Family planning and female sterilization in the United States

This report critically examines the issue of sterilization in the United States based on data from the National Survey of Family Growth, Cycles I and II, spanning the years 1973 to 1976. Of particular concern is analysis of sterilization rates as they vary across categories of race, socioeconomic status, welfare status, number of children and desire for the service. The development of a framework containing competing theories and philosophies, based upon previous literature in the area, provides a useful paradigm for an understanding of the significance of sterilization rates. The methodology includes bivariate techniques involving tabular analysis as well as multivariate techniques through the use of logistic regression analysis. Findings support hypotheses related to class factors and parity, while the racial and altruistic interpretations are not supported. Policy implications and areas requiring further research are specified.     

Long-term care in the United States: an overview

Although long-term care receives far less U.S. policy attention than health care does, long-term care matters to many Americans of all ages and affects spending by public programs. Problems in the current long-term care system abound, ranging from unmet needs and catastrophic burdens among the impaired population to controversies between state and federal governments about who bears responsibility for meeting them. As the population ages, the pressure to improve the system will grow, raising key policy issues that include the balance between institutional and noninstitutional care, assurance of high-quality care, the integration of acute and long-term care, and financing mechanisms to provide affordable protection.     

Family planning clinic services in the United States, 1983

Almost five million women were enrolled in family planning clinics in the United States in 1983, eight percent more than in 1981. The number of family planning provider agencies declined slightly, from 2,504 to 2,462, but the number of clinic sites that could be identified increased slightly, from 5,124 to 5,174. Family planning clinics operate in three-quarters of U.S. counties; in 1975, the last time county coverage was checked, four-fifths of the counties had clinics. About one in 20 women who are exposed to the risk of unintended pregnancy and live in unserved counties are teenagers or low-income women. Nonmetropolitan counties are more likely to be without clinics than are metropolitan counties. Overall, there are 417,000 low-income women and 249,000 teenagers at risk of unintended pregnancy living in counties where there are no family planning clinics. In 1983, health departments constituted six in 10 of all family planning agencies and served two-fifths of all family planning clinic patients; Planned Parenthood affiliates accounted for fewer than one in 10 agencies and served more than one-quarter of all patients. Hospitals and all other agencies served about one-third of the total 1983 caseload. These patterns were similar to those reported for 1981. Family planning clinics continue to serve primarily low-income women: Four-fifths of the nearly five million clinic patients in 1983 had family incomes below 150 percent of the federally defined poverty level. About 1.6 million women aged 19 and younger were served, representing one-third of all clinic patients in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)     

Childlessness in the United States: estimates from the National Survey of Family Growth

Using a representative sample of about 17,000 ever married women 15 to 44 years of age, this article presents national estimates of the prevalence and correlates of voluntary, involuntary, and temporary childlessness in the United States. These three groups of childless couples are compared with the parents of small planned families and other parents on a number of social, economic, marital, and family characteristics. When viewed cross sectionally, voluntarily childless couples constitute between 1.3% and 1.8% of currently married couples, depending on the definitions used. They are a distinctive but rare population. Their future prevalence depends primarily on the decisions of the large group of temporarily childless couples.     

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.     

Teaching the Classics in Family Studies: E. Franklin Frazier's The Negro Family in the United States

Abstract: This paper (a) reintroduces E. Franklin Frazier's 1939 book, The Negro Family in the United States, to family scholars and graduate students and highlights its importance as a groundbreaking and classic text, (b) provides both an introduction to the major thesis of this monograph and a reading of the text, and (c) discusses the challenges of reading classic works and suggests strategies that can be used to guide graduate students in a critical reading of classic works.     

Acute Toxoplasma gondii Infection among Family Members in the United States

We investigated 32 families of persons with acute toxoplasmosis in which >1 other family member was tested for Toxoplasma gondii infection; 18 (56%) families had >1 additional family member with acute infection. Family members of persons with acute toxoplasmosis should be screened for infection, especially pregnant women and immunocompromised persons.     

Small-for-gestational-age births in the United States: an age-period-cohort analysis

BACKGROUND: During the last 2 decades, the rate of low birthweight has increased, as has the rate of preterm delivery, among both whites and blacks. Examination of causes for these secular trends has focused largely on changes in the distributions of maternal age and, less commonly, on birth cohort. Little is known as to how age, period, and birth cohort interact on trends in small births at term. METHODS: The U.S. natality files were used to assess trends in term (>/=37 weeks gestation) small-for-gestational age (SGA) births for 7 5-year maternal age groups (15-19 through 45-49 years), 6 delivery periods (1975, 1980, 1985, 1990, 1995, and 2000), and 12 5-year maternal birth cohorts (1926-1930 through 1981-1985). SGA births were defined as sex-specific birthweight below the 10th percentile for gestational age based on 1995 livebirths in the United States. Logistic regression models were fit to determine the independent effects of age, delivery period, and birth cohort on term SGA trends, separately for blacks and whites. RESULTS: Between 1975 and 2000, term SGA births declined by 23% (from 21% to 16%) among blacks and by 27% (from 12% to 9%) among whites. Term SGA births declined with increasing age up to 30-34 years, but increased among older women. Within strata of maternal age, the risk also declined with later maternal birth cohorts, among both blacks and whites. The strongest influence on SGA trends was from maternal age, followed by maternal birth cohort, and lastly by delivery period. In general, for any combination of age, period, and birth cohort, blacks showed 1.5- to 2-fold higher rates of term SGA than whites. CONCLUSIONS: The persistence of strong maternal age effects on risk of term SGA births suggests that the effect of age is at least partly the result of biologic factors. Term SGA trends were generally consistent for blacks and whites, although the magnitude of difference in the risks for combinations of age, period, or mother's birth cohort was higher among blacks than whites.     

Adolescent pregnancy in the United States: an interstate analysis

Rates of teenage pregnancy, birth and abortion vary greatly among states. Because states that have high birthrates tend to have low abortion rates, pregnancy levels vary much less than do the birth and abortion measures. The role of unintended pregnancy is highlighted by the fact that in states that have very high pregnancy rates, the adolescent abortion rate is higher than the birthrate and the abortion rate combined in states that have the lowest pregnancy rates. A series of multivariate analyses that controlled for the percentage of the state population that was black, poor and metropolitan showed that social factors tend to be more important determinants of state differences in teenage pregnancy, birth and abortion levels than are policy-related variables, particularly for whites. Nevertheless, some policy measures have important associations for both races, especially for blacks. Social factors. High rates of population growth and residential mobility over the previous decade, a high crime rate, a high teenage suicide rate, extensive circulation of sexually explicit magazines, a large percentage not voting in elections and a high level of stress are all associated with high pregnancy-related rates for teenagers. The percentage of children living in female-headed households correlates positively with abortion and pregnancy levels among white teenagers, but has no significant association with the birthrate. The percentage of a state's population that belongs to fundamentalist religious groups is positively associated with adolescent birthrates. Political liberalism correlates with relatively low pregnancy rates and birthrates but with a somewhat higher likelihood of pregnancies being terminated by abortion. In states where women's status is higher, birthrates are lower, but abortion levels are higher. Policy measures. States that have high proportions of teenagers dropping out of school and of young women not graduating from high school tend to have high pregnancy rates and birthrates and a somewhat lower proportion of pregnancies ending in abortion. Increased spending on education is associated with relatively high abortion rates (and, therefore, pregnancy rates). The higher the teacher-student ratio, the lower the adolescent birthrate and the more likely the pregnant teenager is to have an abortion. Welfare payments to teenage mothers are negatively associated with both black and white teenage birthrates, and higher maximum payments are associated with relatively high abortion levels.(ABSTRACT TRUNCATED AT 400 WORDS)     

Partner notification in the United States: an evidence-based review

INTRODUCTION: To conduct an evidence-based review of the literature on the effectiveness of partner notification strategies for syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV) in the United States. METHODS: Systematic literature searches of available databases yielded 212 English language articles on partner notification, 13 of which met the inclusion criteria. These 13 articles were systematically reviewed, abstracted, and rated for quality of study methods, analysis, and generalizability. RESULTS: Partner notification can newly detect HIV and other sexually transmitted diseases among partners. Of the six high-quality studies, the highest numbers of infections per infected person, 0.23 and 0.24, were detected by provider referral while the lowest number of infections per infected person, 0.03, was detected by self referral. None of the 13 studies examined the consequences of partner notification, such as infections or health consequences averted or changes in behavior and partnerships for infected persons or their partners. CONCLUSIONS: There is good evidence that partner notification is a means of newly detecting infections. In addition, there is fair evidence that provider referral generally ensures that more partners are notified and medically evaluated than does self referral. More research is needed to improve elicitation and notification procedures and tailor them to specific populations, to assess the effect of new testing technologies on partner notification, and to understand the consequences of partner notification for infected persons and their partners.     

Underreporting of induced and spontaneous abortion in the United States: an analysis of the 2002 National Survey of Family Growth

Underreporting of induced abortions in surveys is widespread, both in countries where the procedure is illegal or highly restricted and in those where it is legal. In this study, we find that fewer than one half of induced abortions performed in the United States in 1997-2001 (47 percent) were reported by women during face-to-face interviews in the 2002 National Survey of Family Growth (NSFG). Hispanic and black women and those with low income were among the least likely to report their experience of abortion. Women were also less likely to report abortions that occurred when they were in their 20s. Second-trimester abortions were more likely to be reported than first-trimester terminations. The levels of recent spontaneous abortion reported in the 2002 NSFG were consistent with the accumulated body of clinical research, although substantially more lifetime pregnancy losses were reported on self-administered surveys than in face-to-face interviews. Subsequent research should explore strategies to improve information collected on abortion, and, in the interim, research involving pregnancy outcomes should be adjusted for unreported induced abortions.     

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)     

Family Socioeconomic Status and Early Life Mortality Risk in the United States

Maternal and Child Health Journal - We examine the association between several dimensions of parental socioeconomic status (SES) and all-cause and cause-specific mortality among children and youth...     

Aedes albopictus in the United States: rapid spread of a potential disease vector

Aedes albopictus, the Asian "tiger mosquito," was found in Houston, Texas, in 1985. Aedes albopictus is primarily a forest edge inhabiting species that has readily adapted to the container habitats produced by humans. Although not yet incriminated in the spread of any disease in the Americas, it has been repeatedly implicated in epidemic dengue and dengue hemorrhagic fever transmission in Asia. It is a competent laboratory vector of La Crosse, yellow fever and other viruses, and can transovarially transmit at least 15 viruses. In 1986, Ae. albopictus was found in many other Texas counties, and in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Louisiana, Mississippi, Missouri, Ohio, and Tennessee. In 1987, infestations were discovered in Delaware, Kentucky, Maryland, and North Carolina. Aedes albopictus and other exotic species were intercepted in shipments of used tires entering the United States from Asia. All such tires must now be free of mosquitoes before entering the country. Control over the movement and storage of tires, a strong source reduction program, and intensive public education can solve the albopictus problem.