5.1 The rate of pregnancies among females aged 15-17 declined from 80.3 per 1,000 in 1990 to 71.7 in 1995. The year 2000 target is 50. For females aged 10-14, the rate declined from 3.5 in 1990 to 3.0 in 1995. Related data show that the rate of live births among females aged 15-17 declined from 37.5 per 1000 in 1990 to 32.6 (preliminary data) in 1997; for females aged 10-14, the rate declined from 1.4 to 1.2 (preliminary) over the same period. Abortions among females aged 15-17 declined from 26.5 per 1,000 in 1990 to 19.9 in 1995 and, among those aged 10-14, from 1.5 per 1,000 to 1.2 over the same period. For black females aged 15-19, the pregnancy rate per 1,000 declined from 215 in 1990 to 178 in 1995 (target, 120), and the rate of live births per 1,000, from 113 in 1990 to 90 in 1997. The rate of abortions per 1,000 for black females aged 15-17 declined from 55 in 1990 to 44 in 1995. For Hispanic females aged 15-19, the rate of pregnancies increased from 156 per 1,000 in 1990 to 163 in 1995. The rate of live births and the rate of abortions among Hispanic females aged 15-19 have changed only slightly during the decade of the 1990s.

5.2 The proportion of pregnancies that were unintended among the total female population aged 15-44 decreased from 56 percent in 1988 to 49 percent in 1995. The year 2000 target is 30 percent. For black females aged 15-44, the rate of unintended pregnancies declined from 78 percent in 1988 to 72 percent (target, 40 percent), and for Hispanic females in that age group, from 55 percent in 1988 to 48 percent in 1995 (target, 30 percent).

5.3 The prevalence of infertility in married couples with wives aged 15-44 decreased from 7.9 percent in 1988 to 7.1 percent in 1995 (target is 6.5 percent). In black married couples, infertility prevalence decreased from 12.1 percent in 1988 to 10.5 percent in 1995 (target, 9 percent). Over the same period, infertility in Hispanic married couples declined from 12.4 percent to 7.0 percent, surpassing the target of 9 percent.

5.4 Among 15-year old adolescents, the proportion of females who reported having had sexual intercourse declined from 27 percent in 1988 to 22 percent in 1995; the proportion of males declined from 33 percent in 1988 to 27 percent in 1995. The year 2000 target is 15 percent. Among 17-year-olds, the proportion of females remained much the same—50 percent in 1988 and 51 percent in 1995. The target is 40 percent. Supplemental data for in-school adolescents show mixed trends: an increase from 35 percent in 1990 to 44 percent in 1997 among 15 year-old females; a decrease from 48 percent to 42 percent among 15 year-old males over that time span; a decrease among non-Hispanic black males aged 17 from 90 percent in 1991 to 85 percent in 1997; and a decrease among non-Hispanic black 17 year-old females from 84 percent in 1991 to 73 percent in 1997.

5.5 In 1995, 27 percent of sexually-active females aged 15-17 reported abstaining from sexual intercourse for 3 months prior to the interview, as did 37 percent of sexually-active males aged 15-17. These are increases from the 1988 rates of 24 percent and 33 percent, respectively. The year 2000 target is 40 percent. Supplemental data for 1997 indicate that 23 percent of in-school sexually active females aged 15-17 and 32 percent of in-school sexually active males aged 15-17 reported such abstention. For in-school adolescents in this age group, the data show a slight decrease in sexual abstinence for females and a slight increase for males during the 1990s.

5.6 Among sexually-active females aged 15-19, the rate of contraceptive use at first intercourse increased from 65 percent in 1988 to 76 percent in 1995. Use of contraceptives by this group at most recent intercourse declined from 78 percent in 1988 to 71 percent in 1995. Among sexually-active males aged 15-19, the rate of use of contraceptives at most recent intercourse showed little change between 1990 (78 percent) and 1995 (79 percent). The year 2000 target is 90 percent. Supplementary data from school interviews show an increase from 78 percent in 1990 to 85 percent in 1997 in the proportion of in-school, sexually-active females aged 15-17 who used contraceptives at most recent intercourse. For in-school, sexually-active males in this age group, the proportion using contraceptives at most recent intercourse decreased slightly between 1991 to 1997 (from 83 to 81 percent ).

5.7 The proportion of women aged 15-44 experiencing a pregnancy despite use of a reversible contraceptive method decreased from 14 percent in 1988 to 12 percent in 1995. The year 2000 target is 7 percent for all women. In 1995, contraceptive failure resulting in pregnancy was experienced by 15 percent of Hispanic women (down from 16 percent in 1988) and by 19 percent of black women (an increase from 18 percent in 1988). The target for both groups is 8 percent.

5.11 In 1994, 81.8 percent of Title X funded family planning clinics provided pretest counseling on HIV to their clients, an increase from 66 percent in 1990. HIV testing for clients was provided by 73.5 percent of these clinics, compared with 60 percent in 1990. Also in 1994, the proportions of these clinics providing STD services was as follows: 95 percent, testing; 98 percent, counseling; 93 percent, treatment.

5.12 Between 1982 and 1995, the proportion of females aged 15-44 at risk of unintended pregnancy who used contraception increased as follows: for all females, from 88.2 percent to 92.5 percent; for black females, from 78.9 percent to 89.9 percent (of non-Hispanic blacks only in 1995); for females with income below the poverty level, from 79.6 percent to 92.1 percent. For at-risk females aged 15-19 under 200 percent of the poverty level, the proportion using contraception increased from 67.4 percent in 1982 to 84.8 percent in 1995. The year 2000 target is 95 percent for all groups.

HIGHLIGHTS

• Many people in need of family planning services are uninsured. Medicaid is the largest source of funding for reproductive health services in the U.S., but the working poor, adolescents and families without children are usually excluded from coverage because of eligibility requirements. Private health insurance plans usually do not provide coverage for contraceptive services.
• Title X of the Public Health Service Act supports a network of 4,600 clinics providing comprehensive family planning services to 4.5 million people each year, 85 percent of whom are low-income and a third of whom are adolescents.
• Almost one-half of pregnancies in the U.S. are unintended; 23 percent of these end in abortion. Adolescents account for less than half of the total number of unintended pregnancies.
• Since 1991, the rate of first and second births to females aged 15-19 has declined. This trend correlates closely with increased use of contraceptives and delays in initiation of sexual intercourse.
• "Contraceptive switching" significantly increases the risk of unintended pregnancy. One study showed that 64 percent of women switching from one form of contraception to another had an unintended pregnancy during the interval.
• Ninety-three percent of women at risk of unintended pregnancy use some form of contraception. The remaining 7 percent of women account for 47 percent of all unintended pregnancies.

FOLLOW-UP

• Increase public awareness of the benefits of family planning.
• Support coordination of health care delivery systems for all women, but particularly for the uninsured. Increase the integration of STD and HIV screening and referral into family planning services.
• Design family planning services to reflect the perspective of male partners and increase their involvement in these programs.
• Improve private health insurance coverage for contraceptive supplies and services.
• To help women with contraceptive decisionmaking and effective use of chosen methods, strengthen the training of health care practitioners who provide family planning services. Ensure the inclusion of cultural proficiency in this training.
• Achieve better translation and implementation of findings from research and evaluation into effective, sustained family planning strategies.
• Encourage family planning providers to use community-based organizations to serve hard-to-reach populations.

PARTICIPANTS
Centers for Disease Control and Prevention
Child Trends, Inc.
Columbia University
Family Planning Council of Philadelphia
Health Resources and Services Administration
Louisiana Office of Public Health
National Asian Women’s Health Organization
National Black Women’s Health Project
National Latina Institute for Reproductive Health
Office of the Assistant Secretary for Planning and Evaluation
Office of Disease Prevention and Health Promotion
Office of Minority Health
Office of Public Health and Science
Office of Population Affairs
Office of the Regional Health Administrator, Region IV
Office of the Regional Health Administrator, Region VIII
Office on Women’s Health
National Institutes of Health
The Alan Guttmacher Institute
The Urban Institute