Elsevier

Women's Health Issues

Volume 11, Issue 5, September–October 2001, Pages 397-400
Women's Health Issues

Commentary
Counseling to prevent unintended pregnancies: measuring its value

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An American endemic

The judgment of “very small” benefits may seem odd, given the scope—and impact—of unintended pregnancy in the U.S.4 An estimated 6.37 million pregnancies in 1994 resulted in 3.95 million live births, 1.43 million induced abortions, and 0.99 million fetal losses.5 Not counting miscarriages, approximately 49% of all pregnancies in 1994 were unintended; slightly more than half of these unwanted or mistimed pregnancies ended in induced abortion.6 If 1994 rates were to prevail, U.S. women would have

Mortality and morbidity of pregnancy

Although pregnancy and childbirth have become progressively safer in recent decades, they still carry substantial risks.7 The Centers for Disease Control and Prevention reported that the risk of pregnancy-related mortality was 10.0 deaths per 100,000 live births in 1990.8 After accounting for underreporting of these deaths,9 the true figure is probably closer to 24 deaths per 100,000 live births, with black women facing dramatically higher risks of death.8

Although maternal mortality stemming

Missed prevention opportunities

The authors1, 2 identified the services among 14 leading priorities that are provided nationally to 50% or less of their target population. These services represent missed opportunities for prevention, deserving particular attention from policymakers. Family planning counseling would warrant focus as a low-delivery preventive service, since only 36% of family physicians and pediatricians, 53% of nurse practitioners and 65% of obstetricians/gynecologists routinely provide counseling services.12

How—and what—to measure?

Quantifying the benefits of family planning counseling is complicated by the range of health, economic, and social consequences of unintended pregnancy. For example, unintended pregnancies account for a disproportionate amount of poor pregnancy outcomes, including low birthweight, prematurity, and intrauterine growth retardation.13, 14 Women with unintended pregnancies lose out on the opportunity for preconceptional counseling and, perhaps as a result, have higher rates of risky maternal

Family planning and health

Little agreement exists on how to measure the overall health benefits of family planning.20 As the authors noted, complete measurement of the benefits would be beyond the project’s scope.1 While quantifying the impact of family planning may be difficult, its benefits are clear and incontrovertible. Preventing unintended pregnancy saves lives,8 avoids suffering,11 and yields extraordinary economic benefits.21 In 1990, every public dollar spent on family planning saved $4.40 in health and social

References (23)

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