It is clear that much effort and many resources at the local, state, and national levels have been applied to programs to affect sexual behavior and contraceptive use, with much attention focused on young women. Although no formal evaluations of the large programs that help to finance or directly provide contraceptive services (such as Title X and Medicaid) have been completed, the support that these programs furnish undoubtedly helps to increase access to contraception, and thereby helps individuals avoid unintended pregnancy. Evaluations of the long-term effects of these programs are sorely needed, but they will be difficult to design.
Although there are hundreds of programs at the community level that in some way address sexual or contraceptive behavior related to unintended pregnancy, few have been carefully evaluated, and knowledge is therefore very limited about how local programs can reduce unintended pregnancy. Those that have been evaluated illustrate several cross-cutting themes:
- because most of the evaluated programs target adolescents, especially adolescent girls, knowledge about how to reach adult women or men is exceedingly limited;
- there is insufficient evidence to determine whether abstinence-only programs have been effective in increasing the age at first intercourse;
- sexuality education programs that provide information on both abstinence and contraceptive use neither encourage the onset of sexual intercourse nor increase the frequency of intercourse among adolescents; in fact, programs that provide both messages appear to be effective in delaying the onset of sexual intercourse and encouraging contraceptive use, especially among younger adolescents;
- even though most of the evaluated programs encourage contraceptive use in some way, there is a notable reluctance to provide program participants with contraceptive methods themselves or to help participants gain access to contraceptive services at some other site;
- about half of the evaluated programs attempting to reduce rapid repeat pregnancy, especially among adolescents, have been successful; and
- little is known from the evaluated programs about how to influence sexual behavior or contraceptive use by changing the surrounding socioeconomic or cultural environment.
Finally, the weight of the evidence is that public funding of family planning services is likely to reduce net claims on public budgets. The magnitude of such reductions is much in doubt, and will remain in doubt until rigorous research can be directed to this topic.