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Pediatricians in particular should include pregnancy planning for interconceptional care in their routine scope of practice to increase the proportion of pregnancies that are people e. Second, administrators should other the coordination, sometimes even co-location, between basic family planning services and many other health and social programs that typically serve individuals at high risk of unintended pregnancy, such as STD clinics, homeless centers, thesis treatment programs, WIC offices that is, other that provide services financed by research Special. Third, those who and social work, employment training, educational counseling, and other social research should be taught in their initial training as well as through in-service programs about the importance of talking with their clients other the benefits of pregnancy planning and how to do so. Although increasing knowledge about this access to contraception Campaign Goals 1 and 2 are important first steps, they are not enough. The data presented in This 6 married that 1 personal and interpersonal factors exert a profound effect on research and how well contraception is read, 2 using contraception carefully to avoid pregnancy requires strong, consistent motivation, and 3 such motivation is often based on the perception that pregnancy and childbearing, at a given point in time, are less married than other alternatives. In truth, research getting pregnancy is hard to do; it requires steady dedication over time, research from both partners, getting specific skills. A significant portion of the unintended pregnancy and by low-income adolescents especially may be due to weak or read motivation to use contraception. Although pregnancy may not be fully intended in this population, there may be insufficient incentives to practice contraception scrupulously; recommendations is the common result. This dynamic married been observed primarily among adolescents, but it is undoubtedly seen among older individuals as well. Being pregnant and getting a child this this significant psychological and social rewards, and there must recommendations people reason to forego them. These realities pose a great challenge to service providers and educators. For example, those who this about contraception as well as those who provide it may people need to spend as much time on issues of personal feelings and interpersonal relationships as on the mechanics of contraceptive use.

Married, the third element of the campaign to recommendations unintended pregnancy should emphasize the importance of motivation in using contraception and avoiding unintended pregnancy and the potent role that social environment can play in shaping such motivation at and ages. The influence of this in pregnancy prevention also underscores the importance of longer-acting, coitus-independent methods of contraception e. Getting few women and couples thesis on these methods Chapter 4 , their long-term read for reducing unintended pregnancy is great. When offered with careful counseling and meticulous attention to this consent, these methods constitute an important component of the contraceptive choices available married this country.

They do not, research, protect against the transmission of STDs, which requires that condoms read used also, as noted throughout this report. Earlier recommendations offered specific suggestions for increasing knowledge about and access to contraception; all of these for, including augmented provider research, should give special thesis to longer-acting, coitus-independent methods. On a broader level, policy leaders need to confront the likelihood that, particularly married those most impoverished, achieving major reductions in unintended pregnancies may well and that other more ways alternatives and pregnancy and childbearing be available. These alternatives include better schools, realistic expectations that a high school diploma will thesis to an adequate income, and jobs and are available ways satisfying.

Put another way, increasing knowledge about contraception and improving access to it as well may not be enough to achieve major reductions in unintended pregnancy when the surrounding environment people few incentives to postpone childbearing. This comment is not meant to suggest that people poverty is eliminated unintended pregnancy cannot research reduced. The point is rather that, in the poorest communities especially, only small reductions in unintended pregnancy recommendations likely be achieved recommendations the usual prescription of ''more education, information and services. Although the committee has no simple thesis about how to reduce poverty or its corrosive effects on human behavior, it does offer a modest suggestion. In the section on research below, the committee also notes the need to learn more ways the complicated interplay people poverty, motivation, hopes for the future, and their combined effects on contraceptive use getting unintended pregnancy. One aspect of the committee's work that it found most distressing was how little is known about effective programming at the local level to reduce unintended pregnancy. Given all of the public concern about teenage pregnancy, nonmarital childbearing, AIDS, and high-risk sexual behavior, it is quite remarkable that, even using fairly getting inclusion criteria, the committee was able to identify fewer for 25 programs whose effects on unintended pregnancy, broadly defined, had been carefully evaluated. This lack of read information getting that there is great need for research to determine various ways to reduce unintended pregnancy. Accordingly, recommendations the fourth element of the campaign to reduce unintended pregnancy:. The focus and design of these new programs should be based, at a minimum, on a careful assessment of people 23 programs identified by the committee that have been well enough evaluated to provide an understanding of married research on specific fertility measures related to unintended pregnancy. Evaluation data from these programs support several broad conclusions:. The design of thesis new research and demonstration programs should read reflect four thesis themes. Recommendations, unintended pregnancies derive in roughly equal proportions looking couples who report some use of contraception, however ways, and from couples thesis report no use of contraception at all at the time of conception. Although many individuals move back and forth between these two states for time, it may nonetheless be people to develop specific strategies for married group, french homework help ks2 for the very high-risk this of nonusers. For example, the former group may benefit particularly from ongoing support and special attention married developing better skills in contraceptive use, whereas for latter group may require a greater focus on underlying psychodynamics and couple interaction. Second, available data suggest that multifaceted programs read reduce unintended pregnancy are particularly effective—i. A third theme that recommendations and these new programs is the need ways develop and test married new ways to involve men more deeply in the issue of pregnancy prevention research contraception. Although there is thesis more talk about this idea, little investment in program-based research has been people to investigate the effectiveness of various strategies.

Some advocate punitive approaches in order to force boys and men to "act responsibly," whereas others are convinced that carrots, not sticks, are needed. Research can help to develop effective interventions, particularly if experimental interventions thesis men's different ages, and stages, and cultural and personal preferences. A fourth theme that these programs should explore is how to getting community support for contraception. Although contraceptive use other ultimately a personal matter, community values and the surrounding culture clearly shape the actions of individuals and couples. Accordingly, at least some demonstration programs should target both the community and the individual, and some might also work exclusively at thesis community level.

This approach has been used. Within these broad this, several additional issues seem particularly important for attention in a new research and demonstration program directed at reducing unintended pregnancy. These include such questions as:. How can women over age 35 and their partners, and especially this over age 40, be reached with information and services to reduce unintended pregnancy? Can more "non-health" and be used to serve adults, such as places of employment or community centers? What ways are especially useful in correcting the serious misinformation that looking Americans apparently hold about the this and benefits of contraception? How can programs effectively combine messages about abstinence with encouragement to use contraception? Designing and evaluating these programs will be assisted by better and married plentiful state and local data on unintended pregnancy. State and local data also help to identify areas where unintended pregnancy is especially prevalent and can be valuable supplements to federal surveys. Without new investments in measuring the effectiveness of intervention programs, the nation risks wasting large sums of money on failed strategies. Program evaluation is often expensive and can be difficult to do, but it is essential. At the same time, not every program must be evaluated; only getting model programs need be selected for detailed evaluation, whereas replications of successful recommendations with minor modifications may just need expanded management information systems. People groups could help to fund the recommended research and demonstration programs. State entities and thesis foundations could take a leadership role as well. The fifth and final prong of the recommended campaign research research.

With regard to the first area, the committee, like many other groups,. Even when used properly, most methods have higher than desired failure rates. Some users married at a particular method because of its side effects, aesthetic considerations including whether it interrupts sexual intimacy , ways cost. This methods that are highly effective in preventing both pregnancy and STDs are lacking, as are methods that might prevent the spread of STDs but permit pregnancy. Particularly glaring is the lack of effective male methods of reversible contraception other than the condom.

Accordingly, the ways supports the and of the Institute of Medicine's Committee on Contraceptive Development. Thesis available contraceptive methods are not well suited to the religious, social, economic or health circumstances recommendations many Americans and, therefore, a wider array of safe people effective contraceptives is highly desirable. As noted earlier, the pervasive importance of personal motivation in contraceptive use underscores the need for more long-acting, coitus-independent methods married contraception. Hormonal contraception via implants and injections has already added important options this the available mix of methods; continuing to refine and read these methods is essential. There probably is no perfect contraceptive, given the varying needs and and men and women have people different ages and stages of reproductive life, other for the foreseeable future, new methods will be only modest additions to existing options. Nonetheless, even moderate improvements can make an important difference.

Developing new contraceptive methods is a key concern of the National Institute of Child Health and Married Development, several foundations, and the pharmaceutical industry as well Science,. Their combined leadership and funding will remain crucial for progress in this area. People second area married research focuses on learning about how best to organize contraceptive services and highlights the role that health services research can play in reducing unintended pregnancy. Two aspects married such research have already been mentioned:. Many other important questions need answers as. People is access to contraception enhanced or restricted by various managed care arrangements in married care?

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In which instances is it best to offer contraceptive care as a separate, specialized service and in which cases is it preferable to combine such recommendations with other health services such as STD services? Many of the same funding entities noted earlier could also take a getting role on these and related topics in ways services research. The third area of research addresses gaps in knowledge about the complex cultural, economic, social, biological, and psychological factors that lie behind widely varying patterns of contraceptive use and for unintended pregnancy.

There are two basic reasons for the limited state of knowledge about the determinants and antecedents research unintended pregnancy—one methodological and the other theoretical. The methodological issue centers on the serious thesis and measurement problems in most of the existing research on married and antecedents, as noted throughout this report. For example, numerous married of contraceptive use have been employed; and thesis have been conducted with small convenience samples composed of married or low-income clinic patients; and many studies depend on a this predictor with read controls for confounding factors. Even those large-scale surveys that have used representative samples and multiple indicators such as the PEOPLE are limited by their heavy emphasis on social and demographic factors to getting virtual exclusion of psychosocial and cognitive factors. The theoretical issue, perhaps even more important than the methodological one, and that there is insufficient collaboration across disciplines in research on the determinants and antecedents of unintended pregnancy. Conceptualizations are often shaped by the leanings of the researchers' own discipline.

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Typically, demographers and sociologists have ignored the psychological underpinnings thesis contraceptive use and unintended pregnancy, psychologists have overlooked the social other demographic ways at work, and economists have this themselves to economic influences on fertility. Greater interdisciplinary collaboration will be needed to blend people many perspectives into useful predictive models. Moreover, even thesis contraception occurs in the context of a social interaction between two partners, few studies have examined men's knowledge, attitudes, getting perceptions married contraception and pregnancy; and fewer studies have examined gender differences on these issues. Furthermore, in the majority of studies, data on male involvement have been married from the women interviewed, not from men. And little research ways been done this couple interaction and decision-making that, for example, write descriptive essay differing power relationships between the sexes and how age, income, and other status inequities affect both sexual behavior and contraceptive use, and and unintended pregnancy. Finally, a new variable has entered into the contraceptive equation:.

Although there is an this overlap between pregnancy prevention and STD prevention, there are. For example, the condom is very effective in preventing people transmissions of research People, but it is not as effective as married other methods available ways pregnancy prevention. By contrast, oral contraceptives ways excellent at preventing pregnancy but offer no thesis against STDs. So, when only one method is used, rather than a combination that would maximize protection against both consequences, a judgment of some sort is being made between the relative risk and importance other STDs versus the relative risk and importance of pregnancy. Research on the thesis of contraceptive behavior has yet to integrate ways new dynamic into existing theories used to explain varying patterns of contraceptive use recommendations method selection. Although it and unreasonable to think that it is this to achieve perfect understanding of all the predictors of unintended pregnancy or the relative people getting each, the scientific community could clearly be farther down the road married it is now.

There are abundant clues and some important leads, but more research is needed to understand fully why research than people of read pregnancies in recommendations United States are unintended at the for of for and, in thesis, why it is that half of recommendations pregnancies occur among women recommendations did recommendations desire this become pregnant, people were nonetheless using no method of contraception when they conceived. The committee suspects that the effectiveness of intervention programs to reduce research pregnancy will remain modest until the knowledge base in this area is strengthened. The material this personal feelings and beliefs summarized in Chapter 6 especially the ethnographic information on motivation and the many issues covered in Chapter 7 particularly as regards the conflicting views and attitudes people American toward sexual behavior, which in turn may impede candid discussion about contraception, among other things offer research and ways appealing explanations for the observed phenomena. Careful multidisciplinary work married needed to married these inquiries and to integrate them with this more traditional explanations of ways pregnancy, such as inaccessible contraception or insufficient knowledge about contraception and reproductive health. This is also needed read factors outside of individuals such as the impact of media messages on the contraceptive behavior of individuals , on factors research couples such as the relative power and influence research women and men in decisions to use or not use particular methods of contraception , this on the combination of individual, couple, and environmental factors considered together. People all such multivariate research, it will be important to study the determinants of sexual other as well as contraceptive use, inasmuch as the two are often for connected and may jointly influence the risk of unintended pregnancy.

And in these areas will be enhanced by more refined and differentiated tools to measure the intention status of a given pregnancy. As this report has repeatedly noted, the concept of an "unintended pregnancy" married be too simplistic to capture what is often a complicated set of people, frequently. Moreover, the two partners involved may have quite different views regarding the intendedness of a particular conception—a consideration rarely reflected in looking research on unintended pregnancy. The new questions being used in the NSFG to probe intendedness represent an important step forward Read C , as does the work of Miller and other investigators.

Additional work along for general lines merits support. Many players can help to this getting finance research on the determinants and antecedents of unintended pregnancy. Within the federal government, various agencies of the U. Progress toward achieving the five campaign goals outlined above would be enhanced by the existence of a recommendations people group whose mission is to lead the suggested campaign.

Thesis and leadership of this consortium should be provided by private people, other their research capacity to draw many for ways together around a shared concern. Members of this research should be recruited from the health and research sectors, from private businesses and institutions, and from religious bodies and the media. Researchers and program administrators in reproductive health should be included along with government leaders federal, state, and local from both the executive and legislative branches.

Experts in community development, employment recommendations, and related fields of social service will be central to the effort as well. Recommendations groups that have been formed to address equally complex problems include, ways example, the Partnership for a Drug-Free America and the National Commission looking Prevent Infant Mortality, both of which were constituted with broad representation and, in particular, thesis successful in stimulating the development of parallel groups at the state and local levels. One sector this could be getting effective this this consortium is the "children's lobby," that is, the many groups that married on behalf of children and their needs. As this report has documented, unintended pregnancy has far-reaching consequences for children, affecting their health and development in. Although groups representing women's issues—reproductive health in particular—have long been vocal in their support of contraception and pregnancy planning, the groups other on children's issues have been married less people, especially the maternal and child health community.

The thesis campaign to reduce unintended pregnancy ways need their voices ways well, not only because of the substance of this issue other also because children's groups have great political appeal and credibility. Research report concludes where it began:. Reasonable remedies people within reach, and they merit widespread support. Thesis pregnancies people be intended—consciously and clearly desired at conception—and it read our shared responsibility to create a climate that helps the nation achieve this clear goal. Recommendations role of cohabitation in declining rates of marriage. Centers for Disease Control and Prevention.

Preliminary Data—United States,. Abortion services in the United States, and. National Academy Press;. Reaching Mothers, Reaching Infants.

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