Using Surveillance To Promote Public Health
Examples from the Pregnancy Risk Assessment Monitoring System (PRAMS)

EXECUTIVE SUMMARY PUBLICATION YEAR 2002

Unintended Pregnancy

Unintended pregnancy is widespread in the United States. Nearly one-third of babies born in the United States each year are the result of an unintended pregnancy, defined as a pregnancy for which, at the time of conception, a woman either wanted to be pregnant later (mistimed) or did not want to be pregnant at any time (unwanted).^1-3Pregnancy intention is related to infant outcomes such as low birth weight^1,4,9 and to maternal behaviors such as smoking,^1,4-7 drinking,^1,6 illicit drug use,⁸ failure to take prenatal vitamins,⁵ and failure to initiate prenatal care visits.^1,7

Oklahoma

The Board of the Oklahoma State Department of Health (OSDH) used PRAMS data to develop a policy statement supporting a request for additional appropriations for family planning and teen pregnancy prevention during the 1994 legislative session. The Institute for Child Advocacy in Oklahoma and the county health department administrators were instrumental in contacting and educating legislators regarding unintended pregnancy. In addition, extensive statewide community outreach was initiated. PRAMS data were incorporated into presentations that were given to various health professionals and community groups by the Maternal and Infant Health staff; more than 1,500 community members received information on unintended pregnancy. These efforts generated tremendous support, and many people who felt strongly about this issue contacted their legislators to support additional funding for family planning.

As a result, the Oklahoma State Legislature appropriated $605,000 in 1994 to the Oklahoma Department of Health Family Planning Program for the expansion of community-based family planning services targeting high-risk, underserved, low-income women and men. Two new nurse practitioners and one public health nurse were hired in rural areas, and a new clinic site was opened. Additional medications, particularly Depo-Provera, were purchased to meet high demand. The same year, the legislature also appropriated an additional $500,000 to reduce the waiting list for tubal ligations and vasectomies by increasing the availability of these services.

In 1996, the Oklahoma State Legislature again appropriated funds totaling $2 million for family planning programs to continue providing community-based education, to open additional clinic sites, to hire more staff across the state, and to increase the availability of tubal ligations and vasectomies. As of 2002, OSDH continues to receive appropriated funds for providing sterilization services to family planning clients. PRAMS data on unintended pregnancy are used to validate the need for funding.

South Carolina

The Family Planning Program at the South Carolina Department of Health and Environmental Control used PRAMS data to evaluate its state-specific performance measure regarding unintended pregnancy for the Title V Block Grant and to make the prevention of unintended pregnancy a priority in South Carolina. As of 2001, health districts across the state were using a variety of approaches to address unintended pregnancy. These include:

• Increasing access to family planning clinics and appropriate methods of birth control.
   
• Integrating family planning services with other services at the health department, for example, offering counseling and birth control methods to clients seeking women’s health, family support, and services for sexually transmitted diseases (STDs).
   
• Developing partnerships with private physicians to provide family planning services.
   
• Implementing educational interventions within communities.

For example, in the Catawba Health District, the family planning staff participate in workshops at Clinton Junior College and offer “Laundromat Lunch and Learn Classes” focusing on attitudes, knowledge, and behaviors related to family planning and STD/HIV prevention. In Jasper County, the district social worker provides family planning education and counseling to teens at the Family Life Center at Jasper County High School 2 days per week. In the Trident Health District, family planning education is provided at health fairs, in classes in the community, and on the campus of the College of Charleston.

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Page last reviewed: 3/24/06
Page last modified: 3/24/06
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion