Index

A

Abortion

  access issues, 209-211, 256, 282

  age variables in, 42

  as consequence of unintended pregnancy, 18, 23, 50, 51, 80, 210

  data sources, 25, 288, 290

  denied, and subsequent child well-being, 73

  effect of federal family planning programs on, 221-222

  insurance coverage, 139

  for intended pregnancies, 25 n.2

  international comparisons, 42-47

  marital status and, 41-42

  medical risk, 51-52

  neonatal mortality and, 72

  number of, 2, 21, 26, 41, 51, 210

  opposition movement, 208-211

  percentage rates, 2, 26, 41, 45, 251

  psychological issues, 53-54

  public policy development, 282-285

  rate of complications, 52-53

  reducing need for, 80-81, 253

  religious debate, 186-188

  research, 211, 230, 281, 285, 288, 290

  socioeconomic variables in, 42

  sociopolitical controversy, 16, 54, 251

  techniques, 52, 53, 283-284

  trends, 33, 210

  voting behavior and, 187-188

Abstinence, 111

  as one means to prevent pregnancy, 103

  efficacy, 9, 101, 255, 258, 265

  in evaluated programs, 9, 232-236, 265

  as pregnancy-reduction intervention, effectiveness of recommendations, 5, 255

  in school-based sex education programs, 15-16, 134-135

Access to contraception, 18, 126, 127

  anti-abortion movement and, 208-211

  bureaucratic obstacles, 148-150

  current status, 137-139, 244

  in evaluated programs, 236-238

  financial barriers to, 6-7, 139-145, 259-262

  in health maintenance organizations, 140

  individual psychological factors in, 169



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--> Index A Abortion   access issues, 209-211, 256, 282   age variables in, 42   as consequence of unintended pregnancy, 18, 23, 50, 51, 80, 210   data sources, 25, 288, 290   denied, and subsequent child well-being, 73   effect of federal family planning programs on, 221-222   insurance coverage, 139   for intended pregnancies, 25 n.2   international comparisons, 42-47   marital status and, 41-42   medical risk, 51-52   neonatal mortality and, 72   number of, 2, 21, 26, 41, 51, 210   opposition movement, 208-211   percentage rates, 2, 26, 41, 45, 251   psychological issues, 53-54   public policy development, 282-285   rate of complications, 52-53   reducing need for, 80-81, 253   religious debate, 186-188   research, 211, 230, 281, 285, 288, 290   socioeconomic variables in, 42   sociopolitical controversy, 16, 54, 251   techniques, 52, 53, 283-284   trends, 33, 210   voting behavior and, 187-188 Abstinence, 111   as one means to prevent pregnancy, 103   efficacy, 9, 101, 255, 258, 265   in evaluated programs, 9, 232-236, 265   as pregnancy-reduction intervention, effectiveness of recommendations, 5, 255   in school-based sex education programs, 15-16, 134-135 Access to contraception, 18, 126, 127   anti-abortion movement and, 208-211   bureaucratic obstacles, 148-150   current status, 137-139, 244   in evaluated programs, 236-238   financial barriers to, 6-7, 139-145, 259-262   in health maintenance organizations, 140   individual psychological factors in, 169

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-->       insurance system and, 139-140, 153, 259, 260   international comparisons, 136-137   issues in, 135-136   most effective contraceptives and, 138   obstacles for adolescents, 138   obstacles to, 138-139, 153-154   obstacles to research, 135   provider base and, 7, 145-148, 261-262   racial differences, 198   recommendations, 4, 6-7, 254, 257, 259-262   sterilization, 149-150   through public health programs, 137-138, 140-143, 148-149, 154   type of contraceptive method and, 135-136 Advertising, 6, 189, 191-193, 259 Age   abortion and, 42   choice of contraceptive method and, 103   condom use and, 110   father's, parenting styles and, 76   miscarriage risk, 60   risk of unintended pregnancy, 28, 34   sexual activity trends, 96, 116, 172, 189, 255   unintended pregnancy distribution, 31, 55, 250   See also Teenage pregnancy;   Women over 40 years old Agency for Health Care Policy and Research, 266 AIDS. See HIV/AIDS Aid to Families with Dependent Children, 56, 141, 195-197 Alan Guttmacher Institute, 18, 25, 45 Attitudes   about contraceptive advertising, 191   about contraceptive methods, 171-172, 267, 268   about sex education in schools, 132   about sexuality in U.S. culture, 188-189   health system contraceptive policy and, 137   issues in research on pregnancy intendedness, 64-66, 165-166, 269-270, 288-289, 290-292   of physicians toward discussing sex and other related topics, 147   during pregnancy, shift in, 22-23   racist, birth control policy and, 198-203   sexual, international comparison of, 193-194   See also Individual behavior and decision-making;   Social and cultural values B Baby Boom, 194 Benefit:burden ratio, 161-162 Benefit:cost analysis, 241, 339 Block grants, 142, 218-219, 261 Breast cancer, 52 Bureau of Primary Care, 266 C Campaign to reduce unintended pregnancy, 253-271 Canada, 43, 47 Centers for Disease Control and Prevention, 25, 266 Cervical cap, 111 Child abuse and neglect   later unintended pregnancy risk, 104-105   unintended pregnancy as risk factor, 1, 73-74, 81, 251 Child advocacy groups, 270-271 Child care, 74 Child health and well-being   child abuse risk, 1, 73-74, 81, 251   consequences of unintended pregnancy, 12, 50, 81, 251-252

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-->       developmental effects of pregnancy intendedness, 72-74, 81   effects of reducing unintended pregnancy, 79-80, 82   methodological issues in outcomes research, 64-66   outcomes research, 296   preventive public health interventions, 12   See also Fetal and neonatal health Child support, 15, 207 Clinical Laboratories Improvement Act, 143 Community level programs, 218-244 Community of Caring, 227, 311-312 Condom Mailing Program, 227, 312-313 Condoms, 8, 15, 263   access to, 136, 153, 208   age patterns in use of, 115-116   as contraceptive method of choice, 103, 108   determinants of use, 174-175   in dual-method contraception, 91, 118-119, 122, 258, 259-260   effectiveness of, 6, 259, 269   failure of, 99-100, 101, 172   patterns of use, 110-111, 269   race and ethnicity as factors in use of, 116   socioeconomic factors in use of, 117   use in first intercourse, 111-115, 116   user attitudes, 171-172 Congenital malformations, 60-61, 78-79 n.6 Contraceptive methods   access to most effective, 138   advertising, 6, 191-192, 258-259   coitus-dependent, 101, 110-111, 122, 171   coitus-independent, 8, 101, 103, 109-110, 122, 171, 258, 263, 267   dual-method, 91, 118-119, 122, 258, 259-260   effectiveness, 109, 111, 115, 122   emergency contraception, 128 n. 1, 146, 147, 258, 283-284   failure of method, technological failure in, 99-100, 172, 255-256, 267   failure rates, 101   hormonal implants and injections, 99, 103, 109-110   individual attitudes about, 171-172, 264, 267, 268   individual changes in use of or of type used, 94-96   insurance coverage, 139-140   long-term performance, 101-102   for male use, 10, 267   patterns of use, 103, 108-111   prescription vs. nonprescription, 135-136   pricing, 144-145   professional counseling in, 8, 261, 262-263   research in, 5, 9, 10, 266-267   reversible, 92, 94, 98, 99-103, 108-111, 122, 139, 267   sexually transmitted disease prevention, 119-122, 150-151, 153   side effects, 111   sterilization, 98-99   technical development, 16   technical shortcomings, 126-127   training of health care professionals, 7, 8, 145-148, 259-260, 261 -262, 263   See also Contraceptive use;   specific method Contraceptive sponge, 136 Contraceptive use   abortion debate and, 16   access to contraception and, 136   by adolescents, 108, 111, 115-116, 117, 129, 164-165   attitudes about contraceptive methods and, 171-172, 264, 267, 268   attitudes about fertility and, 169-170   attitudes about sexuality and, 168-169, 176   benefit: burden models, 161-162, 176

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-->     causes of unintended pregnancy in, 2, 91, 122   determinants of, 2-3, 16-17, 18, 268   family functioning as factor in, 173-174   federal funding for, 9, 218, 220, 264-265   first intercourse, 96, 111-115, 116   health risk in, 128   impact of income support payments in, 196-198   legal environment, 16   mass media portrayals, 189-190, 191, 192   by men, 111-117, 206-208   misuse, 18, 99-100, 101, 126, 171   motivational perspective, 162-165   opportunities for counseling through existing systems, 150-153   partner and couple issues, 174-176, 207   patterns of, 9, 92-96, 103, 108-111, 265   peer influences, 174, 175   personal factors in, 4, 7-8, 18-19, 160, 167, 168-170, 176, 253, 254, 262-263   planning of sexual activity and, 170   potential effects on birthrate, 72   public interest groups, 270-271   racist connotations in welfare policies, 198-203   recommendations for public education, 5-6, 256-259   recommendations for public policy, 4, 5-6, 254-257, 263   religious practice and dogma, 185-188, 279-282   research considerations, 66, 161, 176, 268, 292-295   research needs, 266-270   school-based sex education and, 131-135, 257   self-image and, 167   sexually transmitted disease risk and, 150-151, 153   sociocultural/socioeconomic factors in, 183-185   substance abuse and, 172-173, 176   trends, 138   unintended pregnancy in nonusers, 96, 122   unintended pregnancy in users, 98, 99-100, 122   user knowledge for, 126, 127-130, 153   user skills and effectiveness of, 130-131, 153   by women over 40, 108   See also Access to contraception Cost:benefit analysis, 241, 339, 347-348 Cost-effectiveness, 240 n.9, 338-339, 347-363 Couples' interpersonal relationships   consequences of unintended pregnancy, 81-82   contraceptive use, 115, 120, 174-176, 207   disagreement on pregnancy planning, 23   in evaluated programs, 232   research needs, 10, 268 D DALYS (disability-adjusted life-years saved) index, 339 Denmark, 136, 193 Depo-Provera, 109-110 Depression, 75 Diaphragm, 111   as contraceptive method of choice, 103   failure rate, 101   insurance coverage, 140   proper use, 130-131 Diversity   cultural-ethnic, 184-185   religious and political, 185-188

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--> Divorce   outcomes for children of single-parent families formed by, 63   as a result of an unintended birth, 61 Domestic violence, 75, 81   prevalence, 203 E Educational attainment   adolescent childbearing and, 55-56   of children from single-parent families, 61-63   father's, 75   proper contraceptive use and, 131 Elmira Nurse Home Visiting Program, 227, 313-314 Embarrassment, 169 Emergency contraception, 128 n.1, 146, 147, 258, 283-284 Employment issues, 195 Evaluation of programs   abstinence-based contraceptive strategies, 9, 233-236, 265   abstinence-only strategies, 9, 232-233, 265   access to contraceptive services, 9, 236-238, 265   adult interventions, 231-232   community level, 240   conclusions from, 9, 264-265   cost of, 229, 266   couples' interventions, 232   criteria, 225-226   cross-cutting themes, 231-240, 244   economic effects, methodology for measuring, 240-243, 244, 338-339, 347-363   effect on sexual behavior, 233-236   evaluated programs, 227-228, 228-240. See also specific programs   family planning programs, federal, 219-222   methodological issues, 229-230   obstacles to, 229   outcomes, 225, 228, 244, 338, 340-347   recommendations, 4, 7, 9, 254, 264-266   reduction of rapid repeat pregnancies, 9, 238-239, 265   self-reported data in, 230   social context of, 230-231   socioeconomic/cultural factors in, 239-240 F Facts and Feelings, 227, 233, 314-315 Family planning, 6   black perspective, 198-203   economic effects, 241-243, 244   effect on infant mortality, 72, 81   employment issues, 195   evaluation methodology, 338-339, 351-363   federally funded programs, 142-143, 218-222   funding issues, 240-242   male role in, 206-208, 256-257, 265   managed care systems and, 13   Medicaid coverage, 139, 141   medical approach, 152-153   neonatal health and, 72   provider base, 146-147   public policy development, 12, 278-285   trends, 137   See also Medicaid;   Programs to reduce unintended pregnancy;   Title X Family Support Act of 1988, 15 Fathers   impact of unintended pregnancy on, 75-76   preconception counseling, 79   socioeconomic consequences of absence of, 61-63 Fetal alcohol syndrome, 70 Fetal and neonatal health   abortion and subsequent pregnancy outcomes, 52

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-->       abortion for problems of, 25 n.2   adolescent childbearing risk, 58-59   childbearing by older women and, 60-61   effect of federally funded family planning programs, 221-222   family planning and, 72   low birthweight, pregnancy intendedness and, 70   maternal substance abuse, 68-70   outcome research, 296   preconception care, 77-78   sexually transmitted disease infection and, 120   spacing of pregnancies and, 70   in unintended pregnancy, 1, 81, 250-251   in unwanted pregnancy, 251   See also Child health and well-being;   Prenatal care Foam, 103 Folic acid, 78 Food Stamp Program, 196 France, 43 G Gender bias, 205-208 Genetic testing, 2, 78, 82, 251 Girls Incorporated Preventing Adolescent Pregnancy, 227, 315-316 Great Britain, 43, 45 Group Cognitive Behavior Curriculum, 227, 317 Guilt, 168-169 H Head Start, 12 Health and Human Services, U.S. Department of, 3, 253 Health care professionals   abortion providers, 210-211   discussion of sexual topics in primary care, 147-148, 151-152   nursing profession, 148   training for contraceptive counseling, 7, 8, 145-148, 260, 261-262, 263 Health care system   accessibility to contraception through, 6, 136, 148-150, 154, 259   early intervention for contraceptive counseling, 150-152   modeling of, 349-350   reform, 12-13   See also Insurance System;   Managed care Health maintenance organizations, 140 HIV/AIDS, 15, 115, 120, 268-269   sex education and, 132, 133 I Implants and injections, contraceptive, 267   insurance coverage, 140   pricing, 145   recommendations for, 258   removal, 145   welfare policy and, 200 Individual behavior and decision-making   among low-income adolescents, 163-165, 262   assessment of, in pregnancy surveys, 23-24   attitudes about contraceptive methods, 171-172, 267   attitudes about fertility, 169-170   attitudes about sexuality, 168-169, 176   benefit:burden models explaining contraceptive use, 161-162, 176   by child of single-parent family, 62   in contraceptive use, 4, 7-8, 18-19, 103, 120, 153, 160, 167, 176, 254, 262-264   couple and partner interactions, 174-176

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-->       determinants of proper contraceptive use, 131   locus of control perspective, 167   media influence, 192-193   modeling, 340-347   motivational perspective, 162-163   obstacles to research, 161   patterns of contraceptive use, 92-96   planning of sexual activity and, 170   preconception care, 77   prenatal care, 68-70   public welfare considerations in, 13-14   religious beliefs and, 187   research needs, 10, 269-270   risk of unintended pregnancy, 28-30   single-factor investigations, 166   strategic significance, 264   welfare considerations in, 196-198 Information gathering and processing, 17-18, 43 n.11   abortion data, 211, 288, 299   contraceptive use, 292-295   measures of pregnancy intendedness, 288-289, 290-292   methodological issues in outcomes research, 64-66   pregnancy prevention programs for evaluation, 226   recommendations, 266   See also Evaluation of programs;   Research needs Insurance system   access to contraception and, 6, 139-140, 153, 259, 260   family planning programs and, 13   health care reform debate, 13   recommendations for, 6, 259, 260 Intended pregnancy   abortion for, 25 n.2   definition, 22, 23, 288   as focus of prevention efforts, 255   international comparisons, 42-43   measurement of, 43 n.11   number of births, 2, 27   number of pregnancies, 26   percentage rates, 25, 31 International comparisons, 19, 42-47   abortion policy and practice, 43-47   access to contraception, 136-137   nonmarital childbearing, 14 n.3   sexual attitudes, 193-194   teenage pregnancy, 42-43 International Conference on Population and Development (Cairo Conference), 19 Intrauterine devices, 129   access to, 147   insurance coverage, 140   patterns of use, 103, 109, 110 L Legal issues   abortion practice, 51, 53   contraceptive use, 16, 279-280   discussion of sexual topics in medical practice and, 147   drug- and alcohol-exposed infants, 70 M Managed care, 12-13, 267-268 Marital status   adolescent pregnancy trends, 56   births from unwanted pregnancy and, 38-39, 41   contraceptive use and, 96, 110-111, 115   data sources, 24   effects of unintended pregnancy on, 74   impact of income transfer programs on, 196-197   likelihood of abortion and, 41-42   never-married women, 31, 38, 41, 250   pregnancy intendedness and, 31   unintended pregnancy demographics, 34, 38, 50, 55, 250   See also Nonmarital childbearing;   Single-parent families Maternal and Child Health Bureau, 266

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--> Maternal health   adolescent childbearing risk, 58-59   health risk for older women, 60-61   preconception care, 77-78   risks of unintended pregnancy, 74-75, 81   in unintended birth, 1, 251 McCabe Center, 227, 238, 317-318 Media   contraceptive education, 127-128, 129   contraception use portrayed in, 189-190, 191   contraceptive advertising in, 191, 192   influence of, on sexual behavior, 192-193   recommendations, 6, 258-259   sexual attitudes and behaviors expressed in, 189-191   sexuality as topic of discussion, 15   violence and, 193 Media Project, 239-240 Medicaid, 6, 7, 12, 13, 19, 153, 218   adolescent services, 142   contraceptive coverage, 141, 196, 219, 259, 260-261   effect on unintended pregnancy rate, 7, 219, 222, 261   eligibility, 141   family planning coverage, 139, 140-142, 282   male role in contraception and, 207-208   spending, 141, 219   sterilization coverage, 149-150, 282 Miscarriage, 25 n.3   age-related risk, 60 Mistimed pregnancy   characteristics of women, 31   child development and, 72-74   definition, 22, 288   effects of eliminating, 50-51, 309-310   low birthweight and, 70   marital status and, 34, 38, 310   maternal behavioral risks and, 68-70   maternal risk in, 81   percentage rates, 25-27   prenatal care and, 66-68   program effectiveness in preventing, economic evaluation of, 242-243   research issues, 65, 290-291 Mortality   abortion, 51, 53   adolescent childbearing risk, 58-59   childbearing risk for older women, 60   infant, 70, 72, 220, 222   maternal, in unintended pregnancy, 74-75 N National Institute of Child Health and Human Development, 219 n.1, 266, 267 National Longitudinal Survey of Youth, 133 National Maternal and Infant Health Survey, 18, 24 n.1 National Survey of Families and Households, 23, 34 National Survey of Family Growth, 11, 22-25, 33-34, 64, 92, 98, 103, 165-166, 286-295 Netherlands, 43, 47 Neural tube defects, 78 New Chance, 227, 239, 319-320 Nonmarital childbearing   effects of reducing unintended pregnancy, 80, 81, 309, 310   intentionality in, 38   international comparisons, 14 n.3   public policy issues, 13-14   social attitudes and, 33 n.8   trends, 13-14, 309, 310   See also Single-parent families Nonmarital pregnancy   abortion outcomes, 41-42   assessing intentionality in, 38   research issues, 56   trends, 34, 38, 41   as unintended, risk of, 31, 50, 55, 250   See also Marital status Norplant, 109, 129, 140, 145, 200

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--> Norway, 47 Nursing profession, 148 O Office of Population Affairs, 266 Oral contraceptives, 100, 101, 103, 108, 109, 110, 135-136   as emergency contraceptive, 147   insurance coverage, 139-140   over-the-counter availability, 144 n.2, 152   pelvic examination in prescription process, 153, 169   pricing, 144-145   proper use of, 131   public understanding of, 5, 128, 130, 256 Ortho Birth Control Studies, 98 Ounce of Prevention Fund's Parents Too Soon Program, 227, 320-321 P Paternity establishment, 15 Political context   abortion in, 16, 54, 187-188   family planning concepts in, 278-285   religious beliefs and, 186, 187-188, 285 Postponing Sexual Involvement, 227, 234, 321-322 Posttraumatic stress disorder, 54 Poverty, 31-33, 41, 55, 263   abortion utilization and, 42   adolescent childbearing attitudes, 163-165, 166   Medicaid eligibility, 141   risk for adolescent mothers, 56 Preconception care, 2, 50, 76-79, 81, 251 Pregnancy rate, 47 Pregnancy Risk Assessment Monitoring System (PRAMS), 75 Prenatal care, 1, 250   access, 82, 256   adolescent childbearing, 59   effect of federally funded family planning programs, 221-222   obstacles to, 66   outcomes research, 296   pregnancy intendedness and, 66-68   social support network and, 68   See also Fetal and neonatal health Private sector   funding for adolescent pregnancy interventions, 225   in public-private consortium for reducing unintended pregnancy, 4, 252-253 Programs to reduce unintended pregnancy   access to contraceptive services, 9, 236-238, 265   contraceptive use, strategies for encouraging, 96   development of, 223-225   economic impact of, 242-244, 245   effects of funding withdrawal, 242   financing of contraceptive methods in, 6-7, 12, 259-61   focus on financial consequences, 195   goals, 3, 252, 254   in health care reform, 12-13   intervention through existing systems, 150-153   leadership, 252-253, 258-259, 270-271   male participation, 14-15, 206-208, 219, 257, 265   national programs, 218-222   noncontraceptive interventions, 8   opposition to, 255   personal motivation as factor in, 264   potential effects of, 79-80, 81, 253, 256, 308-310   public policy, evolution of, 12   recommendations for national campaign, 3-10, 252-266   research needs, 266-270

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-->       risk identification in, 81-82   social context, 240, 257, 263   training of physicians for, 146, 261-262   See also Evaluation of programs;   Schools, sex education in Project Redirection, 227, 238-239, 322-323 Project Taking Charge, 227, 233, 323-324 Psychological functioning   abortion and, 53-54   maternal depression risk in unintended pregnancy, 75   See also Individual behavior and decision-making Public education and information   for adults, 5, 135   for males, 258   media role in, 6, 259   public campaign for, 3-4, 252   sexual behavior topics in, 5-6, 256-259   through health care system, 150-152   See also Schools, sex education in Public health programs   abortion funding, 209   access to contraception, 137-138, 140-143, 148-149, 153-154   campaign to reduce unintended pregnancy as, 4, 254   family planning, 12, 240-242   federally funded clinics, 142-143   funding for contraceptive services, 141   health care reform debate, 12-13   national family planning programs, 218-219   perception of racism in, 202   sexually transmitted disease treatment in, 143   spending, 143   welfare reform debate, 13-14   See also Programs to reduce unintended pregnancy R Race/ethnicity   abortion utilization and, 47   adolescent childbearing outcomes, 56   condom use and, 116   low birthweight and, 70   nonmarital childbearing and, 14   outcomes for children of single-parent families and, 62-63   race-based perceptions of family planning policies, 198-203   risk of rape, 204   risk of unintended pregnancy and, 30, 33   sterilization patterns, 115   unwanted pregnancy resulting in birth and, 38-39, 41   U.S. diversity, 184-185 Rape, 203-205 Reducing the Risk, 228, 234-235 Religion   in contraception policy-making, 279-282   in family planning policy, 279, 285   U.S. diversity, 185-188 Reproductive age range, 28 Reproductive Health Screening of Male Adolescents, 227, 325-326 Research needs   contraceptive use, 5, 9-10, 266-270   individual behavior and decision-making, 10, 269   male contraceptive behavior, 265   measures of intentionality, 23-24, 269-270, 288-289   predictors of unintended pregnancy, 81-82   program efficacy, 9   public financing programs, effectiveness of, 7, 261   on unintended pregnancy, 17 RU 486, 284

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--> S School/Community Program for Sexual Risk Reduction Among Teens, 228, 236-237, 326-327 Schools, sex education in, 5   abstinence as a strategy to prevent pregnancy, 15-16, 131, 134-135   adolescent sexual activity and, 133-135, 235-236, 257-258   anti-abortion movement and, 211   approaches, 131   contraceptive education and information, 131-135, 256-258   effectiveness of, 134-135   evaluation of, 224-225   federal involvement, 224   opportunities for improvement, 132-133, 152   public support for, 132   recommendations for, 5-6, 257-258   religious conflict over, 186 Self Center, 228, 237, 328-329 Self-esteem, 167 Sexual behavior   abstinence-focused interventions, 15, 232-233, 255   adolescent counseling, opportunities for, 151-152   attitudes about, and contraceptive use, 168-169, 176   influence of media on, 192-193   international comparison of attitudes on, 193-194   in mass media advertising, 192   mass media portrayals, 189-193, 259   parent-child interpersonal relations and, 173-174   patterns of contraceptive use, 92-96   planned vs. unplanned, 170   public policy messages about, 5-6, 255   public willingness to discuss, 15   religious beliefs and, 185, 281-282   risk of unintended pregnancy, 28, 33   as a topic in routine medical care, 147-148   sex education and, 133-135, 233-236, 257-258   socioeconomic/cultural influences, 28, 163-165, 239-240   substance abuse and, 172-173   trends, 96, 189, 255, 281   U.S. attitudes, 188-189, 254-255   use of contraception at first intercourse, 96, 111-115, 116, 255   violence toward women, 203-205   See also Contraceptive use Sexually transmitted diseases, 6, 8, 14, 77, 91, 119-120, 254-255, 258-259, 263, 268-269   adolescent mothers, 59   condom use and, 171-172   contraceptive counseling in treatment for, 150-151   dual-method contraception and, 118-119, 258, 259   public health program spending, 143   public understanding of, 129-130   in sexual content of mass media, 191 Single-parent families   adolescent pregnancy and, 56   child outcomes, 61-63   formation of, 61, 63   See also Nonmarital childbearing Six School-Based Clinics, 228, 329-330 Smoking, 68-70 Social and cultural values, 91, 211-212   abortion and, 54   childbearing decisions among low-income adolescents, 163-164, 166, 262   contraceptive use and, 9, 16, 19, 174, 175, 183-184, 265-266, 268   in evaluated programs, 239-240   gender bias in, 205-208   international comparisons, 193-194   peer influences in contraceptive use, 174, 175   pregnancy planning, 3, 252   public policy and, 5-6, 255-256, 281

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-->       religious belief in, 185-188   research needs, 10   sexual content of mass media expression, 189-193   sexuality in U.S. culture, 188-189, 255   U.S. diversity, 184-188, 254-255   value attached to children, 194-195   willingness to discuss sexual subjects, 15 Socioeconomic consequences of births from unintended pregnancies, 1, 18, 50, 74, 251   adolescent childbearing outcomes, 55-58, 195   for child of single-parent family, 61-63   cost-effectiveness modeling, 338-339, 347-363   effect on fathers, 76   for older women, 60 Socioeconomic variables of unintended pregnancy, 31-33, 47, 250   abortion utilization, 42   access to contraception, 6-7, 259-262   contraceptive use, 117, 183-184   decision-making among poor adolescents, 163-165, 166, 262   economic influences on fertility, 194-195   in evaluated programs, 239-240   prenatal care, access and delivery, 66   risk factors, 28, 47-48   strategic significance, 263   unwanted pregnancies resulting in birth, 39-40, 41 Spermicides, 111, 136 St. Paul School-based Health Clinics, 228, 237, 330-331 Sterilization, 28, 98-99   access to, 6, 282   as contraceptive method of choice, 103, 108   gender differences, 115   insurance coverage, 139   obstacles to access, 149-150   racism and, 199-200, 201-202   sociodemographic variables, 282 n.1 Substance abuse, 33   contraceptive counseling in treatment for, 151   contraceptive use and, 172-173, 176   preconception care, 77   rape and, 203, 205   risks in pregnancy, 68-70 Success Express, 228, 232-233, 331-332 Sudden infant death syndrome, 59 Summer Training and Education Program, 228, 239, 332-333 Sweden, 43 T Teenage Parent Demonstration, 228, 333-335 Teenage pregnancy   abortion outcomes, 53   abstinence-focused interventions and, 15-16   adolescent fathers, 75-76   age of father, 205   age at onset of menarche and, 31 n.6   child sexual abuse and, 205   contraceptive nonuse and, 96   contraceptive use, 108, 167   decision-making among low-income adolescents, 163-165, 166, 262   development of prevention programs, 223-225   educational attainment and, 55-56   effect of federal family planning programs on, 221   family planning trends, 137   income transfer programs and, 197-198   intentionality in, 38, 288-289   international comparisons, 42-43   involuntary sexual activity in, 204   marital status trends, 56   medical issues, 58-59

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-->       percentage of unintended pregnancies, 31, 252   rapid repeat, 238-239   risk for child of single-parent family, 62   sex education and, 133-135   socioeconomic outcomes, 55-58, 195   socioeconomic risk factors, 28   trends, 11-12, 13, 14   understanding of reproductive biology and, 129   unintended, percentage rate, 250 Teen Outreach Project, 228, 335-336 Teen Talk, 228, 235, 336-337 Title X, 12, 19, 142, 207-208, 209, 218   access to contraception in, 6, 7, 259-262   effect on unintended pregnancy rate, 219, 222   funding, 278   in health care reform debate, 13   origins and development, 278, 279   prospects for, 278-279   role of, 138, 219   spending, 219   utilization, 219 Title XX, 142 U Unintended pregnancy   benefits of reducing, 4, 79-80, 81, 253, 254   consequences of, 1, 250-251   data sources, 22, 23-25   definition, 11, 22   demographic trends, 2, 11-12, 18, 33-34-41, 250   extent of, 1, 2, 11, 25, 26-27, 92, 250   interrelationship of factors in, 2-3, 8, 10, 19, 211-212, 253   methodological issues in outcomes research, 64-66   methodological issues in research on determinants, 268   number of abortions for, 2, 21, 41, 251   percentage rates, 25-27, 28-31, 45   risk factors, 28-30, 45, 55   trends in births from unintended pregnancies, 33-41, 47   types of, 22 United Nations, 19, 206 Unwanted pregnancy   child development and, 72-74   definition, 22, 288   effects of eliminating, 50-51, 70, 81, 308-309   fetal health risk, 1, 251   likelihood of abortion for, 41-42   low birthweight and, 70   maternal behavioral risks and, 68-70   prenatal care and, 66-68, 81   program effectiveness in preventing, economic evaluation of, 242-243   research issues, 65, 290-291   trends in births from unwanted pregnancies, 38-41, 47 V Vasectomy, 98, 115 Violence, 193, 203   anti-abortion, 209, 211   domestic, 75, 81, 203   unintended pregnancy and, 203-205 W Welfare system   adolescent childbearing outcomes, 56   alcohol- and drug-exposed infants, 70   benefit: burden models in evaluation of, 162   child support payment and, 15   contraceptive services, perception of racism in, 198-203   marital status and, 196-197

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-->   pregnancy prevention programs and, evaluation of, 240-241, 242, 243 -244, 245 reform efforts, 13-14 unintended pregnancy trends and, 196-198 See also Title X Withdrawal method, 103, 111, 115 Women over 40 years old, 1-2, 5, 250, 256-257 abortion utilization, 42 contraceptive use, 94, 108 medical risk in childbearing, 60-61 percentage of unintended pregnancies, 31 program outreach for, 266 socioeconomic issues in childbearing, 60 Women's issues, 11, 271 child care, 74 gender bias, 205-208 violence against women, 203-205 Y Year 2000 objectives, 3, 253