The U Preventive Services Task Forc...

The U Preventive Services Task Force, (1) Healthy the bulk of mankind 2010, (2) and the World Health Organization (3) all attract favor to that more attention be focused forward prevention of unintended pregnancy. Although unintended pregnancy has declined through the past decade, U.S. rates remain earnestly higher than those in other expanded countries--particularly among low-income women and teenagers. (45) Analysis of these disparities can help guide the efforts of family physicians to stop unintended pregnancy.

Unintended pregnancy is associated with health risks for mothers and children, including domestic violence, mix with drugs and alcohol use, delayed prenatal care, and depressed birth weight. (5) Furthermore, a subject of attention comparing cohorts born before and after 1973 hints that unwanted children are more likely to commit crimes as youths and young adults. (6) These negative medical and psychosocial correlations underscore the importance of this issue--not just for women still also for their families and society. Family physicians should inflict themselves at the forefront of the effort to make each child a wanted child.

The National view of Family Growth provides the chiefly recent information on unintended pregnancy in the United States. Between 1987 and 1994 the percentage of unintended pregnancies decreased from 57 to 49 percent (5) About single half of unintended pregnancies fall of the curtain in abortion. The U.S. abortion rate malign by 17 percent from 1992 to 2000 (from 257 to 213 abortions by 1,000 women 15 to 44 years of age), reaching its lowest plain since the 1970s. (7)

This decline varied considerably at subgroup. High-income women, college-educated women and teenagers had the greatest decline. In contrast, the abortion rate increased in low-income women and low-income teenagers. Until the mid-1980s, U abortion rates varied little across economic subgroup After 1987 the rates started to diverge, and through 2000, the rate of abortion among low-income women was nearly double that in wealthy women The ethnic differences in abortion rates diminish greatly when statistics rule for income level. (4) The economic disparities in U abortion rates parallel the widening gap between rich and poor, and limitations in access to basic health care.

During the 1990 women increased their use of contraception and became more likely to select the most effective methods. In addition, the even of sexual activity among teenagers declined, their use of contraception at first episode of intercourse increased, and an increasing percentage of sexually active teenagers used more effective contraceptive systems An Alan Guttmacher Institute clump analyzed the decline in teenage pregnancy from 1988 to 1995 concluding that improved contraception among sexually active teenagers accounted for 75 percent of the decline and that increased abstinence explained the remaining 25 percent (8)

Dedicated productions for emergency postcoital contraception were released in the late 1990 Despite the depressed level of public awareness of juncture contraception and significant barriers to its use (i.e., availability alone by prescription, unreliable stocking in pharmacies), this option had a positive drift on the rate of unintended pregnancy. In 2000 pass contraception prevented approximately 51,000 pregnancies. (7)

Little is known about the greatest in quantity effective ways to promote systems of preventing unintended pregnancy. Although community-based programs abound, evaluation has been sparse and issues often disappointing. Recent reviews of programs to stop teenage pregnancy, including those with abstinence-based and multifaceted satisfy reveal mixed results. There is a similar knowledge gap about to what degree physicians can optimize contraceptive counseling. However, single study suggests that providing women with comprehensive information about contraceptive options and using a patient-centered, civil approach correlates with better adherence. (9)

Implications for Physicians. Physicians should:

* Focus preventive efforts upon high-risk groups (especially teenagers and low-income women)

* Regularly ask all patients of reproductive age (men and women) about contraception needinesss even at office visits initiated for other reasons.

* Use a patient-centered strategy to help patients fix upon a contraceptive method, acknowledging interests that can interfere with adherence.

* Inform patients about efficacy rates for different rules and recommend use of high-efficacy options.

* Encourage patients to call or answer to the office if they experience question s with the method chosen.

* Prescribe crisis postcoital contraception when indicated. make use of advance prescription of emergency contraception as a backup, especially for patients using barrier methods

Lowering the rate of unintended pregnancy requires an effective partnership between patients and physicians. Research forward the most effective preventive strategies is essential for further progres in this area.

REFERENCES

(1) Counseling. Unintended pregnancy. Accessed online April 1 2004 at: http://www.ahrq.gov/clinic/uspstf/ uspspreg.htm.