Use Of More Effective Methods Research Articles

The Need and Prospects for the Creation of a National Exchange of Secondary Resources

The problem of utilization firm municipal and municipal solid waste (and MSW) and rational use of secondary raw material resources in the conditions of the outlined transition to economy of the closed cycle is considered. The analysis of this problem made it possible to identify the insufficiency of currently used measures, including market instruments that stimulate the use of more effective methods of waste processing. The need to create a national exchange of secondary resources as a promising trading platform, an instrument for market regulation of prices for secondary raw materials, a mechanism of interaction between authorities, the business sector and the population is justified. The main functions of the secondary resource exchange and its advantages are described, an analysis of the likely barriers to its creation and highly efficient functioning is carried out.

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

“The Role of the Gamification in Developing the Skills of Fashion Design Students”

The great development in modern technologies has led to the use of more effective methods in the educational process, since the use of these techniques helps to increase interaction and participation among students. Programmed learning relies on controlling human behavior through dialogue, attractive, and interactive methods through progressive progress in education to reach the goals effectively and proficiency. The problem of this research appears in the length of the time, which students take in the design process because of the sense of uncertainty and boredom of the lack of motivation for many students. By contrast, students can spend more time on electronic games without being bored. Hence the idea of the current research. This research aims to take advantage of modern methods in improving the performance of students and develop their skills by encouraging and motivating them and increase interaction, participation and competition to achieve designs through the use of game incentives during the lecture to create the spirit of the game to carry out the required tasks, where the elements of the games are integrated into the educational process to increase motivation among students and achieve the desired goals through increased competition among students. This research follows the descriptive and analytical methodology, by developing a proposed concept for the gamification of the module of fashion design. It is a program with a set of levels to help develop students' skills through increased participation and competition among students, where the required tasks to accomplish the design were identified. The application was done in the traditional way and the proposed method and then was evaluated by using the survey tool (questionnaire, interviews) to find out the views of students and teachers, who teaching the module of fashion design to evaluate the proposed concept. The Questionnaire included some questions, such as: - Do you feel excited to accomplish the required tasks?- Does motivation help you to develop your design skill?- Do you like individual work to show your design features? - Are you trying to be the first one to finish the desired design? - Is there a suitable method for stimulation during the lecture? - Does the spirit of competition help you to accomplish required tasks from you? - Do you seek to complete the tasks to get motivation? After the statistical analysis, the results showed that the proposed program increases the motivation of students to accomplish the required tasks to reach the final design without being bored, which leads to increase the students' ideas and continuous participation with the feeling of enjoyment.

Predictors of More Effective Contraceptive Method Use at 12 Weeks Post-Abortion: A Prospective Cohort Study.

Background: Understanding factors associated with contraceptive use post-abortion can inform clinical practices to improve contraception uptake. Materials and Methods: This prospective cohort study included adult women who completed the survey before surgical abortion at an Atlanta, Georgia clinic, with an online survey 12 weeks later. Poisson regression models assessed associations between demographic and reproductive factors and use of more effective (contraceptive pill, ring, patch, injectables, intrauterine device [IUD], implant, sterilization) versus less effective (none, condoms, withdrawal, rhythm methods) contraception at follow-up. Results: Three hundred ninety three women completed the initial survey; 180 (46%) completed follow-up. Of those completing follow-up, 109 (61%) expressed interest in initiating more effective methods in-clinic, yet only 85 (47%) reported using these methods at follow-up. Sixty-one women (34%) were not using their preferred contraceptive at follow-up; 34 (56%) of whom preferred to use IUD, implant, or sterilization. More effective contraception use was significantly associated with age over 30 (adjusted risk ratio, aRR 1.71, 95% confidence interval (CI): 1.14-2.57); nulliparity (aRR 1.70, 95% CI: 1.20-2.42); use of more effective methods at most recent conception (aRR 2.56, 95% CI: 1.73-3.79); interest in more effective methods at the time of the abortion (aRR 1.55, 95% CI: 1.11-2.18); and receiving a contraceptive/prescription at the time of abortion (aRR 1.97, 95% CI: 1.37-2.81). Conclusions: Over half of women use less effective contraception 3 months post-abortion, despite a high interest in more effective contraception. Additional research is needed to understand contraceptive decision making in the context of abortion care to inform interventions to increase contraceptive uptake.

Interventions using social networking sites to promote contraception in women of reproductive age.

Social networking sites (SNSs) have great potential as a platform for public health interventions to address the unmet need for contraception. To evaluate the effectiveness of interventions using SNSs to promote the uptake of and adherence to contraception in reproductive-age women. We searched CENTRAL, MEDLINE, Embase, and six other databases on January 2018. We also searched Google Scholar, key conference proceedings, checked the reference lists of included studies, and contacted study authors to identify additional studies. We considered randomised controlled trials (RCTs) and non-randomised interventional studies (NRS) in women of reproductive age. SNSs requiring a social profile within a bounded or restricted-access system of shared connections were included. We also included trials that utilised SNSs only or as an adjunct to an intervention. Studies had to have a follow-up outcome assessment of at least three months. Two authors independently screened titles, abstracts and full-text studies, and extracted data from included studies. A third author was assigned to arbitrate areas of disagreement. Authors assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. We were unable to conduct a meta-analysis due to the heterogeneity of the study designs and outcome measures. Of the 461 unique records found, only two studies met our inclusion criteria. Both studies were conducted in the USA and were at high risk of bias. One RCT included 2284 women exposed to a web-based SNS or nothing. The groups were no different post intervention in their self-reported consistency of contraceptive use or knowledge of the relative effectiveness of different methods. There was a small but significant increase in the use of more effective methods (long-acting reversible methods) at 12 months' follow-up.The second study, a cluster RCT with 1578 women, used a closed Facebook page showing sexual health content compared to a modified Facebook news page that avoided sexual health content. They found no differences in the use of condoms at last act of sexual intercourse at six months or the intention to use condoms between the intervention and control groups. Despite the prevalence of SNSs, we found little scientific evidence to support the use of SNSs to improve contraceptive use or adherence among women.

Pregnancy preferences and contraceptive use among U.S. women: new insights using a validated prospective instrument

Objectives: Research documents frequent inconsistencies between women’s reported pregnancy intentions and contraceptive behavior. However, limitations in the conceptualization and measurement of pregnancy intention have made it difficult to determine how feelings and preferences about pregnancy contribute to contraceptive use patterns and less intended pregnancy. Furthermore, it is unknown whether stronger motivation to avoid pregnancy is associated with use of more effective methods.

LITHIUM: RESOURCES, PRODUCTION AND PROSPECTS OF WORLD MARKET DEVELOPMENT

The paper deals with lithium which is currently characterized by one of the fastest growth rates in terms of price, consumption and production volumes. We have estimated the rates of consumption, the growth in production volumes and the growth of the explored volumes of lithium mineral resources and have given forecast of development of the world lithium market, growth of lithium production and price dynamics. Thus, the increase in world production of lithium by 2020 should exceed 12,000 tons per year. The increase in the consumption of lithium is shown to stimulate the growth of geological exploration of its mineral resources and to lead to a sharp increase in the explored lithium reserves. Moreover, we have attempted to evaluate other lithium mineral resources including those with a low content of lithium. The analysis demonstrate that, in accordance with existing technologies and speed of the lithium production growth, lithium ore will run out in about 25 years, and lithium reserves of proven resources associated with salt lakes will be depleted in about 50 years. The paper suggests several ways of solving this problem. The first one is an increase in the extraction of lithium from existing sources of raw materials, that is, the use of more effective methods. The second one is the use of lean lithium resources, such as underground brines and associated oil waters which can become the most promising source of lithium (the possible directions and prospects of extraction have been shown). The third way is the use of secondary lithium resources and the processing of spent lithium batteries. Keywords: lithium; lithium market; world reserves of lithium; lithium mining; underground brines; associated oil waters.

IMPROVING THE EFFICIENCY AND QUALITY OF BUSINESS PROCESSES USING BPMS

Organizations that have set themselves ambitious goals sooner or later have to choose a strategy of development: extensive , due to the growth of production or resource intensive - through the use of more effective methods . It is well known that the implementation of an extensive strategy, organization will face a situation where the coordination efforts on the increased number of employees are comparable with the effect of their activities. Labour productivity is defined not by the level of development of technologies or used equipment. High degree of automation does not guarantee high performance. The latter is a result of proper organization of work – the business processes. To get the most benefits from the process approach, it is necessary to use special means , which are called control system BP (Business Process Management System). This term means: first, information technology, pro-vides an executable model generation process directly from the graphical model of PD, and secondly, the concept of continuous improvement management BP, offering an evolutionary approach to the changes aimed at improving business efficiency. In this paper , based on the analysis of commercial banks concludes application prospects BPMS to automate business processes. Alternatives up process management method not the current state of the economy does not allow enterprises to develop extensively.

Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review

AimTo systematically review the literature on contraceptive use by women with opioid and other substance use disorders in order to estimate overall contraceptive use and to examine method choice given the alarmingly high rate of unintended pregnancy in this population. MethodPubmed (1948–2014) and PsycINFO (1806–2014) databases were searched for peer-reviewed journal articles using a systematic search strategy. Only articles published in English and reporting contraceptive use within samples of women with opioid and other substance use disorders were eligible for inclusion. ResultsOut of 580 abstracts reviewed, 105 articles were given a full-text review, and 24 studies met the inclusion criteria. The majority (51%) of women in these studies reported using opioids, with much smaller percentages reporting alcohol and cocaine use. Across studies, contraceptive prevalence ranged widely, from 6%–77%, with a median of 55%. Results from a small subset of studies (N=6) suggest that women with opioid and other substance use disorders used contraception less often than non-drug-using comparison populations (56% vs. 81%, respectively). Regarding method choice, condoms were the most prevalent method, accounting for a median of 62% of contraceptives used, while use of more effective methods, especially implants and intrauterine devices (IUDs), was far less prevalent 8%. ConclusionsWomen with opioid and other substance use disorders have an unmet need for contraception, especially for the most effective methods. Offering contraception services in conjunction with substance use treatment and promoting use of more effective methods could help meet this need and reduce unintended pregnancy in this population.

Contraceptive counseling and postpartum contraceptive use

The objective of the study was to examine the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use. The Pregnancy Risk Assessment Monitoring System 2004-2008 data were analyzed from Missouri, New York state, and New York City (n = 9536). We used multivariable logistic regression to assess the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use, defined as any method and more effective methods (sterilization, intrauterine device, or hormonal methods). The majority of women received prenatal (78%) and postpartum (86%) contraceptive counseling; 72% received both. Compared with those who received no counseling, those counseled during 1 time period (adjusted odds ratio [AOR], 2.10; 95% confidence interval [CI], 1.65-2.67) and both time periods (AOR, 2.33; 95% CI, 1.87-2.89) had significantly increased odds of postpartum use of a more effective contraceptive method (32% vs 49% and 56%, respectively; P for trend < .0001). Results for counseling during both time periods differed by type of health insurance before pregnancy, with greater odds of postpartum use of a more effective method observed for women with no insurance (AOR, 3.51; 95% CI, 2.18-5.66) and Medicaid insurance (AOR, 3.74; 95% CI, 1.98-7.06) than for those with private insurance (AOR, 1.87; 95% CI, 1.44-2.43) before pregnancy. Findings were similar for postpartum use of any contraceptive method, except that no differences by insurance status were detected. The prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods. Women with Medicaid or no health insurance before pregnancy benefited the most.

Timing of contraceptive initiation and association with future sexual and reproductive outcomes.

Who initiates contraception before, at the time or after first sexual intercourse and how does timing of initiation affect future sexual and reproductive health (SRH) outcomes? Earlier initiation was associated with current utilization of more effective contraception, but had no impact on future unintended pregnancy, abortion or sexually transmitted infection rates, while later initiation was linked to higher rates of unintended pregnancies and abortions. Contraceptive behaviour at first intercourse is associated with later SRH outcomes. Data were drawn from the FECOND study, the last national SRH study in France, conducted in 2010-2011 by phone among 8645 individuals aged 15-49 years. Analysis was performed among 1552 women under the age of 30 years who were sexually experienced and had used contraception at some point. We used logistic regression models to identify factors associated with timing of contraception initiation relative to first intercourse (earlier, at the time and later) and its predictive value on future sexual and reproductive outcomes. Timing of contraceptive initiation across all three categories (earlier, at the time and later initiators) was dependent on women's age at the time of the survey, country of birth, education level, ease of discussing sex with mother and age of first sex. Using at the time initiators as a reference, later initiators had higher odds of unintended pregnancy [odds ratio (OR) = 1.8] and abortion (OR = 1.9), while earlier initiators were more likely to be using more effective contraception at the time of the survey (OR = 1.8). The exclusion of sexually inexperienced women, a quarter of which had ever used the pill, may have reduced the scope of our analysis on the relevance of contraceptive initiation for non-contraceptive benefits. The promotion of early initiation of contraception may contribute to long-term use of more effective methods of contraception. The FECOND study was supported by a grant from the French Ministry of Health, a grant from the French National Agency of Research (#ANR-08-BLAN-0286-01; PIs N. Bajos, C Moreau) and funding from the National Institute of Health and Medical Research (INSERM) and the National Institute for Demographic Research (INED). None of the authors have a conflict of interest.

Contraceptive use and the role of contraceptive counseling in reproductive-aged women with cancer

ObjectiveFew data on contraceptive choices in women with cancer exist. Contraception is challenging for women with cancer, particularly those with breast cancer, who are limited to nonhormonal methods. This study characterized contraceptive use during cancer treatment in a group of reproductive-aged women with a recent cancer diagnosis and assessed the impact of contraceptive counseling on the methods they selected. Study DesignCross-sectional, survey study of reproductive-aged women at a large tertiary care health system with a recent cancer diagnosis. ResultsA total of 107 women completed the survey. Eighty-two women reported 101 contraceptive choices. Twenty-seven percent (27/101) of all methods selected were Tier I/II, and 35% (35/101) were Tier III/IV. Only 4 used an intrauterine device (IUD). Among women reporting sexual activity after diagnosis, 19 (27%) of 71 reported using Tier I/II methods, 21 (30%) of 71 reported using Tier III/IV methods, 16 (23%) of 71 reported abstinence and 10 (14%) of 71 reported using no method. Factors significantly associated with Tier I/II use in the multivariable model included not having a college degree [odds ratio (OR) 0.21, 95% confidence interval (CI) 0.05–0.92, p=.038], intercourse during treatment (OR 5.92, 95% CI 1.48–23.66, p=.012) and non-breast cancer (OR 3.60, 95% CI 1.03–12.64, p=.046). Report of contraceptive counseling was positively associated with Tier I/II contraceptive use during cancer treatment (OR 6.92, 95% CI 1.14–42.11, p=.036). ConclusionReproductive-aged women diagnosed with cancer underutilized Tier I/II contraceptive agents, especially IUDs. Contraceptive counseling by physicians increases contraceptive use, particularly methods most effective at preventing pregnancy. ImplicationsThe study uniquely described the contraceptive practices of over 100 women with cancer. The study sample commonly reported abstinence and use of contraceptive methods with high failure rates. Our data suggest that contraceptive counseling from a health care provider may increase use of more effective methods among women with cancer.

Communicating contraceptive effectiveness: a randomized controlled trial.

Increasing the knowledge of women on effectiveness of contraceptive methods can lead to the use of more effective methods and reduce unwanted pregnancies and adverse outcomes. We aimed to compare three different approaches for increasing women's understanding of effectiveness of contraceptive methods. We ran-domly assigned 630 eligible women of reproductive age to one of the three groups. Each woman received one of three charts presenting pregnancy risk with each contraceptive method. Participants before and while reviewing the chart, answered to three key ques-tions about the effectiveness of the methods. The data were analyzed using chi-square, ANOVA and McNemar's tests in SPSS version 13. The most important reasons for choosing contraceptive methods were their effectiveness (45%), ease of use (18%) and few side effects (14%). At baseline, the participants' knowledge about the effective-ness of the methods was poor. Correct answers were 44% about comparing the effec-tiveness of the combined pills vs. that of condoms, 50% about intrauterine devices vs. injectables, and 52% about condoms vs. withdrawal. While reviewing the charts, the percentages significantly (p < 0.001) increased to 80%, 84% and 85%, respectively. All the three charts almost equally increased the correct responds to the questions. The three approaches had considerable and nearly identical effects on the promotion of women's knowledge about effectiveness of the contraceptive methods. Therefore, appropriate use of the charts is required during counseling sessions for contraceptive choice because it is impossible to have informed choice of the method without understanding their effectiveness.

Emancipatory Sexuality Education and Sexual Assault Resistance

The current study examined whether adding emancipatory sexuality education, which encourages the exploration of women’s own sexual values and desires, to a sexual assault resistance program would improve women’s resistance to sexual assault by known men. The participants were 214 first-year university students. A randomized experimental design evaluated the effectiveness of a basic and sexuality enhanced version of a sexual assault resistance program against a no-program control. Both programs, compared to the control group, increased women’s perception of their own risk, their confidence that they could defend themselves if attacked, and their use of more effective methods of self-defense in hypothetical situations of acquaintance sexual assault. Effects were maintained from 3 to 6 months after program completion. No significant reductions in completed sexual assault were found. The sexuality enhanced program was superior in several areas, particularly risk detection and initiation of sexual activity, which may be important to women’s integration of the program’s content to their lives. Future research will need to strengthen and continue to evaluate the promising programs for women which now exist. Until effective programming for men on campus is developed and implemented widely, our best hope to improve the health and safety of female students lays in comprehensive women-only multi-unit sexual assault resistance education.

Impact of post-abortion family planning services on contraceptive use and abortion rate among young women in China: a cluster randomised trial

Objectives To compare two post-abortion family planning (FP) service packages on contraceptive use and repeat abortion rate among young women in three cities in China.Methods In this cluster-randomized trial, one FP service package included provision of limited information and referral to existing FP services, and the other, more comprehensive, package consisted – in addition to the above simple package – of individual counselling, free provision of contraceptive materials, and involvement of the male partner. Eight matched pairs of hospitals were certified by centralized randomization. Women undergoing abortion were followed up for six months, and data were collected in two rounds, before and after the intervention.Results We followed a total of 2336 women younger than 25 years (555 before and 555 after the simple intervention package; 634 before and 592 after the comprehensive intervention package). Both packages increased use of any contraceptive method, but the comprehensive approach also increased use of more effective methods. Odds ratios for consistent and correct use of condoms were 2.32 (95% confidence interval 1.55–3.46) and 2.78 (1.81–4.26), respectively, compared with the simple package. The rates of unwanted pregnancies and repeat abortions were somewhat reduced for both packages, with no significant statistical difference between them.Conclusion Couples who received the comprehensive post-abortion FP service appear to use more effective contraceptive methods and show better compliance.

Costs and net health effects of contraceptive methods

<h2>Abstract</h2><h3>Background</h3> Pregnancy and contraceptive methods both have important health effects that include risks and benefits. The net impact of contraception on women's health has not been reported previously. <h3>Study design</h3> This is a cost-utility analysis using a Markov model evaluated by Monte Carlo simulation using the societal perspective for costs. The analysis compared 13 methods of contraception to nonuse of contraception with respect to healthcare costs and quality-adjusted life years (QALYs). Discounting was applied for future costs and health effects. The base-case analysis applies to women of average health and fertility, ranging from 15 to 50 years of age, who are sexually active in a mutually monogamous relationship; smoking rates observed in women of reproductive age were used. Sensitivity analysis extended the analysis to nonmonogamous status and smoking status. <h3>Results</h3> Compared with use of no contraception, contraceptive methods of all types result in substantial cost savings over 2 years, ranging from US$5907 per woman for tubal sterilization to US$9936 for vasectomy and health gains ranging from 0.088 QALYs for diaphragm to 0.147 QALYs for depot medroxyprogesterone acetate. Compared with nonuse, even with a time horizon as short as 1 year, use of any method other than sterilization results in financial savings and health gains. Most of the financial savings and health gains were due to contraceptive effects. In a population of patients, even modest increases in the use of the most effective methods result in financial savings and health gains. <h3>Conclusions</h3> Every method of contraception dominates nonuse in most clinical settings. Increasing the use of more effective methods even modestly at the expense of less effective methods will improve health and reduce costs. Methods that require action by the user less frequently than daily are both less costly and more effective than methods requiring action on a daily basis.

Costs and net health effects of contraceptive methods

Background Pregnancy and contraceptive methods both have important health effects that include risks and benefits. The net impact of contraception on women's health has not been reported previously. Study design This is a cost-utility analysis using a Markov model evaluated by Monte Carlo simulation using the societal perspective for costs. The analysis compared 13 methods of contraception to nonuse of contraception with respect to healthcare costs and quality-adjusted life years (QALYs). Discounting was applied for future costs and health effects. The base-case analysis applies to women of average health and fertility, ranging from 15 to 50 years of age, who are sexually active in a mutually monogamous relationship; smoking rates observed in women of reproductive age were used. Sensitivity analysis extended the analysis to nonmonogamous status and smoking status. Results Compared with use of no contraception, contraceptive methods of all types result in substantial cost savings over 2 years, ranging from US$5907 per woman for tubal sterilization to US$9936 for vasectomy and health gains ranging from 0.088 QALYs for diaphragm to 0.147 QALYs for depot medroxyprogesterone acetate. Compared with nonuse, even with a time horizon as short as 1 year, use of any method other than sterilization results in financial savings and health gains. Most of the financial savings and health gains were due to contraceptive effects. In a population of patients, even modest increases in the use of the most effective methods result in financial savings and health gains. Conclusions Every method of contraception dominates nonuse in most clinical settings. Increasing the use of more effective methods even modestly at the expense of less effective methods will improve health and reduce costs. Methods that require action by the user less frequently than daily are both less costly and more effective than methods requiring action on a daily basis.

Unintended Pregnancy in the United States

Current debates on how to reduce the high U.S. abortion rate often fail to take into account the role of unintended pregnancy, an important determinant of abortion. Data from the 1982, 1988 and 1995 cycles of the National Survey of Family Growth, supplemented by data from other sources, are used to estimate 1994 rates and percentages of unintended birth and pregnancy and the proportion of women who have experienced an unintended birth, an abortion or both. In addition, estimates are made of the proportion of women who will have had an abortion by age 45. Excluding miscarriages, 49% of the pregnancies concluding in 1994 were unintended; 54% of these ended in abortion. Forty-eight percent of women aged 15-44 in 1994 had had at least one unplanned pregnancy sometime in their lives; 28% had had one or more unplanned births, 30% had had one or more abortions and 11% had had both. At 1994 rates, women can expect to have 1.42 unintended pregnancies by the time they are 45, and at 1992 rates, 43% of women will have had an abortion. Between 1987 and 1994, the unintended pregnancy rate declined by 16%, from 54 to 45 per 1,000 women of reproductive age. The proportion of unplanned pregnancies that ended in abortion increased among women aged 20 and older, but decreased among teenagers, who are now more likely than older women to continue their unplanned pregnancies. The unintended pregnancy rate was highest among women who were aged 18-24, unmarried, low-income, black or Hispanic. Rates of unintended pregnancy have declined, probably as a result of higher contraceptive prevalence and use of more effective methods. Efforts to achieve further decreases should focus on reducing risky behavior, promoting the use of effective contraceptive methods and improving the effectiveness with which all methods are used.

Contraceptive Practice Doubles in Nigerian City Over a Five-Year Period

Two surveys carried out in 1983 and 1988 revealed that contraceptive use among married women aged 15-35 doubled in Ilorin Nigeria over the 5-year period. The largest relative increase in ever-use was noted among women with less education and the majority (88%) of these women had used a contraceptive method for the first time in the 4 years before the 1988 survey. Overall there was a shift toward the use of more effective methods over the period between the surveys. This sharp increase in method use reflects the abrupt decline in the oil-based economy of Nigeria and the resulting changes in fertility desires and in population policy and programs. In conclusion it is indicated that although it is still too early to announce the start of widespread fertility reduction in Africa the progress of family planning programs in Nigeria warrants close attention.

Wanted and Unwanted Fertility: Victoria 1971 to 1975

In both practical and subjective terms, birth control became more available in Victoria after 1971. During 1971 to 1975, this change seems to be more considerable than changes in social and economic factors affecting wanted births. Therefore it is hypothesized that, during this period, unwanted fertility declined more steeply than wanted fertility. Evidence of a growing use of more effective methods of birth control, and of the differential rates of change in various categories of births, appear to support this hypothesis. Births designated ‘unwanted’ declined more than those designated ‘wanted’, and within the ‘unwanted’ categories, declined most for those women who had best access to birth control.