Periodic estimation of the incidence of global unintended pregnancy can help demonstrate the need for and impact of family planning programs. We draw upon multiple sources of data to estimate pregnancy incidence by intention status and outcome at worldwide, regional, and subregional levels in 2012 and to assess recent trends using previously published estimates for 2008 and 1995. We find that 213 million pregnancies occurred in 2012, up slightly from 211 million in 2008. The global pregnancy rate decreased only slightly from 2008 to 2012, after declining substantially between 1995 and 2008. Eighty-five million pregnancies, representing 40 percent of all pregnancies, were unintended in 2012. Of these, 50 percent ended in abortion, 13 percent ended in miscarriage, and 38 percent resulted in an unplanned birth. The unintended pregnancy rate continued to decline in Africa and in the Latin America and Caribbean region. If the aims of the London Summit on Family Planning are carried out, the incidence of unwanted and mistimed pregnancies should decline in the coming years.

/pdf/intended-and-unintended-pregnancies-worldwide-in-2012-and-4iiskd9hvb.pdf

Intended and unintended pregnancies worldwide in 2012 and recent trends.

Unintended pregnancy can carry serious consequences for women and their families. We estimate the incidence of pregnancy by intention status and outcome at worldwide, regional, and subregional levels for 2008, and we assess recent trends since 1995. Numbers of births are based on United Nations estimates. Induced abortions are estimated by projecting from recent trends. A model-based approach is used to estimate miscarriages. The planning status of births is estimated using nationally representative and small-scale surveys of 80 countries. Of the 208 million pregnancies that occurred in 2008, we estimate that 41 percent were unintended. The unintended pregnancy rate fell by 29 percent in developed regions and by 20 percent in developing regions. The highest unintended pregnancy rates were found for Eastern and Middle Africa and the lowest for Southern and Western Europe and Eastern Asia. North America is the only region in which overall and unintended pregnancy rates have not declined. We conclude with a brief discussion of global and regional program and policy implications.

/pdf/unintended-pregnancy-worldwide-levels-trends-and-outcomes-43xwasuz4e.pdf

Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes

The Case for Marriage: Why Married People are Happier, Healthier, and Better Off Financially. Linda J. Waite & Maggie Gallagher. New York: Doubleday. 2000. 260 pp. ISBN 0-38550085-8. $24.95 cloth. Marriage, our second oldest institution, has been controversial during most of its existence. In The Bankruptcy of Marriage, Calverton (1928) observed, "It is marriage as we know it... the marriage of modern monogamy, of the bindingcontract variety, our system of marriage, in other words, that has broken down, and to-day is bankrupt" (p. 62). Given its age and its undisputed importance, marriage has long been challenged and defended. The Case for Marriage offers a spirited and well-documented but flawed example of such a defense. First, its use of language is far from neutral. Its tone oozes with disrespect for those who deviate from lifelong marriage. Marriage throughout the text is referred to as a "bargain," a superior investment benefiting both those who participate and society at large. Cohabitation, on the other hand, is a "deal," something one picks up at a flea market. Cohabiting partners, regardless of their age, are referred to as "live-in" boy- or girlfriends and are described as "couples living together without commitment" (p. 190). Adult singles are treated as a residual category. As constructionists remind us, the use of language is not just a descriptive but a creative and frequently assertive activity. My second concern is conceptual. Marriage institutionalizes the legitimacy of offspring in human societies. Children born in it, regardless of its form, are considered "legitimate" and belong to a kinship network. The marriage institution, then, has a clear stake in its procreative consequences, as is exemplified by its sole universal rule, the "incest taboo." Its main "enemy" is promiscuous reproduction. Its "allies" are those other forms of "living together" that, regardless of their duration, counter random mating. "Family," the oldest human institution, traditionally is responsible for "caring" for the very young, and nowadays also for the aged. It seems impossible to imagine humanity's pilgrimage without these two institutions. It is quite possible, however, to imagine each one taking on a variety of forms. The core units of the marriage and family institutions are, respectively, married couples and family networks. The bulk of Waite's and Gallagher's book is not about the institutions of marriage and family, but rather about individuals who choose to participate in marital and familial units. They conceptualize marriage as more than a "private emotional relationship" and specify a "lifelong commitment to form a new family" (p. 187) as its raison d'etre. They use the words marriage and family interchangeably. This is confusing. For example, are voluntarily childless married couples to be considered deviants? Uncommitted? What about one-parent families? Are they a different legitimate family form or, as the authors seem to imply, simply an outcome of unwed motherhood, marital failure, or early spousal death? I agree with the authors that marriage's "larger public role must be acknowledged and supported by the larger society and its institutions" (p. 187). All social arrangements, whether sacred or profane, to use Durkheim's terminology, that combat reproductive promiscuity or inadequate family care deserve support from "society and its institutions." The authors' treatment of cohabitation is equally troublesome to me. Analytically, cohabitation, in its many manifestations, should not be contrasted or compared with marriage but rather with the equally diverse category of singlehood. I have no problem with the multitude of quantitative data amassed by the authors to show that enduring marriages and families, on the average, offer some distinct advantages over cohabitation. …

The Case for Marriage: Why Married People Are Happier, Healthier, and Better off Financially

This review details a key innovation across the field of adolescent sexuality research over the last decade—conceptualizing sexuality as a normative aspect of adolescent development. Anchored in a growing articulation of adolescent sexuality as having positive qualities and consequences, we provide an organizing framework for understanding sexuality as normative and developmentally expected. Using this framework, we report on 3 specific areas of research that have developed “critical mass” over the past decade: new views on sexual behavior, sexual selfhood, and sexual socialization in the 21st century. We conclude by suggesting that the next step in the field of adolescent sexuality development is the explicit integration of “positive” dimensions of sexuality with risk management dimensions. Rather than navigating a binary between positive and risky, we propose characterizing the “both/and” quality of adolescent sexuality development as normative. This framework, we argue, encourages empirical research that assumes a wide range of strategies through which adolescents learn about themselves, their bodies, intimate partners, and relationships within contexts where they are required to both manage risks and develop positive patterns for adulthood sexuality. We conclude with considerations for future research and public policy.

/pdf/normative-sexuality-development-in-adolescence-a-decade-in-415rpj5yir.pdf

Normative Sexuality Development in Adolescence: A Decade in Review, 2000–2009

Social Causes of Psychological Distress

Context: Teenagers have a high unintended pregnancy rate in part because of inconsistent use or nonuse of contraceptives. It is important to determine how partner and relationship characteristics are related to contraceptive use and consistency within adolescents first sexual relationships. Methods: Logistic and multinomial logistic regression analyses of data from 1027 participants in the first two waves of the National Longitudinal Study of Adolescent Health examined the influence of relationship and partner characteristics on ever-use and consistent use of contraceptive methods during teenagers first sexual relationships. Results: Teenagers who had waited a longer time between the start of a relationship and first sex with that partner discussed contraception before first having sex or used dual contraceptive methods had significantly increased odds of ever or always using contraceptives. Adolescents who had taken a virginity pledge had an older partner had a greater number of close friends who knew their first partner or reported having a relationship that was not romantic but that involved holding hands kissing and telling their partners they liked or loved them had decreased odds of contraceptive use or consistency. As relationship length increased teenagers were more likely to ever have used a method but less likely to always have used a method. Conclusions: Parents and programs should encourage teenagers to delay sexual intercourse discuss contraception with partners before initiating sex and be vigilant about contraceptive use particularly in long-term sexual relationships and in relationships with older partners. (authors)

/pdf/patterns-of-contraceptive-use-within-teenagers-first-sexual-52rrx6qwl6.pdf

Patterns of Contraceptive Use Within Teenagers’ First Sexual Relationships

The Consequences of Unintended Childbearing: A White Paper.

By using data from the National Longitudinal Study of Adolescent Health, we examine how adolescent relationship characteristics, partner attributes, and sexual relationship histories are associated with contraceptive use and consistency, incorporating random effects to control for respondent-level unobserved heterogeneity. Analyses show that teens’ contraceptive use patterns vary across relationships. Teens with more-homogamous partners, with more-intimate relationships, and who communicate about contraception before sex have greater odds of contraceptive use and/or consistency. Teens in romantic relationships, and who are older when engaging in sex for the first time, have greater odds of ever using contraceptives but reduced odds of always using contraceptives. Teens continue habits from previous relationships: teens with experience practicing contraceptive consistency and females who previously have used hormonal contraceptive methods are better able to maintain consistency in subsequent relationships. Also, relationship and partner characteristics are less important for females who previously used hormonal methods.

https://www.jstor.org/stable/pdfplus/30053104.pdf

Contraceptive use patterns across teens’ sexual relationships: The role of relationships, partners, and sexual histories

CONTEXT: Most U.S. teenage pregnancies are unintended, partly because of inconsistent or no use of contraceptives. Understanding the factors associated with contraceptive use in teenagers’ most recent relationships can help identify strategies to prevent unintended pregnancy. METHODS: Data on 1,468 participants in Waves 1 and 2 of the National Longitudinal Study of Adolescent Health who had had two or more sexual relationships were analyzed to assess factors associated with contraceptive use patterns in teenagers’ most recent sexual relationship. Odds ratios were generated through logistic regression.

/pdf/contraceptive-use-and-consistency-in-u-s-teenagers-most-5c9l1styw4.pdf

Contraceptive use and consistency in U.S. teenagers' most recent sexual relationships.

CONTEXT: Little research links adolescent risk behaviors to reproductive health outcomes beyond adolescence, although young adults—men and women in their early 20s— bear a disproportionate burden of STDs and unintended childbearing.

METHODS: To assess whether individuals who engaged in risk behaviors during adolescence had increased risk of negative reproductive health outcomes in young adulthood, data from Waves 1–4 of the National Longitudinal Study of Adolescent Health on 5,798 sexually active respondents were analyzed. Logistic and multinomial logistic regressions examined associations between risk behaviors (cumulatively and individually) and each of three outcomes.

RESULTS: Four in 10 youth reported at least three risk factors during adolescence. Women who were exposed to an increasing number of risks had an elevated likelihood of having had multiple sex partners in the last year, rather than none (relative risk ratio, 1.3); having had an STD (odds ratio, 1.1); and having had an intended or unintended birth, as opposed to no birth (relative risk ratio, 1.1 for each). Inconsistent contraceptive use and having had multiple partners, a nonmonogamous partner or a nonromantic partner were associated with reporting multiple partners in the last year; inconsistent use, sexual debut after age 16 and not discussing contraception with a partner were associated with having any birth.

CONCLUSIONS: Teenagers’ sexual behaviors have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.

/pdf/risky-adolescent-sexual-behaviors-and-reproductive-health-in-3lahoz68go.pdf

Suzanne Ryan

Papers

Patterns of Contraceptive Use Within Teenagers’ First Sexual Relationships

The Consequences of Unintended Childbearing: A White Paper.

Contraceptive use patterns across teens’ sexual relationships: The role of relationships, partners, and sexual histories

Contraceptive use and consistency in U.S. teenagers' most recent sexual relationships.

Risky adolescent sexual behaviors and reproductive health in young adulthood.