Contraceptive failure in the United States

This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.     

Contraceptive failure in the United States

Data obtained from the 1970 National Fertility Study are analyzed to determine the incidence of contraceptive failure according to intent, social background, and method. Analyzed by life-table procedures, the data indicate that 40% of contraceptive users fail to achieve their goal of either delaying (26%) or preventing (14%) pregnancy. Those women who are relatively young at the beginning of their exposure to risk are much more likely to fail than older women. Pregnancy order and educational attainment do not affect contraceptive failure rates when intent and age are held constant. Blacks are much less successful than whites in delaying and preventing pregnancy, and white Catholics are less successful in delaying, but just as successful in preventing pregnancy as white non-Catholics. Attempts to prevent or delay pregnancy were much more successful in 1970 than 1955, partially because of the use of oral contraceptives, but also because of greater care taken no matter which method was used. Failure rates by method with intent and age constant are as follows: pill--6%, IUD--12%, condom--18%, diaphragm--23%, foam--31%, rhythm--33%, and douche--39%. These figures reflect the characteristics of those who use each method as well as the method itself. Methodological problems with this analysis are discussed along with their implications.     

Contraceptive failure in the United States

This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.     

Contraceptive failure in the United States: an update

This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.     

Educational benefits of the United States school feeding program: a critical review of the literature.

In the Child Nutrition Act of 1966 it was stated that educational progress was an objective of the United States School Feeding programs. In spite of this fact no serious attempt has ever been made to evaluate whether this objective has been met; the few evaluations that have been conducted lack scientific rigor. As a whole the studies fail to provide a strong basis from which to make valid inferences regarding the long-term effects of the feeding program on school achievement and adaptation. Studies that have focused on the short-term effects of hunger or morning feeding suggest that the provision of breakfast may both benefit the student emotionally and enhance his capacity to work on school type tasks.     

The uninsured in the United States: a strategic critical management review

The purpose of this article is to provide a critical review on studies of access and utilization of the uninsured, and some related proposals regarding the health care reform debate. Also, an attempt is made to determine if conclusions or trends can be identified to develop the groundwork for effective policy initiatives to assure access to the 37 million uninsured persons in the United States.     

Contraceptive failure in the United States: estimates from the 1982 National Survey of Family Growth

A multivariate life-table analysis of national survey data from 1982 indicates that among currently married women, the pill and IUD have the lowest use-failure rates. During the first year of use, about three percent of pill users and six percent of IUD users experience an unintended pregnancy. Failure rates for the remaining methods range from 14 percent for the condom to 22 percent for spermicides; between these lie rhythm and natural family planning (16 percent), the diaphragm (17 percent) and other methods, mainly withdrawal, douche and abstinence. Married women using no contraceptive method experience an unintended pregnancy rate of 40 percent during the first year of unprotected intercourse. A woman's age, pregnancy intention (either to delay or to prevent births), parity and income all have significant effects on the risk of unintended pregnancy. The risk generally declines with age, except for women attempting to prevent an unwanted pregnancy, among whom women under 20 have lower failure rates than do those 20-29 years of age. As expected, women attempting to prevent an unwanted pregnancy have lower failure rates than do those seeking to delay a wanted pregnancy, with the difference being greatest for women under 20 years of age and smallest for 20-29-year-olds. Use-failure rates among low-income women are higher than those among women with larger family incomes, while low-parity women have lower failure rates than do women of higher parity. On average, standardized use-failure rates for single women are lower than those for married women, probably because of a lower average level of intercourse among single women. In addition, these rates are understated because of the substantial underreporting of abortion among single women; if abortion reporting were complete, failure rates would be about 1.4 times as high as they appear here, and thus would be close to those of married women. Differences in the risk of unintended pregnancy among single women show a number of similarities with those seen among married women: Use of the pill and IUD is associated with the lowest failure rates, reliance on the condom is associated with intermediate failure rates, and use of spermicides is linked with the highest failure rates. However, while rhythm and the diaphragm exhibit use-failure rates that are among the highest found for single women, failure rates for these methods are at intermediate levels among married women.(ABSTRACT TRUNCATED AT 400 WORDS)     

Contraceptive failure in the United States: revised estimates from the 1982 National Survey of Family Growth

It is estimated that only about half of all abortions occurring during the period covered by the 1982 National Survey of Family Growth were actually reported in the survey; thus, contraceptive failure rates calculated from these data are almost certainly inaccurate. An attempt to correct for the underreporting of abortion indicates that actual 12-month use-failure rates are more than one-third higher than those calculated without taking abortion underreporting into account, with rates ranging from six percent for the pill to 14-16 percent for the condom, diaphragm and rhythm and to 26 percent for spermicides. Patterns of contraceptive failure are similar to those found in earlier studies.     

The health of Arab-Americans living in the United States: a systematic review of the literature

Background  

Despite substantial attention paid to Arab-Americans (AAs) in the media and in public discourse, there is limited research about the health of AAs in the United States (US) in the public health literature. This review aims to synthesize the extant peer-reviewed literature concerned with the health of AAs living in the US.     

Patient empowerment in the United States: a critical commentary

Whilst there is no consensus amongst analysts regarding how best to define 'patient empowerment', at the very least, this concept entails a re-distribution of power between patients and physicians. Empowered patients attempt to take charge of their own health and their interactions with health care professionals. Empowerment can occur at different levels (micro, meso, and macro) and patients have different ideas about what it means to 'take charge' and 'be empowered'. Some patients simply want to be given information about their conditions whilst others want to have full control over all medical decision-making. Some empirical evidence suggests that active patient participation in health care is associated with better patient outcomes. This field is ripe for future studies which both help to develop theoretical models of patient empowerment and articulate the conditions under which patient empowerment occurs.     

Contraceptive discontinuation among married women in the United States

Using data from the 1982 National Survey of Family Growth (NSFG), this analysis reports differentials in contraceptive discontinuation among married women aged 15-44 years in the United States. The total discontinuation rate is broken down into change to no method (termination) or to a different method (a method switch), and rates are obtained for specific methods. In addition, sociodemographic differences in risks associated with each type of discontinuation are shown. Discontinuation rates are compared to use-failure rates to provide a more comprehensive understanding of the implications of discontinuation for contraceptive efficacy.     

The quality of family planning services in the United States: findings from a literature review

CONTEXT: Family planning services are frequently used and important services for American women, yet little is known about their quality. Service quality has important implications for women's reproductive health. If women do not receive adequate information and tools, and learn appropriate skills, from their providers, they may be hampered in their efforts to control their fertility. METHODS: A variety of strategies, including database, journal and Internet searches, were used to identify published and unpublished U.S. studies on family planning service quality that came out between 1985 and 2005. Studies were categorized by their focus, and key points of their methodologies and findings were assessed. RESULTS: Twenty-nine studies were identified, most of which were based on client surveys. Most conceptualized quality as a multidimensional construct, but a uniform definition of quality is lacking, and the domains studied have not been consistent. The available studies focus on four areas: assessments of quality, its correlates, its consequences for client behavior and attitudes, and clients' values and preferences regarding services. Relations between clients and service facility staff have typically been rated favorably, but communication, patient-centeredness and efficiency have been rated more poorly. Service quality varies by characteristics of the facility, provider, client and visit. Research on the consequences of service quality for clients' contraceptive behavior or risk of unintended pregnancy has been very limited and yielded mixed results. CONCLUSIONS: Studies that assess service quality need stronger designs and greater consistency in measures used so that results are comparable.     

Social work education in the United States: a critical analysis

Social work programs accredited by the Council on Social Work Education educate students for practice at the undergraduate and graduate levels. This paper presents a critical analysis of social work education in the United States. The analysis suggests that graduates of social work programs do not appear to master the skills, knowledge and values critical to effective practice and policy intervention. The implications of these findings are offered.     

Contraceptive usage during lactation in the United States: an update.

National Surveys of Family Growth data showed that as of 1982, most lactating women who were sexually active used a contraceptive method; barrier methods were most frequently used. Black women and women of higher parity and lower educational level were more likely to be sexually active and not using a method.