in part, the more generous policies and benefits that these countries offer pregnant women and young families. It may be that these supportive policies also make women less inclined to recall pregnancies as unwanted or mistimed. They may also help to encourage better contraceptive use, as evidenced by their lower rates of unintended pregnancy (Chapter 2), both by enhancing access to family planning services and by strengthening the consensus that pregnancy and childbearing are too important to be undertaken casually, accidentally, or unintentionally.

Data on Overall Access

A variety of data sets are available to consider recent trends in access to contraceptive services. In the aggregate they give a mixed picture. Using the National Survey of Family Growth (NSFG), Mosher (1990) concluded that the proportion of all women aged 15–44 who have had one or more "family planning visits" in the preceding year did not change significantly between 1982 (37 percent) and 1988 (35 percent), and that this evidence of little or no change held across all age and income groups.

However, investigators at the Center for Health Economics Research, using the same data set, recalculated the proportions who had had a family planning visit on the basis of the number of women in each category who were estimated to be sexually active (or were planning to be), and concluded that, among this subset, there was an important decline in family planning visits among teenagers and among both poor (below 200 percent of the poverty level) and nonpoor women between 1982 and 1988. For example, they calculated that of sexually active women under age 20 in 1982, 65 percent had had a family planning visit in the preceding year, versus 57 percent in 1988; for poor women, the figure was 46 percent in 1982 and 42 percent in 1988 (Robert Wood Johnson Foundation and the Center for Health Economics Research, 1993). The investigators believe that these data reflect increased problems with access to contraceptive services (although they may also reflect decreased interest in securing contraception).

Bits of information from various parts of the country suggest that access to the more effective methods of contraception—that is, those requiring some sort of contact with the health care system—may be constrained, particularly in the public sector. For example, in December 1992 and January 1993, a team from the New York City Mayor's Advisory Council on Child Health called 115 service sites that offer family planning care in the city to request an appointment for contraceptive services; one-third of the callers were not able to make an appointment at all, and the rest confronted significant difficulties and delays. The authors concluded that because the family planning system was so underfunded and poorly organized, access was very limited and that, in addition, succeeding



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