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

1987-2009 年美国意外怀孕的测量和解释

• 批准号: 7662948
• 负责人: Lawrence B Finer
• 金额: $ 27.33万
• 依托单位: GUTTMACHER INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7662948
• 关键词: Abortion Rates; Accounting; Address; Adolescent; Adult; Automobile Driving; Behavior; Birth; Censuses; Characteristics; Child; Contraceptive Agents; Contraceptive Usage; Counseling; Couples; Data; Data Collection; Data Files; Data Sources; Decision Making; Education; Ethnic Origin; Ever Married; Exposure to; Failure; Family; Fertility; Funding; Goals; Growth; Health; Health Personnel; Healthy People 2010; Immigration; Incidence; Individual; Induced Abortion; Institutes; Intention; Interview; Link; Marriage Ages; Measurement; Measures; Methodology; Methods; Monitor; Multivariate Analysis; Patients; Play; Policies; Policy Making; Population; Population Group; Poverty; Pregnancy; Pregnancy Rate; Process; Provider; Proxy; Public Health; Publishing; Race; Relative (related person); Religion and Spirituality; Reporting; Research; Research Personnel; Risk; Role; Sampling; Sex Behavior; Standardization; Subgroup; Surveys; Techniques; Time; United States; Unmarried; Unwanted Birth; Update; Use Effectiveness; Variant; Vital Statistics; Woman; Work; abortion; base; child bearing; comparative; fetal; improved; indexing; innovation; parity; pregnant; prevent; programs; public health relevance; response; sexually active; social; tool; trend; unintended pregnancy

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.

描述（由申请人提供）：个人、夫妇、医疗保健提供者和政策制定者为实现《2010 年健康人民》降低全国意外怀孕率的目标所做的努力，由于有关意外怀孕发生率的信息不完整、对导致意外怀孕的因素了解不足而受到阻碍不同社会人口群体的怀孕率趋势和差异，以及缺乏易于使用的工具来定期监测这些趋势和差异。为了应对这些缺陷，该项目将： 1. 估计美国和主要社会人口亚群体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/种族、教育、平等、宗教信仰和（最近一段时间）移民身份。关于怀孕意向的全国数据是由全国家庭成长调查 (NSFG) 收集的，但这些数据对于五分之一以流产告终的怀孕来说基本上不完整。我们将利用从全国堕胎服务提供者普查和具有全国代表性的堕胎妇女样本收集的数据（通过独立资助）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. 分析关键中间因素对不同时间和不同社会人口亚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、性活动、生育力、生育欲望、避孕药具的使用和有效性）在解释 1987-2009 年时间趋势和不同人口群体差异方面的作用。在此过程中，我们将使用多种方法进行测量（基于一个时间点的测量与基于较长暴露时间的测量）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），以便确定最稳定的结果。 3. 估计最新的避孕药具使用失败率，并针对人工流产漏报情况进行纠正，以便为想要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流产可能产生的影响怀孕率趋势和差异。 4. 开发一种仅基于 NSFG 调查数据的工具，用于监测意外怀孕风险和保护的人口趋势，该工具可用作意外怀孕率本身的代理，但可以更频繁、更便宜地实施，从而补充实际怀孕风险的计算利率，这仍然是必要的，但只能以五年或更长时间的定期间隔进行。 公共卫生相关性：公共卫生努力实现“2010 年健康人民”目标，将意外怀孕从目前占所有怀孕的大约一半到 30% 的比例减少，监测解决不合时宜或意外分娩造成的负面健康和社会后果的进展情况，以及减少人工流产需求的努力受到阻碍，因为缺乏针对意外怀孕的准确和定期措施，无法根据主要监测工具中的流产漏报情况进行调整（全国人口调查）家庭成长）。现在特别需要准确、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，因为最近发布的数据表明出生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，而这些妇女目前占相当大的比例，政策和方案也需要采取此类措施，以适当应对这一问题。意外怀孕和堕胎。