Family planning perspectives
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The National Maternal and Infant Health Survey provides new data on the prevalence of unintended childbearing in the United States: Thirty-six percent of births in 1988 were mistimed and 7% were unwanted, while 57% were intended. Although the level of unintended childbearing is high in almost all socioeconomic subgroups of women, the proportion of births that were mistimed or unwanted was 50% or more among age-groups 15-17 (78%), 18-19 (68%) and 20-24 (50%), and among never-married women (73%), formerly married women (62%), black women (66%), women living below the federal poverty level (64%) or at 100-149% of the poverty level (52%), women with less than 12 years of education (58%) and women who already had two children (53%) or three or more children (60%). ⋯ Among currently married women, those who are poorer are more likely than women above 150% of the poverty level to have a mistimed birth. Black women are more likely than either Hispanic or white women to report a birth as unwanted and are more likely than white women to say a wanted birth was mistimed.
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An analysis of data from 8,450 women interviewed in 1988 for the National Survey of Family Growth finds that teenagers, never-married women, black women and those with less than a high school education are less likely than other women to have a birth that is jointly desired by both partners; 29%, 35%, 45% and 51% of births, respectively, are wanted by both partners, compared with an overall average of 69%. Third and higher order births are also less likely than earlier births to be jointly planned--58%, compared with 69% of first births and 76% of second births. In situations in which the birth is not jointly planned, black women, unmarried women, teenagers and women having third or higher order births are all significantly more likely than other women in their race, marital status, age and birth-order categories to have a birth when the man's preference is unknown. Never-married women are significantly more likely than married women to have a birth when the woman desires one but the man does not, while black women are significantly more likely than white women to have a birth that the man wanted but that the woman did not.
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Approximately 2,614 agencies are providing family planning services in at least 5,460 clinics throughout the nation, a slight increase over the 2,462 agencies and 5,174 clinics that were estimated to be providing such services in 1983. Health departments operate an estimated 52% of clinic sites; Planned Parenthood affiliates, 15%; hospital, 6%; and other agencies, 27%. Although many agencies also offer noncontraceptive services, the large majority provide family planning services in separate clinic sessions devoted to that purpose. ⋯ While almost all of the agencies get some income from Medicaid (83%), only 15% receive more than 20% of their budget for contraceptive services from that source. The federal Title X program provides more than 20% of the budgets of 53% of agencies; state and local governments fund 40% of family planning agencies at that level; and client fees do the same for 32% of agencies. Some 92% of clinics with Title X funding provide the initial visit and a three-month supply of the pill without charge to clients with an income below the federal poverty level, compared with about 50% of clinics without Title X funding.
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Women aged 15-44 rate the pill, the condom, vasectomy and female sterilization most highly, according to 1992 data from an annual survey by Ortho Pharmaceutical Corporation of contraceptive attitudes and method use. The 6,955 survey respondents underrepresent women who are black or who have household annual incomes greater than $50,000, but they are similar to all American women in age, marital status and region of the country. About 74-84% of women giving an opinion view these methods favorably and 64% rate the hormonal implant favorably. ⋯ Pill use has increased since 1987, especially among married women, and condom use has increased among all women. Among unmarried women at risk of unintended pregnancy, condom use rose from 18% in 1987 to 33% in 1992. Among condom users, 40% of unmarried users and 13% of married users also use another method.