraceptive access.

Contraception Use by Title X Clients and Clients of Other Providers, 2015–2019

IntroductionTitle X clinics provide access to a wide range of contraceptive options for individuals of all income levels and documentation statuses. As Title X continues to face political uncertainties, it is important to provide up-to-date information about its clients’ use of contraception. This study used recent nationally representative data to compare contraception received by Title X clients with that received by clients of other providers. MethodsThis article draws on 2015–2017 and 2017–2019 waves of the National Survey of Family Growth. The sample was restricted to 15- to 44-year-old women needing contraception. Logistic regressions estimated associations between receiving services at Title X clinics versus at other providers (including private) and use of a range of contraceptive options, as well as number of months’ supply for those using oral contraceptives. ResultsIn 2015–2017, Title X was associated with using any contraception (adjusted odds ratio [AOR], 4.11; p = .004). In both waves, Title X clients were more likely to use long-acting reversible contraceptives (AOR, 1.78 in 2015–2017 [p = .023] and AOR, 2.59 in 2017–2019 [p = .003]) and hormonal methods other than oral contraceptives (AOR, 2.31 in 2015–2017 [p = .007] and AOR, 3.04 in 2017–2019 [p = .001]). In both waves, Title X clients using oral contraceptives were also more likely than non-Title X clients to receive more than a 3-month supply (AOR, 3.54 in 2015–2017 [p = .008] and AOR, 2.61 in 2017–2019 [p = .043]). Title X was not associated in either wave with use of barrier or time-based methods, such as periodic abstinence or withdrawal. ConclusionsPatterns of contraceptive use by Title X clients compared with those of clients of other providers indicate that the Title X program has allowed access to a wide range of contraceptive methods. Ongoing research is necessary to see whether these patterns change over time.

Medicaid compared to private insurance is associated with lower rates of sterilization in people with unwanted births

BackgroundMedicaid, unlike any other insurance mechanism, imposes a consent requirement on female patients desiring sterilization that must be completed at least 30 days, but no more than 180 days, prior to sterilization. Desired sterilization cannot be completed in the Medicaid population without this consent. Large scale national evidence is lacking on the impact of this requirement. ObjectiveThe aim of this study was to explore the influence of insurance status on the achievement of postpartum sterilization following a self-reported unwanted birth in a nationally representative sample. Study DesignWe performed a retrospective cohort analysis using data from the 2013-2015 National Survey of Family Growth (NSFG). The NSFG uses a stratified, multistage clustered sample to make nationally representative estimates for men and women aged 15-44 years in the household population of the U.S. The analysis was limited to a cohort of birthing people who reported their last birth as unwanted and who were insured by either Medicaid or private insurance. The survey was analyzed with application of inverse probability of treatment weights (IPW) to balance those insured by Medicaid and private insurance in addition to the survey weight. The association between completion of postpartum sterilization and insurance type was evaluated using weighted logistic regression, adjusting for demographic and clinical characteristics. ResultsIn an adjusted and IPW balanced analysis of a weighted national sample representing 4,164,304 people (respondent n=416), Medicaid insured birthing people with a history of unwanted birth were found to have 56% lower odds of obtaining postpartum sterilization (OR 0.44; 95%CI 0.22, 0.87; p=0.019) compared to those with private insurance. ConclusionsThis study adds to mounting evidence that insurance type plays a significant role in the achievement of desired postpartum sterilization, with individuals who are insured by Medicaid less likely to undergo the procedure. The findings call for policy reforms around sterilization policy in the United States, emphasizing the need for uniform consent procedures that do not discriminate based on insurance status.

Shortcomings and disparities in contraception counseling and use by hypertensive individuals at risk for unintended pregnancy: a comparative analysis of the National Survey of Family Growth

BackgroundHypertension is a leading cause of adverse pregnancy outcomes. These outcomes disproportionately affect Black individuals. Reproductive life planning that includes patient-centered contraception counseling could mitigate the impact of unintended pregnancy. ObjectiveThe primary objective of the study is to compare contraception counseling and use among hypertensive and non-hypertensive individuals at risk for unintended pregnancy. Our secondary objectives are 1) to evaluate the effect of race on the probability of counseling and the use of contraception and 2) to evaluate the methods used by individuals with hypertension. MethodsData from the 2015-2017 and 2017-2019 National Survey of Family Growth Female Respondent Files were used to analyze whether individuals who reported being informed of having high blood pressure within the prior 12 months received counseling about contraception or received a contraceptive method. Covariates considered in the analysis included age, race, parity, educational attainment, body mass index, smoking, diabetes, and experience with social determinants of health (SDH). The SDH covariate was based on reported experiences within five SDH domains: food security, housing stability, financial security, transportation access, and childcare needs. Linear probability models were employed to estimate the adjusted probability of receiving counseling and the use of a contraceptive. Using difference in difference analyses, we compared the change in counseling and use between hypertensive and non-hypertensive respondents by race, relative to White respondents. ResultsOf the 8,625 subjects analyzed, 771 (9%) were hypertensive. Contraception counseling was received by 26.2% (95%CI 20.4-31.9) of hypertensive individuals and 20.7% (95%CI 19.3-22.2) of non-hypertensive individuals. Contraception use was reported by 39.8% (95% CI 33.2-46.5) of hypertensive and 35.3% (95%CI 33.3-37.2) of non-hypertensive individuals. The linear probability model adjusting for age, parity, education attainment, body mass index, smoking, diabetes and SDH indicated that hypertensive individuals were 8 percentage points (95%CI 3, 18 percentage points). more likely to receive counseling and 9 percentage points (95%CI 3, 16 percentage points) more likely to receive contraception. Hypertensive Black individuals did not receive more counseling or use more contraceptives compared to non-hypertensive Black women. The lack of difference in counseling when hypertension is present is 13 percent less than the change we observed for White respondents when hypertension was present (p=0.01). The most frequently used contraceptive method among hypertensive individuals was combined oral contraceptive pills (COCs) [54.0% (95%CI 44.3-63.5%)]. ConclusionsDespite a higher likelihood of receiving contraception counseling and using contraception among hypertensive individuals at risk for unintended pregnancy, two-thirds of this population did not receive contraception counseling, and less than 40% used any contraceptive method. Furthermore, unlike for White individuals, Black individuals with hypertension did not receive more contraception care than non-hypertensive Black individuals. Of all those who used contraception, half relied on a method classified as Center for Disease Control Medical Eligibility Criteria Category 3. These findings highlight a substantial unmet need for safe and accessible contraception options for hypertensive individuals at risk for unintended pregnancy, emphasizing the importance of targeted interventions to improve contraceptive care and counseling in this population.

How a “Something Else” Response Option for Sexual Identity Affects National Survey Estimates of Associations Between Sexual Identity, Reproductive Health, and Substance Use

This randomized experiment tested whether the inclusion of a “something else” response option for a question about sexual identity in a national health survey would significantly moderate estimated differences between sexual identity subgroups in terms of various health outcomes, including substance use and reproductive health. We conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (NSFG; 2015–2019), where two large national half-samples were randomly assigned to receive one of two different versions of a question about sexual identity (a four-category version that included a “something else” response option or a three-category version omitting this option). We focused on national estimates of differences between subgroups defined by sexual identity. Multivariable models indicated that the estimated subgroup differences changed in a statistically significant fashion when using the four-category version of the sexual identity question for several measures, including 16% of male measures (household size, past-year cigarette use, and past-year illicit drug use) and 15% of female measures (wanting a/another child, ever had a sexually transmitted disease, and past-year marijuana use). The absence of a “something else” response option for questions about sexual identity in national health surveys may cause respondents to select options that do not accurately describe their identities, and this can have a significant effect on national estimates of differences between sexual identity subgroups in terms of selected health outcomes.

Do couples who use fertility treatments divorce more? Evidence from the US National Survey of Family Growth

Do couples who use fertility treatments divorce more? Evidence from the US National Survey of Family Growth

Changes in Oral and Anal Sex With Opposite-Sex Partners Among Sexually Active Females and Males Aged 15 to 44 Years in the United States: National Survey of Family Growth, 2011-2019.

Oral and anal sex with opposite-sex partners is common and associated with sexually transmitted infection (STI) transmission. Trends in these behaviors over the last decade, during which bacterial STI diagnoses have reached historic highs while HIV diagnoses have decreased, are not well understood. We examined recent trends in oral and anal sex and associated condom use with opposite-sex partners among females and males. We analyzed data from 16,926 female and 13,533 male respondents aged 15 to 44 years who reported sex with an opposite-sex partner in the past 12 months from the National Survey of Family Growth, 2011-2019. We used survey-weighted linear or logistic regression to evaluate linear temporal trends in oral and anal sex behaviors. From 2011-2013 to 2017-2019, reports of oral sex and number of oral sex partners in the past 12 months increased among females (85.4% in 2011-2013 to 89.4% in 2017-2019; odds ratio [OR], 1.05 [95% confidence interval {CI}, 1.02-1.09], and β = 0.014 [95% CI, 0.005-0.023]; respectively) but not males (ranges, 87.9%-89.1%; 1.27-1.31). Condom use at last oral sex decreased among both females and males (6.3%-4.3%: OR, 0.93 [95% CI, 0.88-0.99]; 5.9%-4.4%: OR, 0.95 [95% CI, 0.91-1.00]). Anal sex (ranges, 21.0%-23.3% [females] and 23.3%-24.6% [males]), number of anal sex partners (females, 0.22-0.25; males, 0.26-0.30), and condom use at last anal sex (females, 15.3%-18.2%; males, 27.0%-28.7%) remained stable. The frequency of oral and anal sex with opposite-sex partners among U.S. 15- to 44-year-olds, paired with limited and-for oral sex-decreasing condom use, demonstrates the need to understand the role of these behaviors in increasing STI diagnosis rates and the potential role of extragenital screening and condoms in reducing STI transmission.

The status of person-centered contraceptive care in the United States: Results from a nationally representative sample.

The Person-Centered Contraceptive Care measure (PCCC) evaluates patient experience of contraceptive counseling, a construct not represented within United States surveillance metrics of contraceptive care. We explore use of PCCC in a national probability sample and examine predictors of person-centered contraceptive care. Among 2228 women from the 2017-2019 National Survey of Family Growth who reported receiving contraceptive care in the last year, we conducted univariate and multivariable linear regression to identify associations between individual characteristics and PCCC scores. PCCC scores were high ( : 17.84, CI: 17.59-18.08 on a 4-20 scale), yet varied across characteristics. In adjusted analyses, Hispanic identity with Spanish language primacy and non-Hispanic other or multiple racial identities were significantly associated with lower average PCCC scores compared to those of non-Hispanic white identity (B = -1.232 [-1.970, -0.493]; B = -0.792 [-1.411, -0.173]). Gay, lesbian, or bisexual identity was associated with lower average PCCC scores compared to heterosexual (B = -0.673 [-1.243, -0.103]). PCCC scores had a positive association with incomes of 150%-299% and ≥300% of the federal poverty level compared to those of income <150% (150%-299%: B = 0.669 [0.198, 1.141]; ≥300%: B = 0.892 [0.412, 1.372]). Cannabis use in the past year was associated with lower PCCC scores (B = -0.542 [-0.971, -0.113]). The PCCC can capture differential experiences of contraceptive care to monitor patient experience and to motivate and track care quality over time. Differences in reported quality of care have implications for informing national priorities for contraceptive care improvements.

Stability and change in predictors of marital dissolution in the US 1950–2017

AbstractObjectiveOur goal is to measure change over time in the predictors of marital dissolution in the United States.BackgroundThe last comprehensive comparative analysis of predictors of marital dissolution is more than 20 years out of date. Rising inequality in the United States requires a fresh look at the predictors of marital dissolution. The Diverging Destinies hypothesis predicts greater inequality over time in the divorce rate between groups, whereas the Converging Destinies hypothesis predicts convergence in divorce rates.MethodWe use a variety of event history models to examine the change over time in race, ethnicity, intermarriage, premarital cohabitation, education, teen marriages, and family of origin intactness as predictors of marital dissolution using data on first marriages from the National Survey of Family Growth covering seven decades of marital histories. We examine racial differences in the nonracial predictors of divorce.ResultsIn the post‐Civil Rights era, Black women's and White women's marital dissolution rates converged. In the most recent marriage cohorts, marital dissolution rates for Black women have increased relative to White women and teen marriage is increasingly associated with divorce. Women without the BA degree appear to be increasingly at risk for divorce. We find that wives from racial minority groups have divorce rates that are less impacted by premarital cohabitation, low education, and teen marriage.ConclusionThe demographic profile of women at marriage has changed dramatically, while the predictors of divorce have changed modestly. Where there are changes in the predictors of divorce, we find more support for Diverging Destinies.

Contraceptive Behavior Dynamics and Unintended Pregnancy: A Latent Transition Analysis.

The average U.S. woman wants to have two children; to do so, she will spend about three years pregnant, postpartum, or trying to become pregnant, and three decades trying to avoid pregnancy. However, few studies have examined individual patterns of contraceptive use over time. These trajectories are important to understand given the high rate of unintended pregnancy and how little we know about the complex relationship between contraceptive use, pregnancy intention, and patterns of reproductive behavior. We use data from the 2015-2017 National Survey of Family Growth to examine reproductive behavior and pregnancies across three years of calendar data. We identify seven behavior typologies, their prevalence, how women transition between them, and how pregnancies affect transitions. At any given time, half of women are reliably using contraception. A small proportion belong to a high pregnancy risk profile of transient contraceptive users, but some transition to using condoms or other methods consistently. An unintended pregnancy may initiate a transition into stable contraceptive use for some women, although that is primarily condom use. These findings have important implications for the ways contraception fits into women's lives and how that behavior interacts with relationships, sex, and life stage trajectories.

A partner-specific critique of mistimed and unwanted fertility: Results from an analysis of the 2017-2019 United States National Survey of Family Growth.

Despite substantial critiques of retrospective measures of fertility intentions, researchers widely use the metrics of unwanted and mistimed pregnancies as tools for monitoring patterns and trends in reproductive health. However, in focusing exclusively on the timing and numeric elements of fertility these constructs ignore partner-specific desires, which may lead to considerable measurement error and threaten their validity. We use data on births in the last 5 years from the 2017-2019 United States National Survey of Family Growth to compare responses to the standard retrospective measure of fertility intentions with responses to a partner-specific question that asks respondents about whether they had ever desired a child with that partner. We find that women's responses to questions on retrospective fertility desires with and without reference to a particular partner vary in ways that suggest that women and researchers interpret these questions differently. Despite a long history in fertility research, the standard approach to measuring mistimed and unwanted fertility is both conceptually and operationally flawed. In the context of complicated sexual and reproductive lives that do not start and end with a single partner, researchers should reevaluate the usefulness of the constructs of mistimed and unwanted fertility. We conclude by offering recommendations for analysts and survey designers as well as by calling for a move away from the terms entirely to focus instead on the pregnancies that women themselves view as most problematic.

Differences in Use of Fertility Treatment Between People With Medicaid and Private Health Insurance Coverage in the United States.

We aimed to compare differences in receipt of any and specific types of fertility services between people with Medicaid and private insurance. We used National Survey of Family Growth (2002-2019) data and linear probability regression models to examine the association between insurance type (Medicaid or private) and fertility service use. The primary outcome was use of fertility services in the past 12months, and secondary outcomes were use of specific types of fertility services at any time: 1) testing, 2) common medical treatment, and 3) use of any fertility treatment type (testing, medical treatment, or surgical treatment of infertility). We additionally calculated time-to-pregnancy using a method that estimates the unobserved total amount of time the respondent spent trying to become pregnant using their current duration of pregnancy attempt at the time of the survey. We calculated time-to-pregnancy ratios across respondent characteristics to examine if insurance type was associated with differential time-to-pregnancy. In adjusted models, Medicaid coverage was associated with an 11.2-percentage point (95% confidence interval: -22.3 to -0.0) lower use of fertility services in the past 12months compared with private coverage. Relative to private coverage, Medicaid insurance was also associated with large and statistically significantly lower rates of ever having used infertility testing or any fertility services. Insurance type was not associated with differences in time-to-pregnancy. People covered by Medicaid were less likely to have used fertility services compared with people with private insurance. Differences in coverage of fertility services between Medicaid and private payers may represent a barrier to fertility treatment for Medicaid recipients.

Forced intercourse in America: a pandemic update

BackgroundMeasures of forced intercourse from the U.S. National Center for Health Statistics (NCHS) indicate high prevalence among U.S. women, which is likely to produce unintended pregnancies. However, NCHS did not measure forced intercourse during the pandemic, limiting knowledge of recent prevalence rates.MethodsWe use multiple nationally-representative, cross-sectional surveys representing the U.S. population from 2011 to 2022 to document these trends. This includes measures from the National Survey of Family Growth, the Panel Study of Income Dynamics Transition into Adulthood Supplement, and the American Family Health Study (AFHS) to provide population estimates of forced intercourse.ResultsReports of forced intercourse remained high during the pandemic, with more than 25% of U.S. females over 40 reporting lifetime forced intercourse in the AFHS (number of females in AFHS: 1,042). There was a significant increase among females aged 24–28 (p < 0.05) and rates are highest for those who did not complete college. Among females 24–28, 32.5% (S.E. = 5.7%) with less than 4 years of college reported forced intercourse, a significantly (p < 0.05) higher rate than among those with a higher level of education.ConclusionsRates of forced intercourse among U.S. women remained high during the pandemic, increasing significantly in early adulthood. This exposure to forced intercourse is likely to produce an increase in unintended pregnancies and other sexual, reproductive, and mental health problems.