9
Family Planning
9-1	Intended pregnancy 
9-2	Birth spacing
9-3	Contraceptive use 
9-4	Contraceptive failure 
9-5	Emergency contraception
9-6	Male involvement in pregnancy prevention
9-7	Adolescent pregnancy 
9-8	Abstinence before age 15 years
9-8a		Females 
9-8b		Males 
9-9	Abstinence among adolescents aged 15 to 17 years
9-9a		Females 
9-9b		Males 
9-10	Pregnancy prevention and sexually transmitted disease (STD) protection
Condom at first intercourse:
9-10a			Females 
9-10b			Males
	Condom plus hormonal method at first intercourse:
9-10c			Females 
9-10d			Males 
	Condom at last intercourse:
9-10e			Females 
9-10f			Males 
	Condom plus hormonal method at last intercourse:
9-10g			Females 
9-10h			Males 
9-11	Pregnancy prevention education 
9-12	Problems in becoming pregnant and maintaining a pregnancy 
9-13	Insurance coverage for contraceptive supplies and services

9-1.	Increase the proportion of pregnancies that are intended.	
National Data Sources	National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System (NVSS), CDC, NCHS; Abortion Provider Survey, The Alan Guttmacher Institute (AGI); Abortion Surveillance Data, CDC, NCCDPHP.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.2 (Family Planning).	
Measure	Percent.	
Baseline	51 (1995).	
Numerator	Number of intended births among females aged 15 to 44 years. 	
Denominator	Number of live births plus abortions among females aged 15 to 44 years.	
Population Targeted	U.S. resident population; U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	Before you became pregnant this time, was the reason you did not use any birth control methods because you, yourself wanted to become pregnant?	
	•	At the time you became pregnant, did you, yourself actually want to have a baby at some time?	
	•	So would you say you became pregnant too soon, at about the right time, or later than you wanted?
1) Too soon		
2) Right time		
3) Later			
4) Didn’t care	
Expected Periodicity	Periodic.	
Comments	Intended pregnancies include births that were wanted at the time of conception. Births that were wanted at the time of conception are those resulting from pregnancies that happened at the right time, later than wanted or those answering didn’t care. All abortions are considered unintended pregnancies.	
	Estimates of pregnancies that were intended are derived from the following sources: (1) live births to U.S. residents in 1994; (2) the proportion of recent births that were intended according to the 1995 NSFG; and (3) estimates of induced abortions based on reports by CDC and The Alan Guttmacher Institute (AGI). AGI’s national estimates of abortions, based on surveys it conducts of all known abortion providers, are distributed by age, race, marital status, and ethnicity according to estimates prepared by CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), which are based on reports from State health departments. 	
	The proportion of births intended (females who wanted to become pregnant and wanted to have a baby at sometime and became pregnant at the right time, later, or didn’t care) from NSFG are applied to all resident live births, divided by all births and abortions combined.	
	Information about potential sources of error in the data sources have been published.1, 2, 3	
	Known pregnancies that ended in fetal loss (for example, miscarriage, stillbirth, or ectopic pregnancy) are excluded. However, it was found that incorporating information on the planning status of pregnancies resulting in fetal loss, as reported in the 1995 NSFG, had very little impact on the proportions shown.	
	This objective is adapted from a measure in Healthy People 2000 objective 5.2, which tracked the proportion of pregnancies that were unintended. This measure tracks the proportion of pregnancies that are intended.	
	See Part C for a description of NSFG and NVSS and Appendix A for focus area contact information.	

9-2.	Reduce the proportion of births occurring within 24 months of a previous birth.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent.	
Baseline	11 (1995).	
Numerator	Number of females aged 15 to 44 years whose most recent live birth occurred within 24 months of a previous live birth.	
Denominator	Number of females aged 15 to 44 years with at least one live birth.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	How many times have you been pregnant altogether?	
	[For each pregnancy:]
•	In which of the ways did the pregnancy end?
(a)	Miscarriage
(b)	Still birth
(c)	Abortion
(d)	Ectopic or tubal pregnancy
(e)	Live birth by Cesarean section
(f)	Live birth by vaginal delivery	
	[For each live birth:]
•	On what date was (baby’s name) born?	
Expected Periodicity	Periodic.	
Comments	A female is considered to have had a birth within 24 months of a previous birth if she had consecutive pregnancies ending in a live birth by Cesarean section or live birth by vaginal delivery. 	
	The interval between consecutive live births is derived from the date of birth.	
	Vaginal delivery includes delivery through natural or induced labor.	
	Questions addressing how the pregnancy ended and date baby was born are repeated based on the number of pregnancies.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-3.	Increase the proportion of females at risk of unintended pregnancy (and their partners) who use contraception.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	5.12 (Family Planning).	
Measure	Percent.	
Baseline	93 (1995).	
Numerator	Number of at-risk females aged 15 to 44 years who currently use a method of contraception other than withdrawal. 	
Denominator	Number of at-risk females aged 15 to 44 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	[NUMERATOR:]
•	Please write the methods you used each month on the calendar. I need to know about all the methods you used, so if you used more than one method, please write down all methods you used that month. 
1)  Birth control pills
2)  Condom
3)  Partner’s vasectomy
4)  Diaphragm
5)  Foam
6)  Jelly or cream      
7)  Cervical cap	
8)  Suppository, insert
9)  Today sponge
10) Female condom, vaginal pouch
11) IUD, Coil, Loop
12) Norplant	
13) Depo-provera, Injectables	
14) Morning after pill
15) Rhythm or safe period by calendar		
16) Safe period by temperature, or cervical mucus test, or natural family planning
17) Withdrawal, pulling out 
18) Respondent sterile     
19) Partner sterile
20) Other method (specify)         	
	[DENOMINATOR:]
•	Is the reason you are not using a method of birth control now because you, yourself, want to become pregnant as soon as possible?	
	•	Many women have times when they are not having intercourse at all, for example, because of pregnancy, separation, not dating anyone, illness, or other reasons. Since (Date), have there been any times when you were not having intercourse at all for one month or more?	
	•	What months and years were those?	
Expected Periodicity	Periodic.	
Comments	A female (and her partner) is considered to be at risk of unintended pregnancy if there is a negative response to the denominator questions above on wanting to become pregnant (first question) or not having intercourse (second question).	
	“At risk” females are those who had intercourse in the 3 months prior to the survey who were not pregnant, nor seeking pregnancy, nor post partum, nor (themselves or partners) surgically or nonsurgically sterile.	
	“Currently using” refers to having used any contraceptive method (categories 1, 2, 4 through 16 above) other than sterilization or withdrawal in the month of the interview.	
	An unintended pregnancy is one that was not wanted at the time of conception or not wanted at all.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-4.	Reduce the proportion of females experiencing pregnancy despite use of a reversible contraceptive method.	
National Data Sources	National Survey of Family Growth (NSFG), CDC, NCHS; Abortion Patient Survey, The Alan Guttmacher Institute (AGI).	
State Data Source	Not identified.	
Healthy People 2000 Objective	5.7 (Family Planning).	
Measure	Percent.	
Baseline	13 (1995).	
Numerator	Number of pregnancies that occur within the first 12 months of reported continuous use of a reversible contraceptive method among females aged 15 to 44 years, and their partners.	
Denominator	Number of consecutive months that a reversible contraceptive method was used by females aged 15 to 44 years, and their partners.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	Please write the methods you used each month on the calendar. I need to know about all the methods you used, so if you used more than one method, please write down all methods you used that month.
1)  Birth control pills
2)  Condom 
3)  Partner’s vasectomy
4)  Diaphragm
5)  Foam
6)  Jelly or cream      	
7)  Cervical cap	
8)  Suppository, insert 	 
9)  Today sponge 
10) Female condom, vaginal pouch 
11) IUD, Coil, Loop
12) Norplant
13) Depo-provera, Injectables
14) Morning after pill
15) Rhythm or safe period by  calendar
16) Safe period by temperature, cervical mucus test, natural family planning		
17) Withdrawal, pulling out			
18) Respondent sterile             
19) Partner sterile
20) Other method (specify)	
	•	How many months or weeks had you been pregnant when the baby was born/that pregnancy ended? (Note: this yields date pregnancy began.)	
	From the 1994 Abortion Patient Survey:
•	Before you found out you were pregnant, what was the LAST contraceptive method that you used to prevent pregnancy, including rhythm, withdrawal or condoms?
(a)	Pill
(b)	Condom, rubber (for males)
(c)	Female condom, vaginal pouch
(d)	Diaphragm with or without jelly or cream
(e)	Sponge (TODAY)
(f)	Foam/cream/jelly
(g)	Suppository, insert (Semicid, Encara Oval)
(h)	IUD, coil, loop
(i)	Rhythm/natural family planning
(j)	Withdrawal
(k)	Norplant, implants in the arm
(l)	Depo-Prevera, injectables, shot
(m)	Emergency contraception/morning-after pill
(n)	Other method (specify)
(o)	Never used a method before this pregnancy	
	•	In what month and year did you stop using that method?
______/______Month Year	
	•	For about how many months in a row had you been using that method?
Less than 1 month			
1 month
2 months					
3 months
4 months					
5 months
6 months					
7 months
8 months					
9 months
10 months					
11 months
12 months
13 months
14 months
15 months
16 months
17 months					
18-24 months
25-26 months
27-28 months
29-36 months
37 or more months (3 or more years)	
	•	Had you ever used that method before the months specified above?		
	•	Had you stopped using all methods to prevent pregnancy before you became pregnant this time?	
Expected Periodicity	Periodic.	
Comments	Pregnancies include live births, miscarriages, or induced abortions.	
	Females are considered to have experienced pregnancy despite use of a reversible method if there was continuous method use (in 12-month intervals) and they became pregnant during a month of use of one or more of the following methods: birth control pills, condom (rubber), diaphragm, foam/jelly/cream, cervical cap, suppository, insert, TodayTM sponge, female condom (vaginal pouch), IUD, coil, loop, Norplant, Depo-provera, injectables, withdrawal (pulling out), rhythm/natural family planning, or emergency contraception/morning-after pill. 
NSFG data are adjusted for underreporting of abortions according to AGI’s Abortion Patient Survey. Detailed information on adjustment procedure, contraceptive methods and failure rates have been published by AGI.4	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
9-5.	(Developmental) Increase the proportion of health care providers who provide emergency contraception. 	
Comments	An operational definition could not be specified at the time of publication. 	
	A proposed national data source is The Alan Guttmacher Institute (AGI). 	
	See Appendix A for focus area contact information.	
    
9-6.	(Developmental) Increase male involvement in pregnancy prevention and family planning efforts. 	
Comments	An operational definition could not be specified at the time of publication. 	
	A proposed national data source is the National Survey of Family Growth (NSFG), CDC, NCHS.	
	Proposed questions to be used to obtain the data are scheduled to be included in the 2001 NSFG.	
	NSFG collect comparable data on males aged 15 to 49 years starting with data collected in 2001. 	
	See Appendix A for focus area contact information.	
    
9-7.	Reduce pregnancies among adolescent females.	
National Data Sources	Abortion Provider Survey, The Alan Guttmacher Institute (AGI); Abortion Surveillance Data, CDC, NCCDPHP; National Vital Statistics System (NVSS), CDC, NCHS; National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	5.1 (Family Planning).	
Measure	Rate.	
Baseline	68 (1996).	
Numerator	Number of pregnancies among females aged 15 to 17 years.	
Denominator	Number of adolescent females aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population; U.S. resident population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	(For fetal losses) In which of the ways did your pregnancy end?
1) 	Miscarriage
2) 	Stillbirth
3) 	Abortion
4) 	Ectopic or tubal pregnancy
5) 	Live birth by Cesarean section
6) 	Live birth by vaginal delivery
[Responses 1 and 2 are used as indicators of fetal loss.]	
Expected Periodicity	Periodic.	
Comments	Adolescent pregnancies are the sum of all U.S. resident live births, induced abortions, and fetal losses to females aged 15 to 17 years.	
	Data on live births are counts of all births to U.S. residents occurring in the United States. Estimates of induced abortion are based on reports by CDC and The Alan Guttmacher Institute (AGI). AGI’s national estimates of abortions, based on surveys it conducts of all known abortion providers, are distributed by age and race according to estimates prepared by CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), based on reports of induced abortions from selected State health departments. 	
	Estimates of fetal losses are estimates from the 1995 NSFG. Females participating in this survey were asked to report the dates and outcomes of each of their pregnancies in the past 5 years, including spontaneous fetal losses (miscarriages, stillbirths) from recognized pregnancies. 	
		
	Fetal losses refer to pregnancies that end in miscarriage or stillbirth.	
	See Part C for a description of NSFG and NVSS and Appendix A for focus area contact information.	
9-8.	Increase the proportion of adolescents who have never engaged in sexual intercourse before age 15 years.
9-8a.	Females.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.4 (Family Planning) (also 18.3 and 19.9).	
Measure	Percent.	
Baseline	81 (1995).	
Numerator	Number of females aged 15 to 19 years who had no sexual intercourse with a male before age 15. 	
Denominator	Number of females aged 15 to 19 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	At any time in your life, have you ever had sexual intercourse with a man, that is, made love, had sex, or gone all the way?	
	[If yes:]
o	Please look at the calendar and think back to the very first time in your life that you ever had sexual intercourse with a man. In what month and year was that?
____Month	____Year	
Expected Periodicity	Periodic.	
Comments	Females are considered to have never had sexual intercourse before age 15 if they report that they either never had sexual intercourse with a male or their age at first intercourse was greater than 15 years.	
	This objective is adapted from Healthy People 2000 objective 5.4, which tracked the proportion of adolescents aged 15 to 17 years who engaged in sexual intercourse. This measure tracks the proportion of females aged 15 to 19 years who have never engaged in sexual intercourse.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-8b.	Males.	
National Data Source	National Survey of Adolescent Males (NSAM), Urban Institute.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.4 (Family Planning) (also 18.3 and 19.9).	
Measure	Percent.	
Baseline	79 (1995).	
Numerator	Number of males aged 15 to 19 years who had no sexual intercourse with a female before age 15. 	
Denominator	Number of males aged 15 to 19 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Adolescent Males:	
	•	Have you ever had sexual intercourse with a female (sometimes this is called “making love,” “having sex” or “going all the way”)?	
	[Followed by a question of when the intercourse occurred, similar to that used in objective 9.8a]	
Expected Periodicity	Periodic.	
Comments	Males are considered to have never had sexual intercourse before age 15 if they report that they either never had sexual intercourse with a female or their age at first intercourse was greater than 15 years.	
	This objective is adapted from Healthy People 2000 objective 5.4, which tracked the proportion of adolescents aged 15 to 17 years who engaged in sexual intercourse. This measure tracks the proportion of males aged 15 to 19 years who have never engaged in sexual intercourse.	
	NSFG will collect comparable data on males aged 15 to 49 years starting with data collected in 2001 and will thereby replace NSAM for tracking of this measure.	
	See Appendix A for focus area contact information.	
    
9-9.	Increase the proportion of adolescents who have never engaged in sexual intercourse.
9-9a.	Females.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.4 (Family Planning) (also 18.3 and 19.9).	
Measure	Percent.	
Baseline	62 (1995).	
Numerator	Number of females aged 15 to 17 years who had never had sexual intercourse with a male. 	
Denominator	Number of females aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	At any time in your life, have you ever had sexual intercourse with a man, that is, made love, had sex, or gone all the way?	
Expected Periodicity	Periodic.	
Comments	This objective is adapted from Healthy People 2000 objective 5.4, which tracked the proportion of adolescents aged 15 to 17 years who engaged in sexual intercourse. This measure tracks the proportion of females aged 15 to 17 years who have never engaged in sexual intercourse.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
9-9b.	Males.	
National Data Source	National Survey of Adolescent Males (NSAM), Urban Institute.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.4 (Family Planning) (also 18.3 and 19.9).	
Measure	Percent.	
Baseline	57 (1995).	
Numerator	Number of males aged 15 to 17 years who had never had sexual intercourse with a female. 	
Denominator	Number of males aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Adolescent Males:	
	•	Have you ever had sexual intercourse with a female (sometimes this is called “making love,” “having sex” or “going all the way”)?	
Expected Periodicity	Periodic.	
Comments	This objective is adapted from Healthy People 2000 objective 5.4, which tracked the proportion of adolescents aged 15 to 17 years who engaged in sexual intercourse. This measure tracks the proportion of males aged 15 to 17 years who have never engaged in sexual intercourse.	
	NSFG will collect comparable data on males aged 15 to 49 years starting with data collected in 2001 and will thereby replace NSAM for tracking of this measure.	
	See Appendix A for focus area contact information.	

9-10.	Increase the proportion of sexually active, unmarried adolescents aged 15 to 17 years who use contraception that both effectively prevents pregnancy and provides barrier protection against disease.
9-10a.	Condom at first intercourse: Females.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.6 (Family Planning).	
Measure	Percent.	
Baseline	67 (1995).	
Numerator	Number of sexually experienced, unmarried females aged 15 to 17 years who used a condom at first intercourse.	
Denominator	Number of sexually experienced, unmarried females aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	What is your current marital status?  Are you...
1) 	Married 
2) 	Widowed  
3) 	Divorced  
4) 	Separated, because you and your husband are not getting along 
5) 	Have you never been married?	
	[Following a series of questions on when sexual intercourse with a man occurred and whether or not the sexual intercourse was voluntary:]	
	•	The very first time you ever used a birth control method, which method did you use?  If you used more than one method that first time, please tell me about it.
1) Birth control pills		
2) Condom			
3) Partner’s vasectomy	
4) Diaphragm			
5) Foam				
6) Jelly or cream			
7) Cervical cap			
8) Suppository, insert		
9) Today sponge			
10) Female condom, vaginal pouch		
11) IUD, Coil, Loop
12) Norplant
13) Depo-provera, Injectables
14) Morning after pill
15) Rhythm or safe period by calendar
16) Safe period by temperature, or cervical mucus test, natural family planning
17) Withdrawal, pulling out	   	
18) Respondent sterile
19) Partner sterile
20) Other method (specify)	
	•	Thinking again of the very first time you used a method of birth control, was it the first time you had intercourse?	
Expected Periodicity	Periodic.	
Comments	Unmarried females are considered to have used a condom at first intercourse if they reported they were sexually active and partner used a condom (rubber) at their first intercourse.	
	Sexually experienced refers to females who had their first premarital voluntary intercourse in the past 5 years.	
	This objective is adapted from a measure in Healthy People 2000 objective 5.6, which tracked the proportion of sexually active, unmarried people aged 15 to 19 years who used contraception at first intercourse. This measure tracks the proportion of females aged 15 to 17 years who used a condom at first intercourse.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-10b.	Condom at first intercourse: Males.	
National Data Source	National Survey of Adolescent Males (NSAM), Urban Institute.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.6 (Family Planning).	
Measure	Percent.	
Baseline	72 (1995).	
Numerator	Number of sexually experienced, unmarried males aged 15 to 17 years who used a condom at first intercourse.	
Denominator	Number of sexually experienced, unmarried males aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Adolescent Males:	
	[Following a question on marital status:]	
	•	Have you ever had sexual intercourse with a female (sometimes this is called “making love,” “having sex” or “going all the way”)?	
	•	That time (the first intercourse) did you, yourself, use any method of contraceptive to prevent pregnancy or sexually transmitted disease?	
	•	What method did you use?
1) Condom, rubber
2) Withdrawal, pulling out		
3) Combination of methods, specify
4) Other, specify	
Expected Periodicity	Periodic.	
Comments	Unmarried males are considered to have used a condom at first intercourse if they reported they were sexually active and used a condom (rubber) at their first intercourse.	
	Sexually experienced refers to males aged 15 to 17 years who had ever had intercourse.	
	NSFG will collect comparable data on males aged 15 to 49 years starting with data collected in 2001 and will thereby replace the NSAM for tracking of this measure. 	
	This objective is adapted from a measure in Healthy People 2000 objective 5.6, which tracked the proportion of sexually active, unmarried people aged 15 to 19 years who used contraception at most recent intercourse. This measure tracks the proportion of males aged 15 to 17 years who used a condom at first intercourse.	
	See Appendix A for focus area contact information.	
    
9-10c.	Condom plus hormonal method at first intercourse: Females.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted 5.6 (Family Planning).	
Measure	Percent.	
Baseline	7 (1995).	
Numerator	Number of sexually experienced, unmarried females aged 15 to 17 years who used a condom plus hormonal method at first intercourse.	
Denominator	Number of sexually experienced, unmarried females aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	See Questions Used To Obtain the National Data provided with 9-10a.	
Expected Periodicity	Periodic.	
Comments	Unmarried females are considered to have used a condom and hormonal method at first intercourse if they reported they were sexually active; partner used a condom (rubber); and they used either birth control pills, Depo-provera injectables, Norplant implants, or morning-after pills at their first intercourse.	
	Sexually experienced refers to females who had their first premarital voluntary intercourse in the past 5 years.	
	This objective is adapted from a measure in Healthy People 2000 objective 5.6, which tracked the proportion of sexually active, unmarried people aged 15 to 19 years who used both an oral contraceptive and condom at most recent intercourse. This measure tracks the proportion of females aged 15 to 17 years who used a condom plus hormonal method at first intercourse.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-10d.	Condom plus hormonal method at first intercourse: Males.	
National Data Source	National Survey of Adolescent Males (NSAM), Urban Institute.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.6 (Family Planning).	
Measure	Percent.	
Baseline	8 (1995).	
Numerator	Number of sexually experienced, unmarried males aged 15 to 17 years who used a condom plus hormonal method at first intercourse.	
Denominator	Number of sexually experienced, unmarried males aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	See Questions Used To Obtain the National Data provided with 9-10b.	
Expected Periodicity	Periodic.	
Comments	Unmarried males are considered to have used a condom and hormonal method at first intercourse if they reported they were sexually active; used a condom (rubber); and their partner used either pills, Norplant, or Depo-provera at their first intercourse.	
	Sexually experienced refers to males aged 15 to 17 years who had ever had intercourse.	
	NSFG will collect comparable data on males aged 15 to 49 years starting with data collected in 2001 and will thereby replace NSAM for tracking of this measure. 	
	This objective is adapted from a measure in Healthy People 2000 objective 5.6, which tracked the proportion of sexually active students aged 15 to 17 years who used condom and birth control pill at most recent intercourse using the Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. This measure tracks the proportion of males aged 15 to 17 years who used a condom plus hormonal method at first intercourse.	
	See Appendix A for focus area contact information.	
    
9-10e.	Condom at last intercourse: Females.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 19.10a (Sexually Transmitted Diseases) (also 18.4a).	
Measure	Percent.	
Baseline	39 (1995).	
Numerator	Number of sexually active, unmarried females aged 15 to 17 years who used a condom at last intercourse.	
Denominator	Number of sexually active, unmarried females aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	What is your current marital status?  Are you...
1) Married 
2) Widowed  
3) Divorced  
4) Separated, because you and your husband are not getting along 
5) Have you never been married?	
	[Following a series of questions on when sexual intercourse with a man occurred:]	
	•	The last time you had intercourse, did you or your partner use any method?	
	•	Which methods?
1) Birth control pills		
2) Condom			
3) Partner’s vasectomy	
4) Diaphragm			
5) Foam				
6) Jelly or cream			
7) Cervical cap			
8) Suppository, insert		
9) Today sponge			
10) Female condom, vaginal pouch		
11) IUD, Coil, Loop
12) Norplant
13) Depo-provera, Injectables
14) Morning after pill
15) Rhythm or safe period by calendar
16) Safe period by temperature, or cervical mucus test, natural family planning
17) Withdrawal, pulling out	   	
18) Respondent sterile
19) Partner sterile
20) Other method (specify)	
Expected Periodicity	Periodic.	
Comments	Unmarried females are considered to have used a condom at last intercourse if they reported they were sexually active and partner used a condom (rubber) at their last intercourse.	
	Sexually active refers to females who have had intercourse in the 3 months prior to interview.	
	This objective is adapted from a measure in Healthy People 2000 objective 19.10a, which tracked the proportion of sexually active, unmarried people aged 15 to 19 years who report their partner used a condom at last intercourse. This measure tracks the proportion of females aged 15 to 17 years who used a condom (male or female) at last intercourse.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-10f.	Condom at last intercourse: Males.	
National Data Source	National Survey of Adolescent Males (NSAM), Urban Institute.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 19.10b (Sexually Transmitted Diseases) (also 18.4b).	
Measure	Percent.	
Baseline	70 (1995).	
Numerator	Number of sexually active, unmarried males aged 15 to 17 years who used a condom at last intercourse.	
Denominator	Number of sexually active, unmarried males aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Adolescent Males:	
	[Following a question on marital status:]	
	•	Have you ever had sexual intercourse with a female (sometimes this is called “making love,” “having sex” or “going all the way”)?	
	•	The last time you had intercourse with (Initials of partner) did you, yourself, use any method of contraception - that is, something to prevent pregnancy or sexually transmitted disease?	
	•	What method did you use?
1) Condom, rubber
2) Withdrawal, pulling out		
3) Combination of methods, specify
4) Other, specify	
	•	The last time you had intercourse with (Initials of partner) did she use any contraceptive methods?	
	•	What method did she use?
1) Depo-provera			
2) Diaphragm or cervical cap	
3) Douching (washing out) after intercourse
4) Female condom		
5) Spermicidal foam/jelly/cream or suppository	
6) IUD, Coil, Loop			
7) Norplant		
9) Pill 
10) Rhythm, or safe period by calendar  		
11) Sterilization
12) Today sponge
13) Vaginal contraceptive film or insert                  	
14) Combination of methods, specify			
15) Something else, specify			
Expected Periodicity	Periodic.	
Comments	Unmarried males are considered to have used a condom at last intercourse if they reported they were sexually active and used a condom (rubber) at their last intercourse.	
	Sexually active refers to males who have had intercourse in the 3 months prior to interview.	
	NSFG will to collect comparable data on males aged 15 to 49 years starting with data collected in 2001 and will thereby replace NSAM for tracking this measure. 	
	This objective is adapted from a measure in Healthy People 2000 objective 19.10b, which tracked the proportion of sexually active, unmarried people aged 15 to 19 years who used a condom at last intercourse. This measure tracks the proportion of males aged 15 to 17 years who used a condom (rubber) or partner used a female condom (vaginal pouch) at last intercourse.	
	See Appendix A for focus area contact information.	
    
9-10g.	Condom plus hormonal method at last intercourse: Females.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.6 (Family Planning).	
Measure	Percent.	
Baseline	7 (1995).	
Numerator	Number of sexually active, unmarried females aged 15 to 17 years who used a condom plus hormonal method at last intercourse.	
Denominator	Number of sexually active, unmarried females aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	See Questions Used To Obtain the National Data provided with 9-10e.	
Expected Periodicity	Periodic.	
Comments	Unmarried females are considered to have used a condom and hormonal method at last intercourse if they reported they were sexually active; partner used a condom (rubber); and they used either birth control pills, Depo-provera injectables, Norplant implants, or morning-after pills at their last intercourse.	
	Sexually active refers to females who have had intercourse in the 3 months prior to interview.	
	This objective is adapted from a measure in Healthy People 2000 objective 5.6, which tracked the proportion of sexually active students aged 15 to 19 years who used oral contraceptives and condom (by partner) at most recent intercourse. This measure tracks the proportion of females aged 15 to 17 years who used a condom (male or female) plus hormonal method at last intercourse.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-10h.	Condom plus hormonal method at last intercourse: Males.	
National Data Source	National Survey of Adolescent Males (NSAM), Urban Institute.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.6 (Family Planning).	
Measure	Percent.	
Baseline	16 (1995).	
Numerator	Number of sexually active, unmarried males aged 15 to 17 years who used a condom plus hormonal method at last intercourse.	
Denominator	Number of sexually active, unmarried males aged 15 to 17 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	See Questions Used To Obtain the National Data provided with 9-10f.	
Expected Periodicity	Periodic.	
Comments	Unmarried males are considered to have used a condom and hormonal method at last intercourse if they reported they were sexually active; used a condom (rubber); and their partner used either pills, Norplant, or Depo-provera at last intercourse.	
	Sexually active refers to males who have had intercourse in the 3 months prior to interview.	
	NSFG will collect comparable data on males aged 15 to 49 years starting with data collected in 2001 and thereby replace NSAM for tracking this measure. 	
	This objective is adapted from a measure in Healthy People 2000 objective 5.6, which tracked the proportion of sexually active students aged 15 to 17 years who used birth control pills (by partner) and condom at most recent intercourse using the Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. This measure tracks the proportion of males aged 15 to 17 years who used a condom (rubber) or partner used a female condom (vaginal pouch) plus hormonal method at last intercourse.	
	See Appendix A for focus area contact information.	
    
9-11.	Increase the proportion of young adults who have received formal instruction before turning age 18 years on reproductive health issues, including all of the following topics: birth control methods, safer sex to prevent HIV, prevention of sexually transmitted diseases, and abstinence.
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.8 (Family Planning).	
Measure	Percent.	
Baseline	64 (1995).	
Numerator	Females aged 18 to 24 years who report having had formal instruction, before turning age 18 years, on all 4 reproductive health issues.	
Denominator	Number of females aged 18 to 24 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	

	[Question asked for each health topic:]
•	Now I’m interested in knowing about formal sex education you may have had. Before you were 18, did you have any formal instruction at school, church, a community center, or some other place about...
1) Method of birth control?
2) Sexually transmitted diseases?
3) How to prevent AIDS using safe sex practices?
4) Abstinence or how to say NO to sex?	
Expected Periodicity	Periodic.	
Comments	Females are considered as having received formal instruction if they report they received formal sex education before age 18 years on all four topics: birth control, sexually transmitted diseases, safe sex practices, and abstinence.	
	This objective is adapted from a measure in Healthy People 2000 objective 5.8, which tracked the proportion of people aged 10 to 18 years who have discussed human sexuality, sexual abuse, and values surrounding sexuality, with their parents and/or have received information through another parentally endorsed source, such as youth, school or religious programs. This measure tracks the proportion of females aged 18 to 24 years who have received formal, before turning age 18 years, on reproductive health issues, such as birth control methods, safer sex to prevent HIV, prevention of STDs, and abstinence.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-12.	Reduce the proportion of married couples whose ability to conceive or maintain a pregnancy is impaired.	
National Data Source	National Survey of Family Growth (NSFG), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Adapted from 5.3 (Family Planning).	
Measure	Percent.	
Baseline	13 (1995).	
Numerator	Number of married females with impaired fecundity.	
Denominator	Number of married females aged 15 to 44 years.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1995 National Survey of Family Growth:	
	•	What is your current marital status?  Are you...
1) Married, 
2) Widowed,  
3) Divorced,  
4) Separated, because you and your husband are not getting along, 
5) Have you never been married?  	
	[Following a series of questions to ALL respondents that address pregnancy, contraceptive use and periods of no sexual activity:]
•	Have you ever had both your tubes tied, cut, or removed? This procedure is often called a tubal ligation.	
	•	Have you ever had a hysterectomy, that is, surgery to remove your uterus?	
	•	Have you ever had both your ovaries removed?	
	•	Have you ever had any other operation that makes it impossible for you to have another baby?	
	•	As far as you know, are you completely sterile from this operation, that is, does it make it impossible for you to have a baby in the future?	
	•	Has (name of husband/partner) ever had a vasectomy or any other operation that would make it impossible to father a baby in the future?	
	[Nonsurgically sterile respondents are those who have not reported any operations for themselves, or if they are married or cohabiting, for their husbands/partners.]
[For respondents who are nonsurgically sterile:]
•	Some women are not physically able to have children. As far as you know, is it physically possible for you, yourself, to have a baby?	
	•	What about (name of husband/partner)? As far as you know, is it physically impossible for him to father a baby in the future?	
	[If it is physically possible:]
o	Some women are physically able to have a baby, but have difficulty getting pregnant or carrying a baby to term. As far as you know, would you, yourself, have any difficulty getting pregnant or carrying a baby to term?	
	o	As far as you know, does (name of male partner) have any difficulty fathering a baby?	
	o	At any time has a medical doctor ever advised you to never become pregnant (again)?	
Expected Periodicity	Periodic.	
Comments	Females are considered to have impaired fecundity if they reported they are married; and neither they or their husband has had a sterilizing operation; or any one of the following:	
	(a) she and her husband are nonsurgically sterile and it is physically impossible for her to get pregnant or carry a baby to term, or for her husband to father a baby;	
	(b) it is physically difficult for her to get pregnant or carry a baby to term, or for her husband to father a baby; 	
	(c) she has been advised by a doctor (for health reasons) not to become pregnant;	
	(d) she and her husband have been married for at least 36 consecutive months and have reported sexual activity without contraception for at least 36 consecutive months, and have had no pregnancies in that time period.	
	This objective is adapted from a measure in Healthy People 2000 objective 5.3, which tracked the prevalence of infertility. This measure tracks the proportion of married couples who are unable to conceive or maintain a pregnancy due to impaired fecundity.	
	See Part C for a description of NSFG and Appendix A for focus area contact information.	
    
9-13. (Developmental) Increase the proportion of health insurance policies that cover contraceptive supplies and services.	
Comments	An operational definition could not be specified at the time of publication. 	
	A proposed data source is The Alan Guttmacher Institute (AGI).5 	
	See Appendix A for focus area contact information.	

References
1. Henshaw, S.K. Unintended pregnancy in the United States. Family Planning Perspectives 30 (1):24-29, 46, 1998.
2. Abortion surveillance—United States, 1993 and 1994, Special focus: Surveillance for reproductive health. Morbidity and Mortality Weekly Report 46(SS‑4), 1997.
3. Henshaw, S.K., and Kost, K. Abortion patients in 1994‑1995: Characteristics and contraceptive use. Family Planning Perspectives 28(4):140-147, 158, 1996.
4. Fu, H.; Darroch, J.E.; Haas, T.; et al. Contraceptive Failure Rates: New Estimates from the 1995 NSFG. Family Planning Perspectives 31(2):56-63, 1999. <http://www.agi-usa.org/pubs/journals/3105699.html>
5. The Alan Guttmacher Institute. Uneven and Unequal: Insurance Coverage and Reproductive Health Services. New York, NY: the Institute, 1994, 1-38.