April 1999, Vol. 33, No. 2

Certain groups of women are at greater risk of unintended pregnancy and form the bulk of the clientele for public family planning clinics. Women under the age of 20, over the age of 39, the never married, those with incomes below the poverty level and non-teenaged women with less than a high school education are at higher risk than are women 20-39, married women, those with incomes above the Federal Poverty Level and women with a high school education.

Women having one or more of the above noted risk factors accounted for 85 percent of all initial visits, nearly 76 percent of all annual visits and 80 percent of total visits. Although GR/Title V funded family planning clinics draw from a population at high risk of unintended pregnancy, as in previous years, clients making initial visits are even more at risk than are women making annual visits. As Table 1 indicates, nearly twice as many of the clientele making initial visits are under the age of twenty compared to those returning for an annual visit. Women making an initial visit are also more likely to have never been married than are women coming in for an annual visit. It appears that in FY 1997 even more of the initial clientele had incomes at or below 100 percent of the poverty level than in FY 1996.

The use of Depo-Provera is up across the board. Among all clients the choice of Depo Provera has increased nearly 50 percent (12.7 percent in FY 95 to 19.0 in FY 97). Non-teenaged women with less than a high school education are the ones most likely to choose Depo-Provera (25.7 percent) and show an increase of 94 percent since FY 95. Teenagers are the second highest (20.5 percent) in selecting Depo Provera as their contraceptive method. Older women (40 and older) are the least likely to use Depo-Provera but show the largest increase (from 6.9 in FY 95 to 16.4 percent in FY 1997).

One of the primary purposes of family planning is the reduction in the number of unintended pregnancies. Although we cannot directly assess the reduction in the number of unintended pregnancies, we can look at intentionality of pregnancy and change in contraceptive practices.

During FY 1997 10.2 percent (3,706) of all clients making an initial or annual visit to a family planning clinic had been pregnant in the twelve months preceding the visit. Of these pregnancies, 35.6 percent were intended and 62.1 percent were unintended with the intention status of the remaining unknown (2.3 percent). As is indicated in Table 3 the rate of pregnancy was higher among clients making an initial visit to a family planning clinic than for women returning for an annual visit (163.5 versus 59.7 per 1,000 females). The rate for women returning for an annual visit was actually lower than the estimated state rate of 73.8. Nearly 65 percent of all clients who had a pregnancy in the last twelve months were making an initial visit to a family planning clinic.

Among those clients who had been pregnant within the last 12 months and who were making an initial visit to a family planning clinic the proportion of pregnancies which were intended was higher than in previous years yet over 60 percent of the pregnancies remain unintended. Again it must be noted that the clientele visiting public family planning clinics are at high risk for unintended pregnancy. Chart 1 compares the women with an unintended pregnancy with those who were not pregnant in the past twelve month. The women with unintended pregnancies are younger (80 percent under 25), poorer (55 percent under the poverty level) and with less education (40 percent with less than a high school education).

The aim of all family planning services is to help individuals control their fertility through avoiding or delaying pregnancy. Change in contraceptive behavior is a measure of the impact of family planning. As in previous years most clients are using contraception and usually a more effective method following a family planning visit than they were before the visit. Prior to their visit to the family planning clinic, over 3,300 clients who were neither pregnant nor seeking pregnancy were not using any method of contraceptive. Following the visit 76 percent of these clients were using a prescription-based contraceptive with an additional 11 percent using an over-the-counter method.

Both oral contraceptives and Depo Provera are highly effective when used consistently, however inconsistent use can be a problem among high risk groups. Peterson and associates (1998) report on inconsistency in oral contraceptive use related to specific characteristics. In their analysis 16 percent of all those using oral contraceptives were inconsistent with 35 percent of new users (3-6 months) reporting inconsistent use. In addition for users of oral contraceptive alone, having a previous unintended pregnancy was a significant predictor of inconsistent pill use. Peterson, et al (1998) suggest that for these clients who have difficulty with consistent contraceptive use, clinic care needs to be more individualized and perhaps more intensive.

Consequently, subsidized family planning clinics, which primarily serve a population at risk of unintended pregnancies, may need to not only provide contraceptives but also develop procedures to help their clientele use their chosen contraceptive in a consistent manner. The need for family planning services will not decrease in the foreseeable future and both individuals and society will benefit from reducing the incidence of unintended pregnancy.