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

描述（申请人提供）：个人、夫妇、卫生保健提供者和决策者为实现《2010年健康人民》降低全国意外怀孕率的目标所做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，对推动意外怀孕率趋势的因素和社会人口群体之间的差异了解不足，以及缺乏易于使用的工具来定期监测这些趋势和差异。针对这些不足，该项目将：1。估计美国和关键社会人口亚组的总怀孕和意外怀孕的最新水平（自2001年以来的第一次），包括年龄，婚姻和工会状况，贫困状况种族/民族，教育，奇偶性，宗教信仰和（最近一段时间）移民身份。全国家庭增长调查收集了关于怀孕意向的全国数据，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。我们将利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（独立资助），并使用古特马赫研究人员开发的估计方法来填补这一空白。2.分析关键中间因素对随时间推移和跨社会人口统计学亚组的意外怀孕率差异的相对贡献。我们将确定这些因素-人口组成、性活动、生育能力、生育意愿、避孕药具的使用和有效性-在解释1987-2009年的时间趋势和各人口群体之间的差异方面的作用。在此过程中，我们将使用多种方法进行测量（基于一个时间点与较长暴露期的测量）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.估计最新的避孕药具使用失败率，纠正人工流产的漏报，以告知和咨询希望避免怀孕的性活跃夫妇，并确定方法使用效果的变化对意外怀孕率趋势和差异的可能影响。4.开发一个仅以国家安全家庭小组调查数据为基础的工具，用于监测人口在意外怀孕风险和保护方面的趋势，该工具可用作意外怀孕率本身的替代指标，但可以更频繁地实施，成本更低，从而补充实际比率的计算，这仍然是必要的，但只能每隔五年或更长时间进行一次。 公共卫生相关性：* 公共卫生努力实现2010年健康人目标，将意外怀孕从目前占所有怀孕的大约一半减少到30%，监测在处理时机不当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，无法对堕胎报告不足进行调整，主要监测工具（全国家庭成长调查）。现在特别需要采取准确、持续和经常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，而且也是成年妇女和已婚妇女的问题，现在她们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.