Little is known about effective programming at the local level to reduce unintended pregnancy. Accordingly, the campaign to reduce unintended pregnancy should encourage public and private funders to support a series of new research and demonstration programs in this field that are designed to answer a series of clearly articulated questions, evaluated very carefully, and replicated when promising results emerge.
The focus and design of these new programs should be based, at a minimum, on a careful assessment of 23 programs identified by the committee whose effects on specific fertility measures related to unintended pregnancy have been carefully assessed. Evaluation data from these programs support several broad conclusions: (1) even those few programs showing positive effects report only small gains, which demonstrates how difficult it can be to achieve major decreases in unintended pregnancy; (2) because most evaluated programs target adolescents, especially adolescent girls, knowledge about how to reduce unintended pregnancy among adult women and their partners is exceedingly limited; (3) there is insufficient evidence to determine if "abstinence-only" programs for young adolescents are effective, but encouraging results are being reported by programs with more complex messages stressing both abstinence and contraceptive use once sexual activity has begun; (4) few evaluated programs actually provide contraceptive supplies; and (5) only mixed success has been reported from programs trying to prevent rapid repeat pregnancies among adolescents and young women.
The new research and demonstration programs should reflect several additional themes as well. Unintended pregnancies derive in roughly equal proportions from couples who report some use of contraception, however imperfect, and from couples who report no use of contraception at all at the time of conception. Although many individuals move back and forth between these two states over time, it may nonetheless be useful to develop specific strategies for each group, especially for the very high-risk group of nonusers. Another theme that should shape these research and demonstration programs is the need to develop and test out new ways to involve men more deeply in the issue of pregnancy prevention and contraception. And finally, these programs should explore how to build community support for contraception. Although contraceptive use is ultimately a personal matter, community values and the surrounding culture clearly shape the actions of individuals and couples. Accordingly, at least some demonstration programs should target both the community and the individual, and some might also work exclusively at the community level.