Improving Methods and Measures of Reproductive Health Outcomes

项目摘要 使用避孕药具避孕是影响生育能力的最重要行为之一， 人口，并决定个人生活的轨迹。但是，避孕失败会导致 意想不到的，往往是不想要的概念。几乎所有的美国妇女在她们的一生中的某个时候都会采取避孕措施。 生命和数百万人依赖于对失败风险的科学有效估计。临床医生也依赖 在这些关键措施，以咨询客户在他们的选择方法，以及建立广泛的做法， 具有广泛影响力的指导方针。而且，由于美国人口数据的高质量， 基于美国妇女经验的失败率被用于国际研究和政策应用。 事实上，很少有其他人口统计学研究成果能像避孕失败率那样被广泛使用。 尽管它们对公共卫生和研究具有重要意义，但没有提供新的方法学进展 在这一领域的工作在近30年，几乎没有研究存在，以阐明因素，占 避孕失败的风险在个人、人群、地点或时间上的差异。解决 现有研究的局限性，提高故障率估计的质量，并为研究开辟新的道路，我们 提出五个相互关联的目标。目标1将促进对差异化因素的理解 通过开发一个新的理论框架，特别关注避孕失败的经验， 个人对避孕失败风险的看法、信念、关系和外部影响。我们 将利用丰富的现有定性数据为框架的开发提供信息，然后设计和 分析新的调查问题，以在一项具有全国代表性的大规模生殖健康调查中检验这一框架。 年龄女性。在目标2中，我们将通过开发一种新的方法来推进避孕失败的测量 使用贝叶斯统计来估计故障率，以更充分地利用现有知识， 现有的方法限制了我们对人群中失败率变化的理解。在 目标3，我们将使用这些新的子组估计值来确定导致方法随时间变化的因素- 具体失败率和更有效地使用避孕措施在最近美国意外死亡率下降中的作用 怀孕率。这项工作不仅对美国人口的变化有重要意义，而且可能 还为审查全世界避孕药具使用影响的新方法提供信息。在目标4中，我们扩大了 通过审查国家政策对避孕失败的影响程度， 气候和居民的社会经济特征与避孕措施的变化有关。 失败的妇女谁拥有相似的人口特征，但生活在不同的国家。在目标5中，我们将与 由生殖保健提供者和领导人组成的咨询小组， 一套新的临床和公众使用的避孕失败率。

Project Summary Use of contraception for pregnancy prevention is among the most important behaviors affecting fertility in a population, and determining the trajectory of individual lives. But, contraceptive failures contribute to unintended, and often unwanted, conceptions. Almost all U.S. women use contraception at some point in their lives and millions of individuals rely on scientifically-valid estimates of the risk of failure. Clinicians also rely on these key measures to counsel clients in their choice of method as well as to establish broad practice guidelines with wide-reaching influence. And, because of the high quality of U.S. population data, contraceptive failure rates based on the experience of U.S. women are used in international research and policy applications. Indeed, few other products of demographic research are as widely used as contraceptive failure rates. In spite of their significance to public health and research, no new methodological advances have been offered in this area of work in almost 30 years and virtually no research exists to illuminate factors that account for variation in the risk of contraceptive failure across individuals, populations, locations or time. To address limitations of prior studies, improve the quality of failure rate estimates and forge a new path for research, we propose five linked aims. Aim 1 will advance understanding of factors that contribute to differential experiences with contraceptive failure by developing a novel theoretical framework specifically focused on individuals' perceptions, beliefs, relationships and external influences on the risk of contraceptive failure. We will exploit a wealth of existing qualitative data to inform development of the framework and then design and analyze new survey questions to test that framework in a large nationally representative survey of reproductive age women. In Aim 2, we will advance the measurement of contraceptive failure by developing a new approach for estimating failure rates using Bayesian statistics to more fully utilize existing knowledge and to surpass prior approaches that have limited our understanding of variation in failure rates across population groups. In Aim 3, we will use these new subgroup estimates to identify the factors that led to change over time in method- specific failure rates and the role of more effective use of contraception in recent declines in U.S. unintended pregnancy rates. This work has important implications not only for changes in the U.S. population, but could also inform new approaches to examining the impact of contraceptive use worldwide. In Aim 4, we expand our investigation to structural influences on contraceptive failure by examining the extent to which state policy climates and the socioeconomic characteristics of their residents are associated with variation in contraceptive failure for women who share similar demographic traits but live in different states. In Aim 5, we will work with an advisory panel of providers and leaders in reproductive health care to develop effective dissemination of a new set of contraceptive failure rates for clinical and public use.