1. Healthy People 2010 Focus Area 9: Family Planning Richard J. Klein Progress Review November 6, 2008

2. Pregnancy 9-1Intended pregnancy (females aged 15 to 44 years) 9-4Contraceptive failure-females experiencing pregnancy (aged 15 to 44 years) 9-7Adolescent pregnancy (per 1,000 population, aged 15 to 17 years) Male Involvement in Pregnancy Prevention 9-6aGone to family planning clinic with female partner in last 12 months (unmarried males aged 15 to 24) Highlighted Objectives *Percent of targeted change achieved is between -10% and 10% and/or statistically significant ImprovingGetting worseLittle or no progress* Baseline only Target met or exceeded

3. Overview 3.1 million unintended pregnancies in the US in 2001 (the last year for which data are available) Unintended pregnancy is associated with: Increased health care costs Mothers more likely to smoke or use alcohol in pregnancy Child more likely to be low birth weight Depression in mothers more likely Reduced school completion for mother Lower income if mother is unmarried Mother less likely to breastfeed Less time and attention with child In 2004, teen childbearing in the United States cost taxpayers at least $9.1 billion Unintended pregnancies to teens are only 21% of all unintended pregnancies Total costs of unintended pregnancies therefore much higher

4. Percent At Risk of Unintended Pregnancy & Not Using Contraception 0 30 Pregnancy-Related International Comparisons SOURCE: J Trussell and LL Wynn. 2008. Reducing Unintended Pregnancy in the United States. Contraception 77 (1): 1-5, January, 2008. Innocenti Report Card 7, 2007, UNICEF, Child poverty in perspective: An overview of child well-being in rich countries, Innocenti Report Card 7, 2007, UNICEF Innocenti Research Centre, Florence. 10 20 50 40 USAFrance Scotland Pregnancies that are Unintended USAFrance UK Births per 1,000 women age 15-19

5. Answered “right time or later” to the question: “Did you become pregnant too soon, at about the right time, or later than you wanted? ” 20 30 0 80 Proportion of Pregnancies That are Intended Obj. 9-1 NOTE: Data are for females ages 15 to 44 years. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white include only persons who reported only one racial group. SOURCE: L. Finer and S. Henshaw, “Disparities in Rates of Unintended Pregnancy in the US, 1994 and 2001.” Perspectives on Sexual and Reproductive Health 38 (2): 90-96, June 2006. 10 Percent Black Race/ethnicity White Poor Near Poor Total 1995 2002 Income Hispanic Increase desired 2010 Target: 70 Middle/ High 40 50 60 70

6. Obj. 9-1 Proportion of Pregnancies That are Intended < High School 20 Percent 30 Education 0 Current Total 80 1995 2002 Increase desired 2010 Target: 70 Marital Status 10 Never 40 50 60 70 Former* High School Some College Grad NOTE: *Formerly married is defined as divorced, widowed or separated. Data are for females ages 15 to 44 years. SOURCE: L. Finer and S. Henshaw, “Disparities in Rates of Unintended Pregnancy in the US, 1994 and 2001.” Perspectives on Sexual and Reproductive Health 38 (2): 90-96, June 2006. Answered “right time or later” to the question: “Did you become pregnant too soon, at about the right time, or later than you wanted? ”

7. Distribution of pregnancies 20 Percent 30 Obj. 9-1 0 80 Proportion intended Proportion of Pregnancies That are Intended and Distribution of Pregnancies by Age, 2002 10 40 50 60 70 15-19 20-2425-2930-3435-3940-44 NOTE: Data are for females ages 15 to 44 years. SOURCE: L. Finer and S. Henshaw, “Disparities in Rates of Unintended Pregnancy in the US, 1994 and 2001.” Perspectives on Sexual and Reproductive Health 38 (2): 90-96, June 2006.; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP. Increase desired

8. 0 10 20 30 Percent Total White Hispanic Black Poor Near poor Middle/high income Never married Married Cohabiting Proportion of Pregnancies Due to Contraceptive Failure, 2002 Obj. 9-4 = 95% confidence intervals are approximate; Exact confidence intervals are shown in Kost et al. Contraception 77 (2008) 10-21. NOTE: Figures reflect pregnancy occurring during a 12 month period of typical (not perfect) use of contraceptives. Data are for females ages 15-44. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white include only persons who reported only one racial group. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS. Decrease desired 12.4 2010 Target: 8 Proportion of Women Who Became Pregnant While Using Contraception, 2002

9. Percent InjectablesPill Male CondomWithdrawalCalendar/ Rhythm = 95% confidence intervals are approximate; Exact confidence intervals are shown in Kost et al. Contraception 77 (2008) 10-21. NOTE: Data are for females ages 15-44. Figures reflect pregnancy occurring during a 12 month period of typical (not perfect) use of contraceptives. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS. Proportion of Women Who Became Pregnant While Using Contraception, 2002 Rates did not change significantly between 1995 and 2002

10. Rate per 1,000 population1996 2004 Decrease desired Adolescent Pregnancy, Ages 15-17 2010 Target: 39 Obj. 9-7 NOTE: Data are for females ages 15 to 17 years. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white only include persons who reported only one racial group. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP. Total White Black Hispanic

11. Teen Pregnancy, Birth and Abortion Rates, Ages 15-17 Rate per 1,000 women NOTE: Data for 2006 birth rate are preliminary. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP. Pregnancy rate Birth rate Abortion rate 0 10 20 30 40 50 60 70 80 90 100 1976198019851990199520002006

12. Teen Pregnancy, Birth and Abortion Rates, Ages 18-19 Rate per 1,000 women NOTE: Data for 2006 birth rate are preliminary. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System-Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP. Pregnancy rate Birth rate Abortion rate 0 20 40 60 80 100 120 140 160 180 200 1976198019851990199520002006

13. 15-17 20 Percent Females 0 Total15-17 1995 Total 2002 100 Males Never Married-Ever had Sexual Intercourse, Ages 15-19 18-19 40 60 80 SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

14. 15-17 20 Percent 40 Females 0 Total15-17 1995 Total 2002 Males Never Married-Used Contraception at Last Intercourse, Ages 15-19 18-19 60 80 100 NOTE: Last intercourse within three months of interview SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS.

15. Percent Before 1980 1980’s 1990-19941995-19981999-2002 NOTE: Data are for females ages 15-44. SOURCE: Chandra A, Martinez GM, Mosher WD, Abma J, Jones J. Fertility, Family Planning, and Reproductive Health of US Women: Data from the 2002 National Survey of Family Growth. Vital and Health Statistics Series 23, Number 25. Dec 2005. Hyattsville, MD: NCHS. Contraception Use at First Premarital Intercourse, 2002 43 61 70 73 79 Percent who used condom Percent who used any method Year of First Intercourse

16. Total 15-17 18-19 20-21 22-24 Males, 15-24: Visit to Family Planning Clinic with Female Partner, 2002 Increase desired 2010 Target: 22 0 10 20 30 40 Percent 21 NOTE: Data are for unmarried males. Visits to family planning clinics occurred within the last 12 months. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS. Obj. 9-6a

17. Percent Birth Control Advice 0 WhiteHispanic 30 STD Advice Males, 15-24: Receipt of Specified Services in Last 12 Months, 2002 NOTE: Data are for sexually experienced unmarried males. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. The categories black and white include only persons who reported only one racial group. SOURCE: National Survey of Family Growth (NSFG), CDC, NCHS. 10 20 HIV Advice Black 40

18. 9-7. Adolescent pregnancy 9-8a&b. Abstinence before age 15 years 9-9a&b. Abstinence among adolescents 9-10a-h. Pregnancy prevention and STD protection 9-11a-p. Reproductive health prevention education 9-12. Problems in becoming pregnant and maintaining a pregnancy 9-13. Insurance coverage for contraceptive supplies and services 9-1. Intended pregnancy 9-2. Birth spacing 9-3. Contraceptive use 9-4. Contraceptive failure 9-5. Emergency contraception 9-6a. Male involvement-gone to a FP clinic with female partner 9-6b. Male involvement-gone to a FP clinic for himself 9-6c. Male involvement-received birth control counseling Status of Family Planning Objectives *Percent of targeted change achieved is between -10% and 10% and/or statistically significant ImprovingGetting worseLittle or no progress* Baseline only Target met or exceeded

19. NSFG Data in the Future The NSFG has begun continuous interviewing Data for 2006-2008 will be available in late 2009 Beginning late 2009, data will be available every 2-3 years; better for tracking progress on Healthy People objectives

20. Summary Half of all pregnancies in the US are unintended –Only college grads and married couples attained the target of 70% intended Contraceptive failure rates did not improve overall or in any age or race group Teen pregnancy rates fell between 1996 and 2004, especially for black teens –Less pronounced decline for Hispanic teens –In recent years declines in rates have leveled off Young Black men are more likely to get all reproductive health services

21. Progress review data and slides are available on the web at: http://www.cdc.gov/nchs/hphome.htm