Design or accident? The natural history of teenage pregnancy.
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The UK has the highest rate of teenage pregnancy in Western Europe. A retrospective record-based study was conducted in an East Devon general practice to gain greater understanding of the outcome of first teenage pregnancy and subsequent reproductive history. The comparison group was women who had first conceived between the ages of 25 and 29 years. 149/673 women born between 1968 and 1977 became pregnant when teenagers. Of these, 70 (47%) had the baby, 67 (45%) had a termination and 10 (7%) had a spontaneous miscarriage; 2 others experienced fetal loss. Of the women aged 25-29 at first conception, 127 (92%) had the baby, 6 (4%) had a termination and 5 (4%) had a miscarriage. 40 (27%) of the teenage group went on to have a second teenage pregnancy, including 12 of the 67 who had their first pregnancy terminated. Although teenage pregnancy is often viewed as unplanned and unwanted, the reality is more complex. Among this group, many first pregnancies were desired. Even among those whose first pregnancy was terminated, 18% went on to have a baby while still a teenager. (+info)
Family planning clinic services in the United States: patterns and trends in the late 1990s.
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CONTEXT: Publicly funded family planning clinics are a vital source of contraceptive and reproductive health care for millions of U.S. women. It is important periodically to assess the number and type of clinics and the number of contraceptive clients they serve. METHODS: Service data were requested for agencies and clinics providing publicly funded family planning services in the United States in 1997. The numbers of agencies, clinics and female contraceptive clients were tabulated according to various characteristics and were compared with similar data for 1994. Finally, county data were tabulated according to the presence of family planning clinics and private physicians likely to provide family planning care and according to the number of female contraceptive clients served compared with the number of women needing publicly funded care. RESULTS: In 1997, 3,117 agencies offered publicly funded contraceptive services at 7,206 clinic sites. Forty percent of clinics were run by health departments, 21% by community health centers, 13% by Planned Parenthood affiliates and 26% by hospitals or other agencies. Overall, 59% of clinics received Title X funding. Agencies operated an average of 2.3 clinics, and clinics served an average of 910 contraceptive clients per year. Altogether, clinics provided contraceptive services to 6.6 million women-approximately two of every five women estimated to need publicly funded contraceptive care. The total number of providers and the total number of women served remained stable between 1994 and 1997; at the local level, however, clinic turnover was high. Some 85% of all US counties had one or more publicly funded family planning clinics; 36% had one or more clinics, but no private obstetrician-gynecologist. CONCLUSIONS: Publicly funded family planning clinics are distributed widely throughout the United States and continue to provide contraceptive care to millions of US women. Clinics are sometimes the only source of specialized family planning care available to women in rural counties. However, the high rate of clinic tumover and the lack of significant growth in clinic numbers suggest that limited funding and rising costs have hindered the further expansion and outreach of the clinic network to new geographic areas and hard-to-reach populations. (+info)
Social determinants of human reproduction.
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Developed countries have experienced both some population growth and unprecedented declines in fertility rates during the last half of the twentieth century. Couples now have fewer than two children on average in most European countries and they tend to postpone these births until a later age. A decline in male fertility has been suggested by some studies of semen quality, but there is contrasting evidence of shorter times to pregnancy for couples trying to conceive. An important economic factor is the income of young men relative to their parents' incomes, which determines how they rate the ability of their own earnings to support a family. Lower relative income in the 1970s was associated with a lower fertility rate. The decline in fertility in the USA may have been attenuated by the sharp rise in female income during the late 1960s and early 1970s, allowing women to take advantage of purchased child care, thus maintaining the relative family income. The level of demand for children does not appear to be set by known psychological factors, although explanations for the desire to reproduce have been sought in biological, psychoanalytical and socio-cultural research. Recent studies indicate that adults with secure attachment relationships are more interested in being parents. Possible epidemiological factors include age at first marriage, but in Eastern Europe, where age at first marriage is as low as 22 years, fecundity rates do not exceed 1.5. When mothers' age cohorts are analysed, the mean fecundity rate has been falling since the 1920s. Health factors affecting population trends include the change in contraceptive prevalence over the last 40 years. The prevalence of sub-fertility remains close to 10%, and studies from a number of countries indicate that approximately 50% of infertile couples make use of infertility services including IVF and intracytoplasmic sperm injection which are available in 45 countries covering 78% of the world's population. It is estimated that the level of service is sufficient for less than one-third of the need. (+info)
The natural history of violence.
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In the past, human violence was associated with food shortage, but recently it has increased even in relatively well-fed societies. The reason appears from studies of monkeys under relaxed, spacious conditions and under crowding stress. Uncrowded monkeys have unaggressive leaders, rarely quarrel, and protect females and young. Crowded monkeys (even well-fed) have brutal bosses, often quarrel, and wound and kill each other, including females and young. Crowding has similar behaviour effects on other mammals, with physiological disturbances including greater susceptibility to infections. All this appears to be a regular response to overpopulation, reducing the population before it has depleted its natural resources. Human beings, like monkeys and other mammals, need ample space, and become more violent when crowded. Human history is marked by population cycles: population outgrows resources, the resulting violence, stress and disease mortality cuts down the population, leading to a relief period of social and cultural progress, till renewed population growth produces the next crisis. The modern population crisis is world-wide, and explains the increase of violence even in well-fed societies. The solution to the problem of violence is to substitute voluntary birth control for involuntary death control, and bring about relaxed conditions for a reduced world population. (+info)
A comparison of program and contraceptive use continuation rates in a family planning clinic.
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Programs and contraceptive use continuation rates were obtained for a rural Georgia family planning clinic. Program continuation is a measurement of maintenance of clinic attendance, while use continuation is related to actual use of effective contraceptives regardless of clinic activity status. Program continuation rates ranged from 0.77 at 12 months to 0.48 at 36 months. Contraceptive use continuation rates were 0.78 at 12 months and 0.58 at 36 months. Women who moved or were otherwise lost to follow-up formed the largest category of discontinuation. The highest rate of discontinuation from clinic attendance occurred after the first visit with secondary peaks around the time of scheduled annual checkups. Women who were younger and had fewer living children had a greater likelihood of discontinuing clinic attendance and contraceptive use. The reasons for and timing of discontinuation from clinic attendance suggest that clinic personnel should place special emphasis on the first visits, arrange referral for women who might have plans to leave the service area before the scheduled return visit, send reminders before first revisits, and follow up patients soon after missed visits. Priority might be assigned to the younger women of low parity who have been shown to be at higher risk of discontinuation. Other factors which might influence continuation include method of contraception, marital status, and race. Program continuation can be determined by analysis of clinic records alone while contraceptive use continuation often requires follow-up of patients. Although the two continuation rates were not equivalent, program and use continuation were roughly parallel through much of the study period. This suggests that a simple review of records in the clinic or on computer tape, when available, to determine program continuation may give an estimate of actual contraceptive use in the population. (+info)
Intrauterine device retention: a study of selected social-psychological aspects.
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A retrospective study of the association between selected sociopsychological variables and the early discontinuation of intrauterine device use was carried out among patients of the Central Clinic of Family Health, Inc., New Orleans, Louisiana. In toto, 270 women cooperated in a standardized interview which was administered by trained auxiliaries of the clinic's staff; Investigation of sociodemographic characteristics shows a greater proportion of the terminators to be younger, more mobile, and to have experienced more changes in marital partners. Continuers are at greater health risk in pregnancy as rated by the clinic at time of admission, but do not verbalize this as a concern. Responses relating to sexuality image and contraceptive attitudes indicate that a greater proportion of the terminators dislike an internal IUD self string check, hold a more pro-pregnancy attitude, do not feel dependent on the availability of contraceptives, and currently utilize the less effective contraceptive methods. Few significant differences are reported in the side effects experienced after IUD insertion by the terminators or continuers. However, the groups hold decidely different perceptions of the meaning of such complaints. A greater proportion of the terminators perceive themselves as being sick, take to bed during the menses, find that complaints disrupt their normal household activities, and are fearful of the meaning to their health of the difficulties experienced. The majority of both groups are functioning in a segregated marital role pattern. Terminators portray a tendency to be interacting with more "traditional" husbands who visualize the proper role for their wives as mothers whose duty it is to stay home. Continuers, to a greater degree, are more dominant individuals, make more decisions in the running of the home, and feel that contraception is their responsibility alone. Program implications take direction from the findings that the terminator is a more "costly" patient in terms of physician time and is at a decidely greater risk of final closure to all clinic contacts. (+info)
Menstrual regulation in family planning services.
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Menstrual regulation is a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual regulation by vacuum aspiration for treatment of up to 14 days missed menstrual period as probably better medical practice than waiting to confirm the presence of a pregnancy. Because it is a postcontraceptive method, menstrual regulation has potential in family planning services both as a recruitment service and for the treatment of contraceptive failures. Its use as an only method of fertility control is being studied. The acceptance of this new family planning service will primarily depend on its availability, dissemination of information about the service, and the ability of women freely to avail themselves of the service without delay. Although long term effects of single and repeated use of menstrual regulation are not known, its immediate complications are few and it can be recommended as a useful addition to present fertility control methods in family planning programs. (+info)