| The Assistant Secretary for Health and Surgeon General
chaired the third and final review of progress in achieving Healthy People 2000 objectives
for Family Planning. The review was organized by the Office of Population Affairs, Office
of Public Health and Science, which serves as the lead agency for this priority area,
designated as priority area 5 in the Healthy People 2000 document. The discussions
addressed three principal topics—1) assuring a healthy start for every child; 2)
promoting personal responsibility for healthy lifestyles and behaviors; and 3) eliminating
racial disparities in health status, health care access and quality of services. Of the 12
objectives in this priority area, 9 show progress toward the targets, one shows a mixture
of trends, one has moved away from the target, and one lacks an update. During the
overview and discussion, attention focused on the following objectives: 5.1 The rate of pregnancies among females
aged 15-17 declined from 80.3 per 1,000 in 1990 to 71.7 in 1995. The year 2000 target is
50. For females aged 10-14, the rate declined from 3.5 in 1990 to 3.0 in 1995. Related
data show that the rate of live births among females aged 15-17 declined from 37.5 per
1000 in 1990 to 32.6 (preliminary data) in 1997; for females aged 10-14, the rate declined
from 1.4 to 1.2 (preliminary) over the same period. Abortions among females aged 15-17
declined from 26.5 per 1,000 in 1990 to 19.9 in 1995 and, among those aged 10-14, from 1.5
per 1,000 to 1.2 over the same period. For black females aged 15-19, the pregnancy rate
per 1,000 declined from 215 in 1990 to 178 in 1995 (target, 120), and the rate of live
births per 1,000, from 113 in 1990 to 90 in 1997. The rate of abortions per 1,000 for
black females aged 15-17 declined from 55 in 1990 to 44 in 1995. For Hispanic females aged
15-19, the rate of pregnancies increased from 156 per 1,000 in 1990 to 163 in 1995. The
rate of live births and the rate of abortions among Hispanic females aged 15-19 have
changed only slightly during the decade of the 1990s.
5.2 The proportion of
pregnancies that were unintended among the total female population aged 15-44 decreased
from 56 percent in 1988 to 49 percent in 1995. The year 2000 target is 30 percent. For
black females aged 15-44, the rate of unintended pregnancies declined from 78 percent in
1988 to 72 percent (target, 40 percent), and for Hispanic females in that age group, from
55 percent in 1988 to 48 percent in 1995 (target, 30 percent).
5.3 The prevalence of
infertility in married couples with wives aged 15-44 decreased from 7.9 percent in 1988 to
7.1 percent in 1995 (target is 6.5 percent). In black married couples, infertility
prevalence decreased from 12.1 percent in 1988 to 10.5 percent in 1995 (target, 9
percent). Over the same period, infertility in Hispanic married couples declined from 12.4
percent to 7.0 percent, surpassing the target of 9 percent.
5.4 Among 15-year old
adolescents, the proportion of females who reported having had sexual intercourse declined
from 27 percent in 1988 to 22 percent in 1995; the proportion of males declined from 33
percent in 1988 to 27 percent in 1995. The year 2000 target is 15 percent. Among
17-year-olds, the proportion of females remained much the same—50 percent in 1988 and
51 percent in 1995. The target is 40 percent. Supplemental data for in-school adolescents
show mixed trends: an increase from 35 percent in 1990 to 44 percent in 1997 among 15
year-old females; a decrease from 48 percent to 42 percent among 15 year-old males over
that time span; a decrease among non-Hispanic black males aged 17 from 90 percent in 1991
to 85 percent in 1997; and a decrease among non-Hispanic black 17 year-old females from 84
percent in 1991 to 73 percent in 1997.
5.5 In 1995, 27 percent of
sexually-active females aged 15-17 reported abstaining from sexual intercourse for 3
months prior to the interview, as did 37 percent of sexually-active males aged 15-17.
These are increases from the 1988 rates of 24 percent and 33 percent, respectively. The
year 2000 target is 40 percent. Supplemental data for 1997 indicate that 23 percent of
in-school sexually active females aged 15-17 and 32 percent of in-school sexually active
males aged 15-17 reported such abstention. For in-school adolescents in this age group,
the data show a slight decrease in sexual abstinence for females and a slight increase for
males during the 1990s.
5.6 Among sexually-active
females aged 15-19, the rate of contraceptive use at first intercourse increased from 65
percent in 1988 to 76 percent in 1995. Use of contraceptives by this group at most recent
intercourse declined from 78 percent in 1988 to 71 percent in 1995. Among sexually-active
males aged 15-19, the rate of use of contraceptives at most recent intercourse showed
little change between 1990 (78 percent) and 1995 (79 percent). The year 2000 target is 90
percent. Supplementary data from school interviews show an increase from 78 percent in
1990 to 85 percent in 1997 in the proportion of in-school, sexually-active females aged
15-17 who used contraceptives at most recent intercourse. For in-school, sexually-active
males in this age group, the proportion using contraceptives at most recent intercourse
decreased slightly between 1991 to 1997 (from 83 to 81 percent ).
5.7 The proportion of women aged
15-44 experiencing a pregnancy despite use of a reversible contraceptive method decreased
from 14 percent in 1988 to 12 percent in 1995. The year 2000 target is 7 percent for all
women. In 1995, contraceptive failure resulting in pregnancy was experienced by 15 percent
of Hispanic women (down from 16 percent in 1988) and by 19 percent of black women (an
increase from 18 percent in 1988). The target for both groups is 8 percent.
5.11 In 1994, 81.8 percent of
Title X funded family planning clinics provided pretest counseling on HIV to their
clients, an increase from 66 percent in 1990. HIV testing for clients was provided by 73.5
percent of these clinics, compared with 60 percent in 1990. Also in 1994, the proportions
of these clinics providing STD services was as follows: 95 percent, testing; 98 percent,
counseling; 93 percent, treatment.
5.12 Between 1982 and 1995, the
proportion of females aged 15-44 at risk of unintended pregnancy who used contraception
increased as follows: for all females, from 88.2 percent to 92.5 percent; for black
females, from 78.9 percent to 89.9 percent (of non-Hispanic blacks only in 1995); for
females with income below the poverty level, from 79.6 percent to 92.1 percent. For
at-risk females aged 15-19 under 200 percent of the poverty level, the proportion using
contraception increased from 67.4 percent in 1982 to 84.8 percent in 1995. The year 2000
target is 95 percent for all groups.
HIGHLIGHTS
- Many people in need of family planning services are
uninsured. Medicaid is the largest source of funding for reproductive health services in
the U.S., but the working poor, adolescents and families without children are usually
excluded from coverage because of eligibility requirements. Private health insurance plans
usually do not provide coverage for contraceptive services.
- Title X of the Public Health Service Act supports a network
of 4,600 clinics providing comprehensive family planning services to 4.5 million people
each year, 85 percent of whom are low-income and a third of whom are adolescents.
- Almost one-half of pregnancies in the U.S. are unintended;
23 percent of these end in abortion. Adolescents account for less than half of the total
number of unintended pregnancies.
- Since 1991, the rate of first and second births to females
aged 15-19 has declined. This trend correlates closely with increased use of
contraceptives and delays in initiation of sexual intercourse.
- "Contraceptive switching" significantly increases
the risk of unintended pregnancy. One study showed that 64 percent of women switching from
one form of contraception to another had an unintended pregnancy during the interval.
- Ninety-three percent of women at risk of unintended
pregnancy use some form of contraception. The remaining 7 percent of women account for 47
percent of all unintended pregnancies.
|
