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Pregnancy 9-1 Intended pregnancy (females aged 15 to 44 years)

Healthy People 2010 Focus Area 9: Family Planning Richard J. Klein Progress Review November 6, 2008. Baseline only. Target met or exceeded. Improving. Little or no progress*. Getting worse. Highlighted Objectives. Pregnancy 9-1 Intended pregnancy (females aged 15 to 44 years)

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Pregnancy 9-1 Intended pregnancy (females aged 15 to 44 years)

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  1. Healthy People 2010 Focus Area 9:Family Planning Richard J. KleinProgress ReviewNovember 6, 2008

  2. Baseline only Target met or exceeded Improving Little or no progress* Getting worse Highlighted Objectives Pregnancy 9-1 Intended pregnancy (females aged 15 to 44 years) 9-4Contraceptive failure-females experiencing pregnancy (aged 15 to 44 years) 9-7Adolescent pregnancy (per 1,000 population, aged 15 to 17 years) Male Involvement in Pregnancy Prevention 9-6a Gone to family planning clinic with female partner in last 12 months (unmarried males aged 15 to 24) • *Percent of targeted change achieved is between -10% and 10% and/or statistically significant

  3. Overview • 3.1 million unintended pregnancies in the US in 2001 (the last year for which data are available) • Unintended pregnancy is associated with: • Increased health care costs • Mothers more likely to smoke or use alcohol in pregnancy • Child more likely to be low birth weight • Depression in mothers more likely • Reduced school completion for mother • Lower income if mother is unmarried • Mother less likely to breastfeed • Less time and attention with child • In 2004, teen childbearing in the United States cost taxpayers at least $9.1 billion • Unintended pregnancies to teens are only 21% of all unintended pregnancies • Total costs of unintended pregnancies therefore much higher

  4. Pregnancy-Related International Comparisons Births per 1,000 women age 15-19 USA France Scotland Percent 50 40 30 20 10 0 USA France UK At Risk of Unintended Pregnancy & Not Using Contraception Pregnancies that are Unintended SOURCE: J Trussell and LL Wynn. 2008. Reducing Unintended Pregnancy in the United States. Contraception 77 (1): 1-5, January, 2008. Innocenti Report Card 7, 2007, UNICEF, Child poverty in perspective: An overview of child well-being in rich countries, Innocenti Report Card 7, 2007, UNICEF Innocenti Research Centre, Florence.

  5. Proportion of Pregnancies That are Intended 1995 2002 Increase desired 2010 Target: 70 NOTE: Data are for females ages 15 to 44 years. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white include only persons who reported only one racial group. SOURCE: L. Finer and S. Henshaw, “Disparities in Rates of Unintended Pregnancy in the US, 1994 and 2001.” Perspectives on Sexual and Reproductive Health 38 (2): 90-96, June 2006. Obj. 9-1 Answered “right time or later” to the question: “Did you become pregnant too soon, at about the right time, or later than you wanted?” Percent 80 70 60 50 40 30 20 10 0 Black Hispanic White Near Poor Middle/ High Poor Total Race/ethnicity Income

  6. Proportion of Pregnancies That are Intended Increase desired 2010 Target: 70 Answered “right time or later” to the question: “Did you become pregnant too soon, at about the right time, or later than you wanted?” Percent 1995 2002 80 70 60 50 40 30 20 10 0 < High School High School Some College College Grad Total Current Former* Never Marital Status Education NOTE: *Formerly married is defined as divorced, widowed or separated. Data are for females ages 15 to 44 years. SOURCE: L. Finer and S. Henshaw, “Disparities in Rates of Unintended Pregnancy in the US, 1994 and 2001.” Perspectives on Sexual and Reproductive Health 38 (2): 90-96, June 2006. Obj. 9-1

  7. Proportion of Pregnancies That are Intended and Distribution of Pregnancies by Age, 2002 Increase desired 15-19 20-24 25-29 30-34 35-39 40-44 Proportion intended Distribution of pregnancies Percent 80 70 60 50 40 30 20 10 0 NOTE: Data are for females ages 15 to 44 years. SOURCE: L. Finer and S. Henshaw, “Disparities in Rates of Unintended Pregnancy in the US, 1994 and 2001.” Perspectives on Sexual and Reproductive Health 38 (2): 90-96, June 2006.; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP. Obj. 9-1

  8. Proportion of Pregnancies Due to Contraceptive Failure, 2002 Proportion of Women Who Became Pregnant While Using Contraception, 2002 Decrease desired Total White Hispanic Black Poor Near poor Middle/high income Never married Married Cohabiting 12.4 2010 Target: 8 0 10 20 30 Percent = 95% confidence intervals are approximate; Exact confidence intervals are shown in Kost et al. Contraception 77 (2008) 10-21. NOTE: Figures reflect pregnancy occurring during a 12 month period of typical (not perfect) use of contraceptives. Data are for females ages 15-44. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white include only persons who reported only one racial group. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS. Obj. 9-4

  9. Proportion of Women Who Became Pregnant While Using Contraception, 2002 Percent Rates did not change significantly between 1995 and 2002 Injectables Pill Male Condom Withdrawal Calendar/ Rhythm = 95% confidence intervals are approximate;Exact confidence intervals are shown in Kost et al. Contraception 77 (2008) 10-21. NOTE: Data are for females ages 15-44. Figures reflect pregnancy occurring during a 12 month period of typical (not perfect) use of contraceptives. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

  10. Adolescent Pregnancy, Ages 15-17 2004 Rate per 1,000 population 1996 Decrease desired 2010 Target: 39 Total White Black Hispanic NOTE: Data are for females ages 15 to 17 years. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white only include persons who reported only one racial group. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP. Obj. 9-7

  11. Teen Pregnancy, Birth and Abortion Rates, Ages 15-17 Rate per 1,000 women 100 90 80 Pregnancy rate 70 60 50 40 Birth rate 30 Abortion rate 20 10 0 1976 1980 1985 1990 1995 2000 2006 NOTE: Data for 2006 birth rate are preliminary. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP.

  12. Teen Pregnancy, Birth and Abortion Rates, Ages 18-19 Rate per 1,000 women 200 180 Pregnancy rate 160 140 120 100 Birth rate 80 60 Abortion rate 40 20 0 1976 1980 1985 1990 1995 2000 2006 NOTE: Data for 2006 birth rate are preliminary. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP.

  13. Never Married-Ever had Sexual Intercourse, Ages 15-19 Percent 1995 2002 100 80 60 40 20 0 Total 15-17 18-19 Total 15-17 18-19 Females Males SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

  14. Never Married-Used Contraception at Last Intercourse, Ages 15-19 Percent 1995 2002 100 80 60 40 20 0 Total 15-17 18-19 Total 15-17 18-19 Females Males NOTE: Last intercourse within three months of interview SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

  15. Contraception Use at First Premarital Intercourse, 2002 Percent Percent who used condom Percent who used any method 79 73 70 61 43 Before 1980 1980’s 1990-1994 1995-1998 1999-2002 Year of First Intercourse NOTE: Data are for females ages 15-44. SOURCE: Chandra A, Martinez GM, Mosher WD, Abma J, Jones J. Fertility, Family Planning, and Reproductive Health of US Women: Data from the 2002 National Survey of Family Growth. Vital and Health Statistics Series 23, Number 25. Dec 2005. Hyattsville, MD: NCHS.

  16. Males, 15-24: Visit to Family Planning Clinic with Female Partner, 2002 Increase desired Total 15-17 18-19 20-21 22-24 21 2010 Target: 22 0 10 20 30 40 Percent Obj. 9-6a NOTE: Data are for unmarried males. Visits to family planning clinics occurred within the last 12 months. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

  17. Males, 15-24: Receipt of Specified Services in Last 12 Months, 2002 Percent White Black Hispanic 40 30 20 10 0 HIV Advice STD Advice Birth Control Advice NOTE: Data are for sexually experienced unmarried males. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white include onlypersons who reported only one racial group. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

  18. Status of Family Planning Objectives Baseline only Target met or exceeded Improving Little or no progress* Getting worse 9-1. Intended pregnancy 9-2. Birth spacing 9-3. Contraceptive use 9-4. Contraceptive failure 9-5. Emergency contraception 9-6a. Male involvement-gone to a FP clinic with female partner 9-6b. Male involvement-gone to a FP clinic for himself 9-6c. Male involvement-received birth control counseling 9-7. Adolescent pregnancy 9-8a&b. Abstinence before age 15 years 9-9a&b. Abstinence among adolescents 9-10a-h. Pregnancy prevention and STD protection 9-11a-p. Reproductive health prevention education 9-12. Problems in becoming pregnant and maintaining a pregnancy 9-13. Insurance coverage for contraceptive supplies and services *Percent of targeted change achieved is between -10% and 10% and/or statistically significant

  19. NSFG Data in the Future • The NSFG has begun continuous interviewing • Data for 2006-2008 will be available in late 2009 • Beginning late 2009, data will be available every 2-3 years; better for tracking progress on Healthy People objectives

  20. Summary • Half of all pregnancies in the US are unintended • Only college grads and married couples attained the target of 70% intended • Contraceptive failure rates did not improve overall or in any age or race group • Teen pregnancy rates fell between 1996 and 2004, especially for black teens • Less pronounced decline for Hispanic teens • In recent years declines in rates have leveled off • Young Black men are more likely to get all reproductive health services

  21. Progress review data and slides are available on the web at: http://www.cdc.gov/nchs/hphome.htm

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