Identifying Services Changes to Improve Contraceptive U*

该项目旨在通过扩大从基础研究转向有效计划和政策变革所需的知识基础，提高避孕药具的使用率，减少美国的意外怀孕。 具体而言，我们的目标是从妇女的角度提供一个全面的国家参考框架或“地图”，说明造成避孕药具使用率低的关键因素，并将这一地图与避孕服务提供做法的信息相匹配，以确定最有可能减少意外怀孕的变化。 为了实现这些目标，我们建议开展三项相互关联的活动：（1）我们将对美国有意外怀孕风险的妇女在成功使用避孕药具方面面临的困难进行广泛、全面的调查，并根据她们对国家意外怀孕水平的贡献评估她们的优先关注事项。为了实现这一目标，我们将收集目前不存在的数据，从全国性的性活跃的妇女在意外怀孕的风险样本。(2)我们将确定避孕服务提供者在多大程度上意识到阻碍成功使用避孕方法的问题，并能够提供服务，解决导致避孕失败和不使用的因素。我们将从对国家公共资助的计划生育诊所和私人医生的抽样调查中获得这一信息。(3)我们将联合收割机结合这些信息，其他人的研究结果，以及研究人员和服务提供专家的建议，以确定政策和计划的限制，并为服务提供和研究的下一步提出建议，这将有助于减少美国的意外怀孕。我们希望该项目将确定阻碍有效避孕的因素，这些因素可以通过服务提供产生影响（以及那些至少在短期内没有实现的目标），并将导致就以下问题达成更大的共识：需要在避孕保健方面进行哪些变革和新的承诺，哪些类型的变革能够最大限度地减少意外怀孕水平，以及需要采取哪些步骤来实现这些变革。 通过查明知识和有效干预模式方面的差距，它还将促进新的研究和干预措施的制定和评价。

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.