Identifying Services Changes to Improve Contraceptive U*

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This project aims to improve contraceptive use and reduce unintended pregnancy in the United States by expanding the knowledge base needed to move from basic research to effective program and policy change. Specifically, our goals are to provide a comprehensive, national frame of reference or "map" of key factors contributing to poor contraceptive use from women's perspectives and to match this map with information on contraceptive service delivery practices in order to identify changes that have the greatest potential for reducing unintended pregnancy. To accomplish these goals, we propose to carry out three interrelated activities: (1) We will undertake a broad, comprehensive mapping of the difficulties women at risk of unintended pregnancy in the U.S. face in successfully using contraception and assess their priority for attention based on their contribution to national levels of unintended pregnancy. To accomplish this, we will collect data that do not now exist from a national sample of sexually active women at risk for unintended pregnancy. (2) We will ascertain the extent to which contraceptive service providers are aware of the problems hindering successful method use and are able to provide services that address factors leading to contraceptive failure and nonuse. We will obtain this information from surveys of national samples of publicly funded family planning clinics and of private physicians. (3) We will combine this information, findings from others' research, and advice from researchers and service delivery experts to identify policy and program limitations and make recommendations for next steps in service delivery and research that will help reduce markedly unintended pregnancy in the U.S. We expect that this project will identify factors hindering effective contraceptive use that are amenable to impact through service delivery (and those that are not, at least in the short run), and that it will result in greater consensus on what changes and new undertakings in contraceptive care are needed, which types of changes offer the largest potential reduction in unintended pregnancy levels, and what steps are needed to effect those changes. By identifying gaps in knowledge and effective intervention models, it will also stimulate new research and intervention development and evaluation.