individuals clearly need increased attention and services, reducing unintended pregnancy will require that influential organizations and their leaders—corporate officers, legislators, media owners, and others of similar stature—address this problem as well.
As noted above, the committee calls for a campaign that is both multifaceted and long-term, emphases that derive from the data presented in Chapters 4 through 7 showing that no single factor accounts for unintended pregnancy and that the underlying issues are very complex. In truth, there are many antecedents to the problem: socioeconomic, cultural, educational, organizational, and individual. Therefore, only a comprehensive effort will succeed in reducing unintended pregnancy, as has been the case for other national campaigns, such as those to reduce smoking, limit drunk driving, and increase the use of seat belts. Unintended pregnancy will not be reduced appreciably, the committee believes, unless more individuals and institutions make a major commitment to resolving this problem. Similarly, the campaign must be long-term. Past experience teaches that brief, intermittent efforts to address important social and public health challenges have very limited success.
The U.S. Department of Health and Human Services, through its National Health Promotion and Disease Prevention Objectives, has urged that the proportion of all pregnancies that are unintended be reduced to 30 percent by the year 2000 (U.S. Department of Health and Human Services, 1990). The committee endorses this goal, and stresses that it is a realistic one, already reached by other industrialized democracies. Achieving this goal would mean, in absolute numbers, that each year there would be more than 200,000 fewer births that were unwanted at the time of conception and about 800,000 fewer abortions annually as well.
What should the campaign emphasize? Should it stress contraceptive services? School-based information? Abstinence? parent-child or male-female communication about contraception? Community norms regarding reproductive behavior? The specific skills required to use reversible methods? Or, to put these questions in a slightly different way, which factors best predict unintended pregnancy and should therefore be the main targets of action?
The information presented throughout this report, past experience in the public health sector with complex health and social issues, and common sense itself are all helpful in sorting through various options. The committee proposes a portfolio of activities to prevent unintended pregnancy that, like many public health campaigns, emphasizes basic information and preventive services accompanied by comprehensive program evaluation and research. It also addresses the important domain of personal feelings and relationships