to become pregnant. For those women who become pregnant unintentionally, access to both high-quality prenatal care as well as to safe abortion is needed in order to present women and couples with a range of options for managing the pregnancy. Unfortunately, access to both services is limited, especially in some areas of the country (Institute of Medicine, 1988; Henshaw and Van Vort, 1994), a situation that requires focused attention, advocacy, and resolution. Restricted access to safe, legal abortion, in particular, is often associated with maternal mortality and morbidity, as was the case before the full legalization of abortion in the United States over two decades ago (Institute of Medicine, 1975). Recent reports from Romania further underscore the horrors that women face when they must live in an environment that fails to provide accessible, medically safe termination of pregnancy (The Lancet, 1995).
The first focus of the campaign to reduce unintended pregnancy should be to increase knowledge about contraception, unintended pregnancy, and reproductive health generally. The evidence summarized in Chapter 5 indicates that individuals of all ages are poorly informed about these issues. The fact that many people mistakenly believe that childbearing is less risky medically than using oral contraceptives and that so few providers or consumers know about emergency contraception are sobering examples of this problem. Misinformation can impede the careful and consistent use of contraception, particularly because many reversible methods in particular require considerable skill to be used properly. Although knowledge alone is often insufficient to increase contraceptive vigilance, it can be viewed as a necessary precondition to other actions needed to reduce unintended pregnancy.