Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 9-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Data to measure progress toward the targets were available for birth spacing (9-2), contraceptive use (9-3), emergency contraception (9-5), adolescent pregnancy (9-7), abstinence before age 15 years (9-8a and b), abstinence among adolescents aged 15 to 17 years (9-9a and b), pregnancy prevention and STD protection (9-10a through h), and problems in becoming pregnant or maintaining pregnancy (9-12). Four objectives moved toward their targets: adolescent pregnancy in females (9-7), abstinence before age 15 years (9-8), abstinence among adolescents aged 15 to 17 years (9-9), and pregnancy prevention and STD risk reduction in adolescents aged 15 to 17 years (9-10). Within pregnancy prevention and STD protection (9-10), six subobjectives exceeded their targets.

The causes for progress toward the targets are not known. However, a study to access declining pregnancy rates for teens aged 15 to 17 years from 1991 to 2001 indicated that an estimated 53 percent of the decline was due to decreased sexual experience and 47 percent was due to increased contraceptive use.⁸

Four objectives moved away from their targets: birth spacing (9-2), contraceptive use in females aged 15 to 44 years (9-3), access to emergency contraception (9-5), and infertility (9-12).

Tracking data were not yet available for five objectives: intended pregnancy (9-1), contraceptive failure (9-4), male involvement in pregnancy prevention (9-6), reproductive health education (9-11a through p), and insurance coverage (9-13). Baselines and targets were set for the formerly developmental objectives of male involvement in pregnancy prevention (9-6) and insurance coverage for contraceptive supplies and services (9-13). Data to measure progress toward all of these objectives, with the possible exception of the six developmental subobjectives in reproductive health education (9-11), are anticipated by the end of the decade.

Objectives that met or exceeded their targets. Several subobjectives under pregnancy prevention and STD risk reduction (9-10c through h) surpassed their targets. Between 1995 and 2002, use of condoms plus hormonal methods at first intercourse exceeded its target. Among unmarried females aged 15 to 17 years (9-10c), condom plus hormonal method increased from 7 percent to 16 percent, surpassing the target of 9 percent. Usage among unmarried males (9-10d) increased from 8 percent to 12 percent, exceeding its target of 11 percent. Targets for condom use at last intercourse by teens aged 15 to 17 years were also surpassed: Usage by females (9-10e) increased from 39 percent to 56 percent, exceeding the target of 49 percent, while usage by males (9-10f) increased from 70 percent to 84 percent, exceeding the target of 79 percent. Finally, the targets for condom plus hormonal use at last intercourse by teens aged 15 to 17 years were also exceeded. Usage by females (9-10g) increased from 7 percent to 24 percent, exceeding the target of 11 percent, while male usage (9-10h) rose from 16 percent to 24 percent, above the target of 20 percent.

Objectives that moved toward their targets. Progress toward targets was noted for adolescent pregnancy (9-7), abstinence before age 15 years (9-8), abstinence among adolescents aged 15 to 17 years (9-9), condom use at first intercourse for unmarried females aged 15 to 17 years (9-10a), and condom use at first intercourse for unmarried males aged 15 to 17 years (9-10b).

Between 1996 and 2000, 54 percent of the targeted change in adolescent pregnancy (9-7) was achieved; pregnancies declined from 67 births per 1,000 females aged 15 to 17 years to 54 births per 1,000 females. Female abstinence before 15 years of age (9-8a) achieved 86 percent of the targeted change between 1995 and 2002, while 67 percent of the targeted change was achieved for males (9-8b). During the same time period, abstinence among adolescents aged 15 to 17 years moved toward its target. In addition, 62 percent of the targeted change for females (9-9a) and 61 percent of the targeted change for males (9-9b) were achieved. Finally, condom use at first intercourse by unmarried adolescents 15 to 17 years of age made progress, reaching 33 percent of the targeted change for females (9-10a) and 46 percent of the targeted change for males (9-10b).

Objectives that moved away from their targets. Four family planning objectives moved away from their targets: birth spacing (9-2), contraceptive use by women at risk of unintended pregnancy (9-3), family planning clinics providing emergency contraception (9-5), and infertility among married women (9-12).

The reasons why birth spacing (9-2) moved away from its target are not clear. Research is needed to clarify whether closely spaced births were intended, whether the outcomes of these births were healthy, and how old the mothers were at first and second birth. The data for birth spacing (9-2) by family income level showed an increase in closely spaced births between 1995 and 2002 for all income groups. A sharp increase in closely spaced births occurred among the middle/high-income group (from 7 percent to 15 percent).⁴ A smaller increase was noted among poor females (from 20 percent to 25 percent). This result may suggest that at least some of the increase was deliberate, but further research using NSFG and other sources may clarify this unexpected finding. Better information about family planning supplies and services, as well as improved access to those services, can assist couples in achieving preferred birth-spacing intervals.⁹

For teens, investments in abstinence education focus on preventing a first pregnancy. In addition, "secondary prevention" through the provision of services to pregnant and parenting teenagers can help them avoid or delay a subsequent pregnancy.¹⁰

In 2002, 13.5 million women received family planning or medical services from clinics.¹¹ Although 98 percent of women have used at least one contraceptive method at some time in their lives, data showed that the proportion of adult (not teen) women at risk of pregnancy who are currently using contraception (9-3) dropped significantly between 1995 and 2002. The decreases appeared to be greater among black non-Hispanic females (from 90 percent to 85 percent) than among white non-Hispanic females (93 percent to 91 percent) and greater among poor females (92 percent to 86 percent) than among middle/high-income females (93 percent to 90 percent).

The developmental objective for emergency contraception (9-5) became measurable. Between the baseline year of 1999 and 2003, the percentage of family planning clinics providing emergency contraception (9-5) decreased from 80 percent to 79 percent, respectively, moving away from the target of 90 percent. The baseline in 1999 was 80 percent; the target is 90 percent. Access to emergency contraception varies by State.¹²

Between 1995 and 2002, difficulties in initiating and maintaining a pregnancy among married women 15 to 44 years of age (9-12) increased from 13 percent to 15 percent, moving away from the target of 10 percent. The National Infertility Prevention Program, a collaboration between the Centers for Disease Control and Prevention and the Office of Population Affairs, is an example of a program effort focused on infertility prevention. The program supports chlamydia screening and treatment services for low-income, sexually active women attending family planning clinics. Untreated chlamydia can cause severe and costly reproductive and other adverse health consequences, including pelvic inflammatory disease (PID) that may lead to infertility. At least 15 percent of infertile American women are infertile because of tubal damage caused by PID.¹³ Although universal screening of sexually active females for chlamydia is required to detect asymptomatic disease and reduce the risk of infertility, overall only 60 percent of women aged 15 to 19 years in the United States are screened for chlamydia.¹⁴ Other contributing factors may be an increase in the proportion of women who delay childbearing to later ages, improved diagnosis of infertility, or both.

Objectives that could not be assessed. Tracking data for five objectives were unavailable at the time of the midcourse review. Data to track intended pregnancy (9-1) and contraceptive failure (9-4) are anticipated by the end of the decade. With the availability of additional data, progress toward the targets for the objectives regarding male involvement in pregnancy prevention (9-6) and insurance coverage for contraceptive supplies and services (9-13) will be assessed by the end of the decade. Similarly, data for the 16 reproductive health education subobjectives (9-11a through 11p) are anticipated by the end of the decade.

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