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thereby often finding themselves at odds with federal policy leaders. The intensity of the debate had the unfortunate effect of polarizing many groups who share a common interest in reducing adolescent pregnancy. Thus, the time seemed right for a review of the knowledge base regarding the causes, consequences, and prevention of unintended pregnancy, including the effectiveness of abstinence-based education.
Abortion is perhaps the most divisive issue related to unintended pregnancy. As any observer of the American scene over the last 20 years could readily discern, the abortion controversy has dominated discussions of reproductive health and has led to painful divisions across many ideological, political, and religious lines. The heated debate over the acceptability of abortion itself has diverted attention from many other important and closely related issues, such as finding ways to encourage couples to prevent both unintended pregnancy and STDs simultaneously or learning how best to offer contraceptive services in communities whose health care systems are changing rapidly. Put another way, in arguing about how to resolve problem pregnancies, less attention has been given to preventing such pregnancies in the first place. The controversy has also obscured the very important differences between abortion and contraception and has led, in some instances, to contraception being treated as gingerly as abortion. Among other results, this unfortunate confusion between abortion and contraception has shifted attention away from the proposition that better use of contraception is a highly effective way to reduce the incidence of abortion.
This is not to suggest, however, that unintended pregnancy in the United States would have been eliminated by now were it not for the abstinence and abortion controversies. In fact, only 40 years ago the notion of carefully planned, controlled fertility in this country seemed an elusive, futuristic goal with little reasonable chance of actually occurring. Many of the most effective reversible methods of contraception—for example, intrauterine devices and oral contraceptives—have only been available since the early 1960s and have just recently been joined by hormonal implants and injections. Moreover, it was only in 1965 that it was clearly declared legal in the United States for married couples to secure and use contraception (Griswold v. Connecticut); similar protection was not granted to unmarried individuals until 1972 (Eisenstadt v. Baird). Thus, modern patterns of contraceptive use in the United States—and even the legality of many methods—are recent developments. It would be unrealistic to expect that in the mid-1990s contraception would be used universally and with no errors, failures, or missteps along the way (additional historical perspectives are presented in Appendix B). The use of many forms of reversible contraception carefully and successfully can be a complicated undertaking that requires a unique convergence of several factors including a supportive social environment, peer and personal values consistent with diligent contraceptive use, affordable and accessible methods of contraception, and partner agreement and, often,