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

Contents

• Committee On Unintended Pregnancy
• Acknowledgments
• Summary
• 1. Introduction
  • Focus of this Report
  • Study Methods and Report Organization
• 2. Demography of Unintended Pregnancy
  • Terminology
  • Percentage Rates of Unintended Pregnancy
  • Women at Risk of Unintened Pregnancy
  • Women Who Have Unintended Pregnancies
  • Trends in Unintended Pregnancy
  • The Role of Abortion
  • International Comparisons
  • Conclusion
  • References
• 3. Consequences of Unintended Pregnancy
  • Abortion as a Consequence Of Unintended Pregnancy
  • Maternal Demographic Status
  • The Effects of Intendedness
  • Preconception Care
  • The Demographic Implications of Reducing Unintended Pregnancy
  • Conclusion
  • References
• 4. Patterns of Contraceptive Use
  • Patterns of Contraceptive Use and Unintended Pregnancy
  • Contraceptive Use Among Men
  • Use of Dual Contraceptive Methods
  • Sexually Transmitted Diseases
  • Conclusion
  • References
• 5. Basic Requirements: Contraceptive Knowledge and Access
  • Knowledge, Skills, and School-Based Education
  • Access to Contraception
  • Missed Opportunities
  • Conclusion
  • References
• 6. Personal and Interpersonal Determinants of Contraceptive Use
  • A Comment on Available Data
  • Underlying Themes
  • Single Factor Investigations
  • Conclusion
  • References
• 7. Socioeconomic and Cultural Influences on Contraceptive Use
  • Diversity in U.S. Culture
  • Conflicting Views About Sexuality
  • Economic Influences on Fertility
  • Racism
  • Violence
  • Gender Bias
  • Opposition to Abortion
  • Conclusion
  • References
• 8. Programs to Reduce Unintended Pregnancy
  • National Programs
  • Local Programs
  • Cross-Cutting Themes
  • The Fiscal Impact of Family Planning Funding
  • Conclusion
  • References
• 9. Conclusions and Recommendations
  • A New Social Norm
  • The Campaign to Reduce Unintended Pregnancy
  • Campaign Leadership
  • References
• Appendixes
  • A Commissioned and Contributed Papers
  • B The Political Storms over Family Planning: Supplement to Chapters 1 and 7
  • C The National Survey of Family Growth: Principal Source of Statistics on Unintended Pregnancy: Supplement to Chapter 2
  • D Tables of Odds Ratios: Supplement to Chapter 3
  • E Technical Notes on the Recalculation Exercise: Supplement to Chapter 3
  • F Summaries of Evaluated Programs: Supplement to Chapter 8
  • G Assessing Program Effectiveness and Cost-Effectiveness: Supplement to Chapter 8
  • References

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This project was funded by the Carnegie Corporation of New York, which does not take responsibility for any statements or views expressed; the Robert Wood Johnson Foundation; and the U.S. Public Health Service (specifically the Maternal and Child Health Bureau, the Centers for Disease Control and Prevention, the National Institute of Child Health and Human Development, and the Office of Population Affairs).

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.