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

说明(申请人提供)：个人、夫妇、保健提供者和政策制定者为实现2010年健康人降低全国意外怀孕率的目标所作的努力受到以下因素的阻碍：关于意外怀孕率的信息不完整，对导致意外怀孕率趋势和社会人口群体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。针对这些不足，该项目将：1.估计美国和关键社会人口亚群的最新总怀孕和意外怀孕水平(自2001年以来首次)，包括年龄、婚姻和结合状况、贫困状况、种族/族裔、教育、平等、宗教信仰和(最近时期)移民状况。全国家庭增长调查(NSFG)收集了关于怀孕意向的全国数据，但这些数据对于五分之一以堕胎告终的怀孕来说基本上是不完整的。我们将使用从全国堕胎提供者普查中收集的数据(用独立资金)和具有全国代表性的堕胎妇女样本来填补这一空白，并使用古特马赫研究人员开发的估计方法。2.分析关键中间因素对不同时期和不同社会人口子组意外怀孕率差异的相对贡献。我们将确定这些因素--人口构成、性行为、生育力、生育意愿、避孕措施的使用和效果--在解释1987-2009年的时间趋势和人口群体之间的差异方面所起的作用。在这样做的过程中，我们将使用多种方法来衡量(基于一个时间点的衡量，而不是较长的暴露时间)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.估计最新避孕药具使用失败率4.开发一种工具，仅根据NSFG的调查数据，监测意外怀孕风险和保护方面的人口趋势，该工具本身可以作为意外怀孕率的替代指标，但可以更频繁和更便宜地实施，从而补充实际怀孕率的计算，这仍然是必要的，但只能每隔五年或更长时间定期进行一次。与公共卫生有关：公共卫生努力实现2010年《健康人》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%，监测在解决不当或意外分娩对健康和社会的不利影响方面取得的进展，以及减少人工流产的需要，因为缺乏对意外怀孕的准确和常规的衡量标准，这些措施在主要监测工具(全国家庭增长调查)中对堕胎的报告不足。现在尤其需要准确、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和堕胎率趋势可能发生变化。政策和项目也需要采取这样的措施，以适当地应对越来越多的人认识到，意外怀孕及其后遗症不仅是青少年和未婚妇女的问题，也是成年和已婚妇女的问题，她们现在占意外怀孕和堕胎的很大比例。

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.