A study using data for mothers from the National Longitudinal Survey of Youth and their children aged 14 or older indicates that, after accounting for a wide range of demographic and socioeconomic antecedents, children are significantly more likely to become sexually active before age 14 if their mother had sex at an early age and if she has worked extensively. In addition, early sexual debut is eight times as likely among black boys as among non-Hispanic white boys. Children who use controlled substances at an early age are more than twice as likely to have sex before age 14 as those who do not, although the type of substance having an effect is different for girls (cigarettes) and boys (alcohol). Church attendance is an important determinant of delayed sexual activity, but only when a child's friends attend the same church.
Teenagers wait an average of about 1 year before seeking birth control help at a family planning clinic. Nearly 4 in 10 teens come to the clinic only because they fear they are pregnant; only 1 in 7 come for help in anticipation of their 1st sexual encounter. While 3/4 use a nonprescription method at some time before they arrive at the clinic, most use methods of doubtful effectiveness and 1/2 of these used no method at last intercouse. Blacks are more likely than whites to come to the clinic as virgins or soon after beginning intercourse. Fear of pregnancy is the main reason given for finally going to the clinic, and fear that the family would find out was often mentioned. Shorter delays found among users of nonmedical methods suggest that initiative to expand and improve such usage may help teenagers prevent pregnancies during the early part of their sexual careers and also accelerate their adoption of more effective methods. If clinics become known as a source of free supplies of nonprescription methods as well as of general contraceptive advice, they might be more utilized by teenagers earlier. Thorough counseling about these methods as a backup to prescription methods is also needed. The importance of emphasizing confidentiality is noted, although it is also noted that teenagers who are able to talk to their parents about such matters are more likely to come to the clinic before or soon after they begin having intercourse. Data came from a 1980 survey of a wide range of family planning services in 8 cities, representing over 1200 adolescents.
About 780,000 teenagers experience a premarital pregnancy each year. If they weren't using contraception, an additional 680,000 would become pregnant--a total of 1,460,000. However, if all who did not want a baby were practicing contraception consistently, we could reduce the number of pregnancies by at least 313,000. Only 467,000 would become pregnant, and half of these pregnancies would be wanted.
The continuous decline in fertility in the United States since 1957, while affecting all elements of the population, has been most pronounced and most rapid among those groups which previously had the highest fertility - blacks, American Indians and Mexican Americans-all of whom experienced fertility declines more rapid than those experienced by urban whites between 1957-1960 and 1967-1970. Among urban whites, fertility decline has been heavily concentrated among those of low income. The decline was especiallyrapid for third and higher order births, suggesting a heavy concentration of completed fertility at two-child families. The rapid decline, and the narrowing of the traditionalfertility differentials among various subgroups have important implications in the areasof poverty, education, the role of women in society and the dynamics of local area growth.
Changes in marital fertility have accounted for 83 percent of the decline in total fertility since 1971; changes in marital status accounted for 19 percent, and changes in nonmarital fertility had only a negligible effect. Declines in the level of marital fertility account for a substantial part of the overall decrease; postponement of childbearing did not occur in any significant degree until the 1970s.
The proportion of U.S. women who used a contraceptive method at their first premarital intercourse rose from 47 percent in 1975-1979 to 65 percent in 1983-1988. Overall, and among non-Hispanic white women, this change resulted entirely from an increase in the use of condoms by their partners. The proportion of whites who used a condom at first premarital intercourse, for example, increased from 24 percent to 45 percent. Among blacks, condom use at first intercourse increased from 24 percent to 32 percent during that period, and pill use rose from 15 percent to 23 percent. Among all women, the method most often used at first intercourse during every period in the study was the condom, followed by the pill and withdrawal. The proportion of women using a method at first premarital intercourse varies strikingly according to individual characteristics. Among the various demographic subgroups, the proportion who use a method varies from 32 percent of Hispanic women to 68 percent of Jewish women. Whites are more likely to use a method than are blacks, and fundamentalist Prostestants are less likely to use a method than are other Protestants or Catholics. The proportion using a method is higher among women whose mothers completed high school than among those whose mothers did not. In addition, the proportion rises with age at first intercourse. Multiple logistic regression showed that the independent effects of Hispanic origin, Jewish or fundamentalist Protestant religious affiliation and the education of a woman's mother are large and significant.(ABSTRACT TRUNCATED AT 250 WORDS)
The proportion of US couples who were surgically sterile rose from 16% in 1965 to 28% in 1976, according to estimates derived from national fertility surveys carried out in those years. However, surgical sterilization for contraceptive reasons more than doubled--from 8% to 19%--leaving the proportions sterilized for noncontraceptive reasons virtually unchanged over the 11 years. The overall increase was greatest among white couples, couples in which the wife was aged 30-44, and those with 3 or more children. In 1976 1/2 of all couples with 3 or more children, and 1/3 of those with 2, were surgically sterile. In 1976, about 2.8 million couples--some 10% of those in which wives were aged 15-44--were classified as infertile. Infertility was higher among blacks than whites in both survey years, and the largest increase in infertility occurred among black couples where the wife was aged 20-24. In almost every race, age and parity group surveyed, the proportion fecund declined considerably between the 2 years, mostly as a result of concomitant increases in surgical sterility. In 1965, 73% of all US couples were capable of childbearing; by 1976, this proportion had dropped to 62%. In 1976, only 42% of couples in which the wife was aged 35-39 and 74% in which the wife was aged 25-29 were capable of conceiving a child. Moreover, only 62% of couples with 2 children were classified as fecund in 1976--a decline of 15 percentage points in 11 years. author's modified
Although the pill remains the most popular method of contraception among young married women, sterilization is now the method of choice among couples married a decade or more, as well as among couples who have had all the children they want. Indeed, contraceptive and medical sterilizations combined now comprise the most frequent barrier to conception among all married couples of reproductive age. Three-quarters of couples using contraception now use the most effective methods, the pill, sterilization or the IUD, and the trend data suggest a continuing increase in the reliance on such methods.
Results of surveys sponsored by the National Opinion Research Center between 1965 and 1980 show that approval of abortion increased from an average of 41% for 6 different reasons in 1965 to 68% in 1973, with levels remaining stable through 1977, decreasing to an average of 64% in 1978, and rebounding to the 1973-77 level in 1980. 7% of respondents disapproved of abortion for all 6 of the stated reasons, which ranged from endangerment of the woman's health through a married woman wanting no more children. More than half of those approving of abortion do not do so for all reasons, with approval ranging from 90% if the woman's health is endangered to 47% if the women is married and wants no more children. Multiple regression analysis of the independent effect of 8 types of factors on abortion attitudes, by themselves and in combination, was conducted. Those favoring and opposing legal abortion do not differ on 11 of 13 values ascribed to child development, but differ on obedience and curiosity, suggesting a more authoritarian attitude toward childrearing and less emphasis on children's self-reliance among abortion opponents. Education has the strongest effect of the various social and demographic variables examined, with the better educated more likely to favor abortion availability, except among Catholics. Approval of abortion decreases with conservatism regarding various aspects of personal morality. The strongest negative relationship occurs with disapproval of premarital sex and preference for large numbers of children. Political party and ideology are only weakly linked to legal abortion approval. Approval of abortion increases with support for women's rights and basic civil liberties.
In Britain, as in the United States over the last decade, there has been a considerable decline in the birthrate, in average family size and in the number of children wanted, at the same time that use of the most effective forms of contraception--the pill, the IUD and contraceptive sterilization--and use of abortion have become more and more widespread.
Unwanted U.S. marital fertility was down to just nine percent by 1973. The largest proportion of unwanted births was reported by poor black women--23 percent--but this group registered the steepest decline in unwanted childbearing of all the poverty-status and racial groups studied.
Between 1968 and 1972, organized family planning programs in the United States more than tripled their caseloads and were providing services to an estimated 2,612,000 women in the latter year. About nine in 10 of these women came from families with incomes at or below 200 percent of poverty; about three quarters of them were from families at or below the 150 percent of poverty level, and about seven in 10 were from families at or below 125 percent of poverty. Looking at the patients, most were young (median age was 23), of low parity (median was 1.8, including about 30 percent childless), with a high school education. Less than one sixth (16 percent) were receiving public assistance. Typically, in other words, these are educated, poor or low income young women, not yet burdened down with large families, women who with the help of family planning services may yet avoid unwanted childbearing and its attendant foreclosure of opportunity.
More than one in 10 legitimate births that occurred in the United States during 1968, 1969, and 1972 were not wanted at all, and more than one-quarter of the births were timing failures. A substantial reduction in unwanted childbearing took place between 1968 and 1972. The proportion of legitimate births reported by their mothers to be unwanted ever declined from 13 percent in 1968 to eight percent in 1972. If, as reported in a number of cross-sectional surveys taken during this approximate period, there was a sharp reduction in wanted family size reported by married women, then these women would have remained at risk of having an unwanted birth for a longer period than when their wanted family size had been higher. Thus, these estimates of a decline in unwanted childbearing may be understated (although there was the countervailing trend of later age at marriage during these years). The decline in unwanted childbearing between 1968 and 1972 is only partially attributable to the shift toward lower birth orders that occurred. Declines in unwanted births occurred for almost all birth orders. There was no significant reduction in mistimed births. Because the decline in unwanted fertility during the study period was much greater for nonwhites than whites, the traditional racial differential in unwanted childbearing narrowed considerably between 1968 and 1972. In 1968, 12 percent of the white legitimate births were classified as not wanted, compared to 21 percent of the legitimate births to nonwhites. However, between 1968 and 1972, nonwhites experienced extremely sharp declines in unwanted childbearing. Thus, in 1972 only 9.5 percent of the legitimate births to nonwhites were reported as unwanted, compared to 8.1 percent of the white births. Mothers of higher parity were much more likely to report a birth as unwanted than those of lower parity. Mothers who had completed more schooling were less likely than poorly educated mothers to report births as unwanted. Income level seems unrelated to whether the birth is unwanted, but is inversely related to whether it is a timing failure. Births that resulted from premarital conceptions tended to be reported as timing failures. Viewed from the cross-sectional perspective of period rates of population change, the elimination of unwanted legitimate childbearing would have had a substantial effect on population growth in each of the study years even without decreasing marital mistimed births or illegitimate fertility. The data also suggest that eliminating unwanted marital childbearing could significantly reduce completed family size. However, this conclusion must be viewed with great caution, since we do not know the future variations in timing and spacing of births, and the extent to which the childbearing experience of the sampled mothers is representative of their birth cohorts.
If the efforts now underway to limit access to abortion services in the United States are successful, their greatest impact will be on women who lack the funds to obtain abortions elsewhere. There is little published information, however, about the experience of medically indigent women who sought abortions under the old, restrictive state laws. This article details the psychiatric evaluation of 199 women requesting a therapeutic abortion at a large municipal hospital in New York City under a restrictive abortion law. Thirty-nine percent had tried to abort the pregnancy. Fifty-seven percent had concrete evidence of serious psychiatric disorder. Forty-eight percent had been traumatized by severe family disruption, gross emotional deprivation or abuse during childhood. Seventy-nine percent lacked emotional support from the man responsible for the pregnancy, and the majority were experiencing overwhelming stress from the interplay of multiple problems exacerbated by their unwanted pregnancy.
There were about 2.0--2.3 million unintended pregnancies in the United States each year during the early 1970s. Within this framework, the rapid rise in the number of abortions since 1973, to 1.3 million in 1977, is quite predictable.
Analysis of the 1975 National Fertility Study data on pill and IUD discontinuation shows an upward trend in discontinuation rates for both methods between 1970 and 1975, with particularly sharp increases in pill discontinuation starting in 1972. Almost 40 percent of pill discontinuation was attributable to problems of use; three-fifths of these problems were physical. About one-quarter of pill discontinuation was for reasons other than problems of use. The single most common of these was that the woman wanted to become pregnant. Almost 40 percent of IUD discontinuation was due to method-related problems; only 13 percent was due to the women's desire to become pregnant, a finding which suggests that women do not use this method for childspacing. Examination of the relationship between pill and IUD discontinuation and unfavorable news stories about these two methods reveals that after specific news events, discontinuation rates for both methods tend to increase. Rates climb for 5-6 months following specific unfavorable news stories, with peaks in the rate of change in discontinuation reached 3-5 months after a pill-related story and 2-4 months after an IUD-related story. General media coverage of the adverse effects of pill use in particular (where general coverage is defined as the cumulative number of pill articles appearing between 1970 and 1975) accounts for 34 percent of the variance in pill discontinuation rates. This correlation is strongly suggestive of a causal relationship between general mass media coverage of the adverse effects of the pill and discontinuation rates for this method.
Between 1969 and 1975, the U.S. family planning program helped its patients avert 1.1 million unwanted and mistimed births. These averted births resulted in short-term savings to the government for health and social welfare services of $1.1 billion, compared to a federal investment in family planning of $584 million--a benefit/cost ratio of $1.80 for every federal dollar invested.
A declining proportion of young women who become premaritally pregnant marry during their first pregnancy: Thirty-three percent of metropolitan-area women aged 15-19 interviewed in 1971 did so, compared to 16 percent of those interviewed in 1979. At the same time, those who do marry have a high probability of conceiving again within 24 months of the outcome of the first pregnancy: Of those surveyed in 1979, almost 50 percent did so, up from 15 percent in 1976. While a number of factors may account for the high rate of second pregnancies among married teenagers, it apparently results from less use, or less efficient use, of contraceptives. Among teenagers who experienced a premarital pregnancy and remained single, most age, race and pregnancy subgroups showed either no change in the cumulative risk of a second pregnancy within 24 months or a decline in that risk between 1976 and 1979. The most notable decline was among young women whose first pregnancy ended in abortion; an increasing proportion of premaritally pregnant women, especially those who do not marry, are included in this group. White teenagers show a small increase in the risk of a premarital second pregnancy--an exception to the decline generally noted in second pregnancies among young women who do not marry. The increase parallels rises in the proportions of those who do not use contraceptives and of those who use less effective methods following the premarital first pregnancy. The apparent increase between 1976 and 1979 in the risk of a second pregnancy both among whites who married during the first pregnancy and among those who did not is in contrast to a decrease in risk for those two groups between 1971 and 1976. Although 1979 data are not available for nonmetropolitan-area women, a comparison of second pregnancies in 1971 and 1976 indicates that the decline in risk of a second pregnancy was greater for nonmetropolitan women than for metropolitan women.
One in five U.S. females have had intercourse by age 16, and two-thirds, by age 19. Almost all the experience is premarital. One in 10 U.S. women get pregnant before age 17; one-quarter before they are 19, and eight in 10 of these pregnancies are premarital. More than one-third of those who are sexually active premaritally have a premarital pregnancy before they turn 19, one-quarter by the time they are 17.
Results of national studies have shown that there was very little decline in premarital 1st pregnancies among sexually active teenagers in the US interviewed in 1971 and 1976, although there had been marked improvement in their contraceptive practice. This was attributed to an increase in sexual activity among younger teenagers who were not using contraception when they began to have intercourse. As a result, 1/2 of premarital 1st pregnancies occurred in the 1st 6 months after initiation of coitus. Since improved contraceptive use is preventing many pregnancies, this article explores whether this improvement may have been more effective in preventing 2nd pregnancies among teenagers. This is apparently the case. Repeat pregnancies declined by more than 40% overall (from 50 to 30% of those who had had a premarital 1st conception) within 24 months after resolution of 1st pregnancy. The decline was most marked among whites (a 57% drop), those 16 or older at 1st outcome (48%) and, especially among those whose 1st pregnancy was terminated by abortion (65%). Among those who remained unmarried after the resolution of the 1st pregnancy, the decline over 24 months in 2nd premarital pregnancies was only 9%. But the fall was more dramatic among certain groups: repeat pregnancies declined by 21% among whites, by 14% among those whose 1st pregnancies were resolved at age 15 or younger, and by 63% among those whose 1st pregnancy was terminated by abortion. Those whose 1st pregnancy ended in a live birth were more likely in 1976 than in 1971 to have a subsequent premarital pregnancy. Those who legitimated 1st pregnancies had declined by as much as 2/3. The data suggest that contraceptive advice and service is more available to the unwed teenager who aborts than to those who give birth. Although the 12-month repeat pregnancy rate is nowhere near the 44% frequently cited by federal officials, the fact that 15% conceive again after a premarital pregnancy reminds us that young people must be reached early -- before they begin intercourse -- with accurate and practical information about sex, the risk of pregnancy, contraception and how and where to obtain it, to prevent unwanted teenage pregnancies.
Results of a 1979 national survey concerning attitudes and practices of 15-19 year old women living in metropolitan areas are presented and compared with survey findings for 1971 and 1976. The proportion of 15-19 year old metropolitan area women who report having had premarital sexual intercourse rose from 30% in 1971 to 43% in 1976 and to 50% in 1979. Among whites the proportion sexually active rose from 26% in 1971 to 47% in 1979. Almost all of the increase is accounted for by increased sexual activity of never-married white women. 12% of the sexually active women in 1979 reported having had intercourse only once. The level of premarital pregnancy among teenagers increased from 9% in 1971 to 13% in 1976 and to 16% in 1979. The proportion of premaritally pregnant teenagers who married before resolution of the pregnancy decreased from 33% in 1971 to 16% in 1979. The proportion terminated by abortion rose from 23% in 1971 to 37% in 1979. 34% of sexually active teenagers said they always used contraception in 1979 compared to 29% in 1976, while those who reported they never used it declined from 36 to 27%. The proportion of premarital pregnancies occurring among those reporting they had always used a contraceptive method rose from 10% to 14% between 1976 and 1979, partly due to a decline in the use of the most effective medical methods between 1976 and 1979 and a rise in the use of the least effective methods, especially withdrawal.
The prevalence of sexual activity among never-married U.S. teenage women increased by 30 percent between 1971 and 1976; so that by age 19, 55 percent have had sexual intercourse. The increase, which has occurred at all ages and among all races, has been accompanied by a dramatic increase in the use of contraception, the use of the most effective methods, and the more regular use of all methods. Nevertheless, few teenagers begin use of contraception at the same time that they initiate intercourse--and many wait until after they have experienced pregnancy.
There has been significant progress in 1971 in the financing and organization of population control research, but some setbacks continue and the overall funding level compared to need is still only one-third. Total funding for population research in the United States reached $53 million in 1971 compared to $12.5 million in 1967. However, training grants have been cut by the U.S. government, seriously hurting graduate research. Internationally, two new organizations have been established: one under the World Health Organization which will set up collaborative research centers on each continent and one directed by the International Committee for Contraceptive Research under the Population Council to evaluate contraceptive products. These agencies have the potential to fulfill a pressing world-wide need for collaborative effort.
2 debates over national policy are currently underway: 1) a major review of the national policies has been demanded by virtually all segments of the American people; and 2) an evaluation has been undertaken of policies which influence the growth of U.S. population, of the kinds of changes in population growth, and distribution which would be socially and economically desirable, and of the means available and acceptable to bring about the desired changes. Crucial to these policy discussions are the nature and scope of health services. This article d escribes preliminary research to estimate the costs to U.S. society of f ertility-related health services. Fertility control through voluntary sterilization, contraception, pregnancy termination, and medical treatment of infertility make up 1 group of services; maternity care forms a 2nd group; and pediatric care is a 3rd essential service. It is clear from this study that many fertility-related health services are not covered by private health plans and that additional expenditure is needed to upgrade hospital services and improve health care. The study also raises questions about deficits in service to people who are not re ached by the medical care system at all and those who receive care of low quality. Women, especially those in the low-income bracket, need more aid. The range of costs shown here suggests that comprehensive financing of fertility-related health services is well within the nation's fiscal capabilities.