Family Planning: The Facts

Introduction

The 1970s and 1980s have seen significant changes in patterns of family development: more women are waiting until their 30s to begin families; there has been an increase in the number of births to unmarried women; family size is decreasing as employed women have fewer children; and the total fertility rate is declining. Contraceptive practices have also changed, resulting in sterilization becoming the most common contraceptive method among married women, while the pill remains most popular with unmarried women. Abortion ratios have increased slightly with higher ratios for Blacks, teenagers and unmarried women. There has been little change in the percentage of infertile couples. Sexually active teenagers, with their high rates of unintended pregnancies, high abortion ratios and low utilization of contraceptive methods, remain an important target group for family planning services.

Prevalence

Births and Fertility

In 1983 there were 3,638,933 live births in the U.S., a 1% decline from 1982. Provisional data for 1984 indicate an increase to 3,697,000 births.

The 1983 U.S. fertility rate was 65.8 live births per 1,000 women aged 15-44 years.

Unmarried Mothers

20% of all births in the U.S. in 1983 were to unmarried women, over one-third (36.67%) of them teenagers.

The 1983 rate of childbearing by unmarried women was 30.4 live births per 1,000 unmarried women–the highest rate ever observed for that group.

In 1983, 12.8% of all births to white women were to unmarried women, while 58% of all births to Black women were to unmarried women.

A white teenage mother is more than 2 times as likely to be married as a Black teenage mother. 88.5% of births in 1983 to Black mothers aged 15-19 were to unmarried mothers and 39.2% of births to comparable white mothers were to unmarried mothers.

Teenage Fertility

About 500,000 births occurred to teenage mothers in 1983. This represents 14% of all births in the U.S. for that year.

There were 9,752 births to women under 15 years of age in 1983.

80% of births to teenagers were either unwanted or mistimed in 1983.

In 1983, 25% of births to Black women were to teenagers, 22% of births to American Indian women were to teenagers and 12% of births to white mothers were to teenagers.

Unwanted Pregnancy

In 1982, 10% of all births to never-married women were unwanted at the time of conception.

In 1982, of all the 4.3 million children born to never-married women, 25% had been unwanted at the time of conception; among those wanted (75%), over half had been wanted at a later time, leaving only 21% who had been deliberately conceived.

The proportion of unwanted births among Black women (21.8%) is nearly 3 times that for white women (7.7%).

Terminated Pregnancy

In 1981 there were 1,300,760 legal abortions in the U.S. The abortion rate was 24 abortions per 1,000 women aged 15-44. The abortion ratio was 358 abortions per 1,000 live births.

The abortion ratio among teenagers was 727 abortions per 1,000 live births, double the ratio for all women.

There was 1 abortion for every 10 live births for married women in 1981. There were nearly 15 abortions for every 10 live births for unmarried women in 1981.

In 1981 the abortion ratio for whites was 329 abortions per 1,000 live births, whereas the abortion ratio for Blacks was 549.

About 90% of legal abortions occurred during the first trimester in 1981.

The overall legal abortion related death rate for 1981 was 0.5 deaths per 100,000 legal abortions, the lowest rate ever recorded.

Contraception

Sterilization is the leading method of contraception for ever-married women, whereas the oral contraceptive is still the most common method among never married women.

In 1983, there were 568,000 procedures performed for the bilateral occlusion of fallopian tubes in U.S. short stay hospitals.

76% of never-married women at risk of unintended pregnancy in 1982 used some contraceptive method versus 93% of comparable currently married women.

Black women in 1982 were slightly less likely than white women to be using some method of contraception (51% vs. 55%), and more likely to be having unprotected intercourse (13% vs. 6%).

Infertility

6 million couples in the U.S. in 1982 were unable or unlikely to have additional births, including 1.4 million childless couples.

8.2% of women aged 15-44 in the U.S. have “impaired fecundity” (i.e., it is difficult or dangerous for them to conceive or deliver, or they are nonsurgically sterile, or they have not conceived for 36 months or more despite all attempts).

22% of childless couples have some degree of impaired fecundity.

13% of Black couples aged 15-44 are infertile compared with 8% of white couples.

Working Women and Childbirth

84% of wives in 1976 had been employed at some time since their first marriage.

According to a 1976 National Survey of Family Growth, ever-employed women have born an average of 2.0 children compared to 2.3 children born to wives with no work experience outside the home.

The same survey revealed that the mean number of children born to employed mothers aged 15-44 depends on the percent of family income from the wife’s employment: lower than 25%-2.22 children, 25-49%-1.68 children; higher than 50%-1.38 Children.

Public and Professional Awareness

In a 1985 National Health Interview Survey, 74% of women were aware that smoking while taking birth control pills increases the risk of stroke; however, only 56% of males were aware of that association.

In a 1982 survey, 75% of sexually active 15-44 year old women showed awareness of 11 out of 13 contraceptive methods.

Increased professional awareness of the risks involved with oral contraceptives containing more than 50 micrograms of estrogen has led to a steady decline in estrogen use from 23.9% of oral contraceptive tablets , dispensed in 1978 to just 9% in 1983.

A poll reported to The American College of Obstetricians and Gynecologists in 1985 showed that women overestimate the risks of the pill. Among unmarried women under 35 (the group most likely to use the pill), 73% of those with an opinion felt that using the pill is at least as dangerous as childbirth.

The same poll indicated that women underestimate the effectiveness of contraceptives; a majority of unmarried women under age 35 felt 10 or more pregnancies will occur per year for every 100 users of each specified means of birth control except the pill.

Service Delivery

Family Planning Services

79% of nonsterile married women aged 15-44 had used family planning services in the 3 years prior to being interviewed in 1982. There was no statistically significant difference between whites, Blacks or Hispanics.

Teenagers, aged 15-19, visit family planning providers 1.5 times more often than the average woman of childbearing age. This fact may be at least partially explained by the greater likelihood that they will use oral contraceptives which require more visits than methods used by older women.

61% of all family planning visits were to private medical sources.

Infertility Services

18.6% of white, 13.5% of Black and approximately 13.6% of Hispanic ever-married women aged 15-44 have ever used infertility services.

82% of infertility visits were to private medical sources in 1983.

Significant Trends

Toward Later Childbearing

During the 8 year period from 1975-83, the birth rate for women aged 30-34 increased 24% and for women aged 35-39 it increased 13%. For women aged 15-19 the birth rate declined 7% and for women aged 20-24 it decreased 4% from 1975 to 1983.

In 1983, 23% of births occurred to women 30 years and older compared to 17% in 1975.

Nearly one quarter (24%) of women in 1983 aged 30-34 years had no children versus only 12% in 1970.

Increased Births to Unmarried Mothers

Over the past two decades the proportion of births occurring to unmarried women has increased from 5% in 1960 to 19% in 1982.

In 1983, the nonmarital birth rate among Black women (77.7 births per 1,000 women of childbearing age) was 4 times that of white women (19.3), but this represents a sharp reduction since 1975 when the birth rate for unmarried Black women was 7 times that of comparable white women.

Decline in Unwanted Childbearing

In 1973, 14% of births to ever-married women of childbearing age were unwanted at the time of conception. In 1982 that figure had dropped to less than 10%.

Increased Use of Sterilization as Contraception

The percentage of married women aged 15-44 using contraceptive sterilization increased from 16% in 1973 to 28% in 1982, while the proportion of married women of childbearing age using the pill declined from 25% to 14%.

Decline in Total Fertility Rate

The total fertility rate predicts the implication of current levels of fertility on completed family size. If 1,000 women would bear the number of children indicated by the age-specific birth rates of 1983, then a total of 1802.5 children would be born. This represents the lowest total fertility rate observed since 1978 and is 15% below the level (2110.0) considered necessary for a given generation to exactly replace itself.

Special Issues

Lack of Contraceptive Use Among Teenagers

At first intercourse, 48.2% of 15-19 year olds reported using some method of contraception according to a 1982 survey. Nearly half of those using some contraception used condoms and almost a one-third used withdrawal or rhythm.

Lack of Family Planning Among Blacks

Black women have 3 times the percentage of unwanted pregnancies of whites, 2 times the abortion ratio of whites, 4 times the percentage of births to unmarried women and 2 times the proportion of births to teenagers than white women.

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