Best Intentions

Experts estimate that nearly 60 percent of all U.S. pregnancies—and 81 percent of pregnancies among adolescents—are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted.

Now, current issues—health care and welfare reform, and the new international focus on population—are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts.

This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs.

The Best Intentions explores problematic definitions—"unintended" versus "unwanted" versus "mistimed"—and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear.

Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care."

The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals.

• Front Matter
• Summary
• Introduction
• Demography of Unintended Pregnancy
• Consequences of Unintended Pregnancy
• Patterns of Contraceptive Use
• Basic Requirements: Contraceptive Knowledge and Access
• Personal and Interpersonal Determinants of Contraceptive Use
• Socioeconomic and Cultural Influences on Contraceptive Use
• Programs to Reduce Unintended Pregnancy
• Conclusions and Recommendations
• Appendixes
• A Commissioned and Contributed Papers
• B The Political Storms over Family Planning
• C The National Survey of Family Growth
• D Table of Odds Ratios
• E Technical Notes on the Recalculation Exercise
• F Summaries of Evaluated Programs
• G Assessing Program Effectiveness and Cost-Effectiveness
• Index