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Women's Health

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Over half of poor and unmarried Medicaid-insured women do not take steps to prevent unintended pregnancy

More than half of all pregnancies in the United States are unintended, that is, either mistimed or unwanted. These unwanted pregnancies often result in problems ranging from abortions and domestic violence to higher divorce rates, inadequate prenatal care, and low birthweight babies.

A recent study of young Medicaid-insured women—most of whom were unmarried and black—has found that over half of those who did not want to get pregnant were not using any birth control during the 30-day period prior to conception. Among those who did use birth control, about 20 percent used a method with low effectiveness, that is, a diaphragm, condom, sponge, foam, withdrawal, rhythm, or douching, according to a study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00032).

The study also found that 23 percent of women had an unintended pregnancy even when using contraceptive methods deemed to have high effectiveness (e.g., Norplant, Depo-Provera, and IUD) or medium effectiveness (birth control pill). This suggests that women may not be using these methods consistently or correctly (for example, consistent taking of birth control pills) or obtaining required medical followup (for example, with Depo-Provera), notes the study's first author, Ruth Petersen, M.D., M.P.H., of the University of North Carolina.

The researchers interviewed 279 women enrolled in a Medicaid managed care health plan who had been pregnant in the last 5 years. Seventy-eight percent of women said that their most recent or current pregnancy had been unintended. Over 57 percent of women with unintended pregnancies said they had not used any birth control the month before conception, 5 percent had used birth control of high effectiveness, and 19 percent had used birth control of medium effectiveness. About 90 percent of the women studied had received a regular check-up, and 77 percent had seen an obstetrician/gynecologist in the year prior to the study.

See "How contraceptive use patterns differ by pregnancy intention: Implications for counseling," by Dr. Petersen, Julie A. Gazmararian, M.P.H., Ph.D., Kathryn Andersen Clark, M.S., and Diane C. Green, M.P.H., Ph.D., in the September 2001 Women's Health Issues 11(5), pp. 427-435.

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