informally, during committee meetings and at other times, with experts on the various topics it was studying; requested one original piece of analytic work by The Alan Guttmacher Institute using the 1988 National Maternal and Infant Health Survey; conducted an analysis of what the childbearing population in the United States would look like if unintended pregnancies were eliminated; and held five meetings of the full committee over a 14-month period (from September 1993 through October 1994). Both committee members and staff participated in drafting the report. In addition, a careful effort was made to learn about programs in place around the country that address unintended pregnancy; the methods used in that portion of the committee's work are described in more detail in Chapter 8.

Following this introductory chapter, Chapter 2 presents data on rates of and trends in unintended pregnancy and on the populations in which unintended pregnancy is concentrated. Chapter 3 summarizes data on the health and social consequences of unintended pregnancy from the perspective of children and adults and discusses abortion as a major consequence of unintended pregnancy. It also addresses the socioeconomic consequences for children and their mothers of both adolescent parenthood and childbearing among unmarried women, because unintended pregnancy is particularly common among women who are teenaged, unmarried, or both.

Subsequent chapters address the fundamental question that unintended pregnancy poses: Why do Americans report such high levels of unintended pregnancy, even in the presence of numerous contraceptive methods? The most immediate and obvious answer, of course, is contraceptive nonuse, misuse, or failure. Thus, Chapter 4 is devoted to reviewing patterns of contraceptive use as they relate to unintended pregnancy.

The report then moves on to a discussion of factors that influence contraceptive use. Information on these factors—often called determinants—is scattered and often confusing and is peppered with as much opinion as data. On one point, however, there is clear consensus: many, many factors affect the use of contraception and thus unintended pregnancy. The committee found it helpful to group these factors into three sets: (1) knowledge about contraception, unintended pregnancy, and human reproduction in general, as well as access to contraception itself; (2) personal motivation, attitudes, beliefs, and feelings related to contraceptive use; and (3) the overall socioeconomic and cultural environment.

Chapter 5 addresses the first set of factors, asking whether unintended pregnancy may be explained in part by insufficient knowledge about contraception and related topics, as well as by limited access to the most effective methods of birth control. In the discussion of knowledge about contraception, schools and the media are highlighted; in the area of access to contraception, the emphasis is on financial and other barriers that limit an individual's ability to secure various methods of birth control.



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