Family planning perspectives
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About 50 studies based on the 1988 National Survey of Family Growth (NSFG) and a telephone reinterview conducted with the same women two years later provide continuing information about the fertility and health of American women. Among the findings of these studies are that black women have almost twice as many pregnancies as do white women (5.1 vs. 2.8), with nearly all of the difference being unintended pregnancies. Unwanted births increased between 1982 and 1988, particularly among less-educated, poor and minority women. ⋯ Rates of teenage pregnancy were fairly stable during the period 1980-1988, as increases in the proportion of teenagers having intercourse were offset by increases in condom use. Rates of infertility did not change significantly in the 1980s, but because of delayed childbearing and the aging of the baby-boom cohort, the number of older childless women increased substantially. The 1995 NSFG was redesigned in a number of ways in order to answer a new generation of questions about fertility and women's health in the United States.
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A review of five rigorously evaluated adolescent pregnancy prevention programs shows that all five incorporate an emphasis on abstinence or delay of sexual initiation, training in decision-making and negotiation skills, and education on sexuality and contraception. Four of the five directly or indirectly provide access to contraceptive services. ⋯ Three of these four programs also significantly increased rates of contraceptive use among participants relative to controls; the most successful programs, which increased contraceptive use by as much as 22 percentage points, provided access to contraceptive services and targeted adolescents who were younger and those who were not yet sexually experienced. Two programs significantly decreased the proportion of adolescents who became pregnant; these programs were the two that were most active in providing access to contraceptive services.
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A review of about 50 studies based on the 1982 National Survey of Family Growth (NSFG) illustrates the ways in which the survey sheds new light on trends and differentials in such areas as fertility, contraceptive use, infertility and the use of family planning services in the United States. The total fertility rate declined by nearly 50 percent between 1960 and 1973, from 3.6 to 1.9 births per woman, and changed little from then until 1982. It would appear that growing use of the pill, the IUD and sterilization--but principally the pill--is the prime factor in the dramatic decline in unwanted and mistimed births among married couples. ⋯ Despite the increasing levels of premarital exposure, however, there was actually a decline in teenage birthrates in the 1970s, which was due in part to the rising abortion rates among teenagers. Finally, although racial differences in fertility have narrowed, black women still have higher fertility than whites. The 1982 NSFG data suggest that four factors are principally responsible for the higher birthrates of black women: Blacks begin having intercourse earlier than whites; black women are one-third less likely to use contraceptives at first intercourse; they are more likely to be currently exposed to the risk of unplanned pregnancy and not using a method; and they have higher pregnancy rates when they are using no contraceptives or less-effective methods, such as the condom, rhythm and withdrawal.
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Ever since induced abortion was legalized in the United States, there has been a running controversy over whether induced abortion affects subsequent childbearing; for example, it has been claimed that women who terminate a pregnancy are at a greater risk of miscarrying a subsequent pregnancy or of having a low-birth-weight baby. Ten studies of the later impact of first-trimester induced abortion by vacuum aspiration (the dominant method in the United States) are examined here; they find that compared with women who carry their first pregnancy to term, women whose first pregnancy ends in induced abortion have no greater risk of bearing low-birth-weight babies, delivering prematurely or suffering spontaneous abortions in subsequent pregnancies. ⋯ In addition, some evidence from other studies links dilatation and curettage (D&C) procedures with later infertility, but most studies have found no such association. No definite conclusions can be reached about the impact of multiple induced abortions, since the results of 13 different epidemiologic studies are almost evenly divided between those that show no effect and those reporting related reproductive problems.