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Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

   

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

   

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

 

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

   

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

   

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

   

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

   

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

   

  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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
×

 

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

Suggested Citation:"Index." Institute of Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: The National Academies Press. doi: 10.17226/4903.
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Experts estimate that nearly 60 percent of all U.S. pregnancies--and 81 percent of pregnancies among adolescents--are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted.

Now, current issues--health care and welfare reform, and the new international focus on population--are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts.

This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs.

The Best Intentions explores problematic definitions--"unintended" versus "unwanted" versus "mistimed"--and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear.

Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care."

The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals. May

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