Healthy People 2010 Focus Area 9:

Family Planning

Richard J. KleinProgress Review

November 6, 2008

Pregnancy

9-1 Intended pregnancy (females aged 15 to 44 years)9-4 Contraceptive failure-females experiencing pregnancy

(aged 15 to 44 years) 9-7 Adolescent 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)

Highlighted Objectives

*Percent of targeted change achieved is between -10% and 10% and/or statistically significant

Improving Getting worse

Little or no progress* Baseline onlyTarget met or exceeded

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

11 3 3

49

3328

Percent

At Risk of Unintended Pregnancy & Not Using Contraception

0

30

Pregnancy-Related International Comparisons

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.

10

20

50

40

USA France Scotland

Pregnancies that are Unintended

USA France UK

Births per 1,000 women age 15-19

Answered “right time or later” to the question: “Did you become pregnant too soon, at about the right time, or later than you wanted?”

52 51

31 31

5246

58 60

39 3847 43

61 62

20

30

0

80

Proportion of Pregnancies That are Intended

Obj. 9-1NOTE: 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.

10

Percent

Black

Race/ethnicity

White Poor

Near PoorTotal

1995 2002

Income

Hispanic

Increase desired

2010 Target: 70

Middle/

High

40

50

60

70

Obj. 9-1

Proportion of Pregnancies That are Intended

52 51 51 5057 53 53 48

6874 72 73

32 3724 23

< HighSchool

20

Percent

30

Education

0CurrentTotal

801995 2002 Increase desired

2010 Target: 70

Marital Status

10

Never

40

50

60

70

Former*HighSchool

SomeCollege

CollegeGrad

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.

Answered “right time or later” to the question: “Did you become pregnant too soon, at about the right time, or later than you wanted?”

Distribution of pregnancies

1812

40

26

57

25

67

22

71

12 3

62

20

Percent

30

Obj. 9-1

0

80

Proportion intended

Proportion of Pregnancies That are Intended and Distribution of Pregnancies

by Age, 2002

10

40

50

60

70

15-19 20-24 25-29 30-34 35-39 40-44NOTE: 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.

Increase desired

0 10 20 30

Percent

Total

White Hispanic

Black

PoorNear poor

Middle/high income

Never marriedMarried

Cohabiting

Proportion of Pregnancies Due to Contraceptive Failure, 2002

Obj. 9-4

= 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.

Decrease desired12.4 2010 Target: 8

Proportion of Women Who Became Pregnant While Using Contraception,

2002

8.7

17.4 18.4

25.3

6.70

5

10

15

20

25

30

35

40

Percent

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.

Proportion of Women Who Became Pregnant While Using Contraception,

2002

Rates did not change significantly between 1995 and 2002

42 4022

130

80

109

8363

0

20

40

60

80

100

120

140

Rate per 1,000 population 1996 2004 Decrease desired

Adolescent Pregnancy, Ages 15-17

2010 Target: 39

Obj. 9-7

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.

Total White Black Hispanic

Teen Pregnancy, Birth and Abortion Rates,

Ages 15-17Rate per 1,000 women

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.

Pregnancy rate

Birth rate

Abortion rate

0

10

20

30

40

50

60

70

80

90

100

1976 1980 1985 1990 1995 2000 2006

Teen Pregnancy, Birth and Abortion Rates, Ages 18-19

Rate per 1,000 women

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.

Pregnancy rate

Birth rate

Abortion rate

0

20

40

60

80

100

120

140

160

180

200

1976 1980 1985 1990 1995 2000 2006

49 4638

30

68 6955

46 4331

7564

15-17

20

Percent

Females

0Total 15-17

1995

Total

2002

100

Males

Never Married-Ever had Sexual Intercourse, Ages 15-19

18-19 18-19

40

60

80

SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

7183

67

8674

81 8291

8392

8190

15-17

20

Percent

40

Females

0Total 15-17

1995

Total

2002

Males

Never Married-Used Contraception at Last Intercourse, Ages 15-19

18-19 18-19

60

80

100

NOTE: Last intercourse within three months of interviewSOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

676158

38

22

0

20

40

60

80

100

Percent

Before 1980

1980’s 1990-1994

1995-1998

1999-2002

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.

Contraception Use at First Premarital Intercourse, 2002

43

61

7073

79

Percent who used condom

Percent who used any method

Year of First Intercourse

Total

15-17

18-19

20-21

22-24

Males, 15-24: Visit to Family Planning Clinic with Female Partner, 2002

Increase desired

2010 Target: 22

0 10 20 30 40 Percent

21

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. Obj. 9-6a

8

2015

8

1916

9

24

17

Percent

Birth Control Advice0

White Hispanic

30

STD Advice

Males, 15-24: Receipt of Specified Services in Last 12 Months, 2002

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 only persons who reported only one racial group.SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

10

20

HIV Advice

Black

40

9-7. Adolescent pregnancy 9-8a&b. Abstinence before age 15 years9-9a&b. Abstinence among adolescents9-10a-h. Pregnancy prevention and STD protection 9-11a-p. Reproductive health prevention education9-12. Problems in becoming pregnant and maintaining a pregnancy9-13. Insurance coverage for contraceptive supplies and services

9-1. Intended pregnancy 9-2. Birth spacing9-3. Contraceptive use9-4. Contraceptive failure9-5. Emergency contraception9-6a. Male involvement-gone to a FP clinic with female partner9-6b. Male involvement-gone to a FP clinic for himself9-6c. Male involvement-received birth control counseling

Status of Family Planning Objectives

*Percent of targeted change achieved is between -10% and 10% and/or statistically significant

Improving Getting worse

Little or no progress* Baseline onlyTarget met or exceeded

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

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

Progress review data and slides

are available on the web at:

http://www.cdc.gov/nchs/hphome.htm