•   consequences and is accompanied by contraception when appropriate. Similarly, advertising of contraceptive products and public service announcements regarding unintended pregnancy and contraception should be more plentiful.  

There is reason to be optimistic about enlisting the help of the media to reinforce messages about preventing unintended pregnancy. Over the last decade and more, programming has increasingly avoided the portrayal of smoking or drinking as glamorous, high-status activities, and seat belt use by actors in many movies and on television has increased significantly. In enlisting the help of the media in preventing unintended pregnancy, it will be important to ensure that any media-based social marketing efforts are theory-based, long-term, and carefully evaluated.

The second focus of the campaign to prevent unintended pregnancy should stress increasing access to contraception, especially the more effective methods that require contact with a health care professional. The committee was persuaded that one of the reasons for such high rates of unintended pregnancy in the United States is that, through a combination of financial and structural factors, the health care system in the United States makes access to prescription-based methods of contraception a complicated, sometimes expensive proposition. Private health insurance often does not cover contraceptive costs; the various restrictions on Medicaid eligibility make it an unreliable source of steady financing for contraception except for very poor women who already have a child; and the net decline in public investment in family planning services (especially those services supported by Title X of the Public Health Service Act), in the face of higher costs and sicker patients, may have decreased access to care for those who depend on publicly-financed services. Condoms, the most accessible form of contraception, provide valuable protection against STDs but must be accompanied by other contraceptive methods (preferably those that require a prescription) to afford maximum protection against unintended pregnancy. Unfortunately, other accessible nonprescription methods such as foam and other spermicides neither prevent the transmission of STDs nor offer the best protection against unintended pregnancy.

The two recommendations that follow take different approaches to increasing access to contraception: reducing financial barriers and broadening the pool of health professionals and institutions that promote pregnancy planning. These reflect the committee's conclusion that financial barriers may limit access to prescription-based methods of contraception, especially for low-income women, and that, overall, there are too few health professionals who actively promote