No abstract

The concept of unintended pregnancy has been essential to demographers in seeking to understand fertility, to public health practitioners in preventing unwanted childbearing and to both groups in promoting a woman's ability to determine whether and when to have children. Accurate measurement of pregnancy intentions is important in understanding fertility-related behaviors, forecasting fertility, estimating unmet need for contraception, understanding the impact of pregnancy intentions on maternal and child health, designing family planning programs and evaluating their effectiveness, and creating and evaluating community-based programs that prevent unintended pregnancy. 1 Pregnancy unintendedness is a complex concept, and has been the subject of recent conceptual and methodological critiques. 2 Pregnancy intentions are increasingly viewed as encompassing affective, cognitive, cultural and contextual dimensions. Developing a more complete understanding of pregnancy intentions should advance efforts to increase contraceptive use, to prevent unintended pregnancies and to improve the health of women and their children.To provide a scientific foundation for public health efforts to prevent unintended pregnancy, we conducted a review of unintended pregnancy between the fall of 1999 and the spring of 2001 as part of strategic planning activities within the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC). We reviewed the published and unpublished literature, consulted with experts in reproductive health and held several joint meetings with the Demographic and Behavioral Research Branch of the National Institute of Child Health and Human Development, and the Office of Population Affairs of the Department of Health and Human Services. We used standard scientific search engines, such as Medline, to find relevant articles published since 1975, and identified older references from bibliographies contained in recent articles; academic experts and federal officials helped to identify unpublished reports. This comment summarizes our findings and incorporates insights gained from the joint meetings and the strategic planning process. CURRENT DEFINITIONS AND MEASURESConventional measures of unintended pregnancy are designed to reflect a woman's intentions before she became pregnant. 3 Unintended pregnancies are pregnancies that are reported to have been either unwanted (i.e., they occurred when no children, or no more children, were desired) or mistimed (i.e., they occurred earlier than desired). In contrast, pregnancies are described as intended if they are reported to have happened at the "right time" 4 or later than desired (because of infertility or difficulties in conceiving). A concept related to unintended pregnancy is unplanned pregnancy-one that occurred when the woman used a contraceptive method or when she did not desire to become pregnant but did not use a method. Intentions are often measured or reported only for pregnancies ending in live births; pregnancies ending in abortion a...

This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

Objective. The authors used data from a larger study to evaluate the longterm effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk for HIV infection.Methods. HlV-infected women in one study and women at high risk for HIV infection in a second study were selected from the Women and lnfants Demonstration Project and assigned to a standard or an enhanced HIV prevention treatment group. The enhanced intervention included support groups and one-on-one contacts with peer advocates tailored to clients' needs, The authors interviewed women at baseline and at 6-, l2-and I Bmonths, and measured changes in consistency of condom and contraceptive use and in self-efficacy and perceived advantages and disadvantages of condom and contraceptive use.Results. Of HIV-infected women, the enhanced group had improved consistency in condom use, increased perceived advantages of condom use, and increased level of self-efflcacy compared with the standard group. Of women at risk, the enhanced intervention group at six months maintained consistent condom use with a main partner and perceived more benefit of condom use compared with the standard group. These differences diminished at l2 months.Conclusions. The enhanced intervention was generally effective in the HIV+ study. In the at-risk study, however, intervention effects were minimal and shorl-lived. Factors related to the theory, intervention design, and sample characteristics help explain these differences. PUBLIC HEALTH REPORTS .2OoISUPPLEMENT I . VoLUME I16

Women at risk of STDs find the female condom acceptable and will try it, and some use it consistently. Mixing use of female condoms and male condoms may facilitate consistent condom use. The female condom may improve an individual's options for risk reduction and help reduce the spread of STDs.