Measuring and Explaining Unintended Pregnancy in the United States, 1987-2009

描述（由申请人提供）：个人、夫妇、卫生保健提供者和政策制定者为实现2010年健康人群减少全国意外怀孕率的目标所作的努力受到以下因素的阻碍：关于意外怀孕发生率的信息不完整，对导致意外怀孕率趋势和不同社会人口群体之间差异的因素了解不足，以及缺乏易于使用的工具来定期监测这些趋势和差异。为了应对这些赤字，该项目将：1。估计美国和主要社会人口亚群体的最新总怀孕和意外怀孕水平（2001年以来的第一次），包括年龄、婚姻和婚姻状况、贫困状况、种族/民族、教育、平等、宗教信仰和（最近一段时期的）移民身份。关于怀孕意向的全国数据是由全国家庭增长调查（NSFG）收集的，但关于五分之一以堕胎告终的怀孕，这些数据基本上是不完整的。我们将用从全国堕胎提供者普查和全国代表性堕胎妇女样本中收集的数据（由独立资助）来填补这一空白，并使用古特马赫研究人员开发的估计方法。2. 分析不同时间和不同社会人口亚组间意外怀孕率差异的关键中间因素的相对贡献。我们将确定这些因素（人口构成、性活动、生育能力、生育欲望、避孕药具使用和有效性）在1987-2009年的时间趋势和人口群体之间的差异中的作用。在此过程中，我们将使用多种方法进行测量（基于一个时间点的测量与跨较长暴露期的测量）和分析（描述性比较分析，分解和标准化技术以及多变量分析），以确定最稳定的结果。3. 估计经人工流产漏报校正的最新避孕药具使用失败率，以便向希望避免怀孕的性活跃夫妇提供信息和咨询，并确定方法使用有效性的变化对意外怀孕率趋势和差异可能产生的影响。4. 仅根据NSFG调查数据开发一种工具，用于监测意外怀孕风险和保护方面的人口趋势，可作为意外怀孕率本身的代表，但可以更频繁和更便宜地实施，从而补充实际比率的计算，这仍然是必要的，但只能以五年或更长时间的周期间隔进行。公共卫生相关性：为实现《2010年健康人口》的目标，即将意外怀孕从目前占所有怀孕的大约一半减少到30%，开展公共卫生工作，监测在解决不合时宜或意外生育对健康和社会的负面影响方面取得的进展；由于缺乏准确和定期的意外怀孕措施来调整主要监测工具（全国家庭增长调查）中堕胎漏报的情况，从而阻碍了减少人工流产的需要。现在特别需要采取准确、持续和频繁的措施来监测和了解意外怀孕趋势和亚组差异，因为最近公布的数据表明出生率和堕胎率趋势可能发生变化。人们日益认识到，意外怀孕及其后遗症不仅是青少年和未婚妇女的问题，也是成年妇女和已婚妇女的问题，她们现在在意外怀孕和堕胎中占很大比例，因此，政策和方案也需要采取这些措施，以适当地应对这一问题。

DESCRIPTION (provided by applicant): Efforts by individuals, couples, health care providers and policymakers to achieve the Healthy People 2010 goal of reducing the nation's rate of unintended pregnancy are hampered by incomplete information about its incidence, by inadequate understanding of the factors driving unintended pregnancy rate trends and differences across sociodemographic groups, and by lack of easy-to-use tools for regular monitoring of these trends and differences. In response to these deficits, this project would: 1. Estimate up-to-date levels of total and unintended pregnancy (the first since 2001) for the United States and key sociodemographic subgroups, including age, marriage and union status, poverty status race/ethnicity, education, parity, religious affiliation, and (for the most recent period) immigration status. National data on pregnancy intendedness are collected by the National Survey of Family Growth (NSFG), but these data are substantially incomplete with regard to the one-fifth of pregnancies that end in abortion. We would fill this gap with data collected (with independent funding) from a national census of abortion providers and a nationally representative sample of women having abortions, and using estimation methodologies developed by Guttmacher researchers. 2. Analyze the relative contributions of key intermediate factors to differences in unintended pregnancy rates over time and across sociodemographic subgroups. We would ascertain the role of these factors - population composition, sexual activity, fecundity, desire for childbearing, contraceptive use and effectiveness) - in accounting for time trends 1987-2009 and for differences across population groups. In the process of doing so, we will use multiple approaches to measurement (measures based on one point in time vs. across a longer period of exposure) and to analysis (descriptive comparative analysis, decomposition and standardization techniques and multivariate analyses) in order to identify the most stable results. 3. Estimate up-to-date contraceptive use-failure rates corrected for underreporting of induced abortion, in order to inform and counsel sexually active couples who want to avoid becoming pregnant and to determine the possible impact of changes in method use-effectiveness on unintended pregnancy rate trends and differences. 4. Develop a tool based on NSFG survey data alone for monitoring population trends in unintended pregnancy risk and protection that can be used as a proxy for unintended pregnancy rates themselves, but can be implemented more frequently and less expensively and thus supplement the calculation of actual rates, which remain necessary but which can only be done at periodic intervals of five or more years. PUBLIC HEALTH RELEVANCE: Public health efforts to reach the Healthy People 2010 goal to reduce unintended pregnancy from its current proportion of roughly half to 30 percent of all pregnancies, to monitor progress in addressing the negative health and social consequences of mistimed or unwanted births, and to reduce the need for induced abortion are hindered by the lack of accurate and regular measures of unintended pregnancy that adjust for abortion underreporting in the primary monitoring tool (the National Survey of Family Growth). Accurate, ongoing and frequent measures are now especially needed to monitor and understand unintended pregnancy trends and subgroup differences, since recently published data indicate possible changes in birth and abortion rate trends. Such measures are also needed for policy and programs to appropriately respond to the growing recognition that unintended pregnancy and its sequelae are issues not only for adolescents and unmarried women, but also for adult and for ever-married women, who now account for a substantial proportion of unintended pregnancies and abortions.