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Risks and prevention of unintended pregnancy and STDs.

A fertile woman has about a 3% chance of becoming pregnant in a single act of unprotected intercourse, although the risk ranges from virtually zero to 30%, depending on when during the menstrual cycle intercourse occurs. (84) Within a year, however, a sexually active teenager who does not use a contraceptive has a 90% chance of becoming pregnant (85) (Figure 19, page 30).

Other things being equal, teenagers and women in their early 20s theoretically have a higher risk of pregnancy than older women, because the ability to conceive declines slowly after the mid-20s. (86) However, pregnancy levels may be relatively low in the first few years after puberty, before regular ovulation and sperm production are established. (87) In addition, since unmarried sexually active teenagers generally have less-frequent intercourse than older unmarried individuals, they may experience lower pregnancy rates.

The chance of acquiring a sexually transmitted infection may be substantially greater than the risk of becoming pregnant, although the likelihood varies considerably, depending on one's sex, on whether one's partner has an STD and on what the disease is. Women are at greater risk of acquiring an STD than men, because anatomical differences make many of these diseases more easily transmissible to women. (88)

* In a single act of unprotected intercourse with an infected partner, for example, a woman is twice as likely as a man to acquire gonorrhea or chlamydia (Figure 20, page 31), as well as hepatitis B (not shown).

* Some STDs are more easily transmissible than others, however. For example, in a single act of unprotected intercourse with an infected partner, a woman has a 1% risk of acquiring HIV, a 30% risk of getting genital herpes and a 50% chance of contracting gonorrhea; a man's risk of infection ranges from 1% for HIV to 30% for genital herpes.

The more partners an individual has, the higher the risk of being exposed to a sexually transmitted infection.

* Overall, younger women are more likely than older women to have more than one partner in a three-month period, because most are unmarried (89) (Figure 21, page 32).

* Many teenagers, as well as adults, are indirectly exposed to more than one sexual partner each year because their partner has had sex with someone else. (90)

In addition, adolescent women maybe biologically more susceptible to sexually transmitted infections than older women. Young women may have a higher risk of cervical infections because their cervix has not completely undergone age-related developmental changes. (91) In addition, they have fewer protective STD antibodies. (92)

Correct and consistent use of a latex condom (93) at each act of intercourse markedly reduces the risk of acquiring an STD, including HIV. (94) Even imperfect use (95) reduces the risk by about 50%. (96) By contrast, in a year of regular intercourse with a man infected with gonorrhea, an estimated 90% of women would become infected if they used no method, a hormonal method, periodic abstinence or the IUD; an estimated 60--70% would become infected if they used the diaphragm or spermicide alone. (97)

The Difficulties of Prevention

Although contraceptives can prevent pregnancy and STDs, they can be complicated to use, and some may seem inappropriate to teenagers who have sex sporadically. In addition, contraceptives can be difficult or expensive for adolescents to obtain.

Planning. All contraceptive methods other than withdrawal require planning, either to obtain supplies or to give the method time to take effect (It is generally recommended, for example, that for the first several days after a woman begins to use the pill, she and her partner also use a second method.) Planning can be difficult, especially in the early stages of a relationship, when it may not be clear whether or when intercourse might occur. In addition, ambivalence about sex and a romantic desire to be "swept away" can impede the willingness of people who are not in a long-standing relationship to be prepared "just in case." (38)

Some methods, such as the male condom, the female condom and spermicides, are available without a prescription. Their relative accessibility and low cost make it feasible to keep them on hand in case they are needed. (This may be problematic for teenagers who do not want their parents to know they have contraceptives--and therefore, presumably, are having sex.) On the other hand, use of any of these methods is usually apparent to one's partner and may even require the partner's cooperation. The necessary communication and agreement between partners may be awkward to achieve in a new relationship, and may be especially difficult for teenage women, whose partners often are considerably older. (99) (It may also be difficult to introduce or continue using condoms in long-standing relationships. (100))

Other methods--hormonal methods, such as the pill, the contraceptive implant or the injectable contraceptive; and the Diaphragm--require a medical visit prior to use and either a prescription or insertion or injection by a clinician. (IUDs are seldom offered to young women because of the possible risks of infection leading to infertility.) A woman can use any of these methods, with the possible exception of the diaphragm, without her partner's knowledge; however, the continuous protection against pregnancy provided by these methods, as well as by periodic abstinence (which requires ongoing monitoring of the time of ovulation), may seem unnecessary to women who do not have sex regularly. (101)

In addition, hormonal methods and periodic abstinence offer no protection against STDs, although hormonal methods do lower a woman's risk of developing an upper genital tract infection if she contracts certain diseases. (102) Thus, a woman relying on one of these methods must also use a barrier method--preferably, the male condom--to protect herself or her partner against STDs as well as pregnancy.

Obtaining Methods. Acquiring the services and supplies needed to prevent pregnancy or STDs can be difficult or even forbidding for teenagers.

* Many people are embarrassed to buy condoms. (103)

* Clinicians often do not initiate discussion about contraception and STDs with adolescents, who maybe too timid or embarrassed to raise such subjects themselves. (104)

* Young women seeking the pill and other prescription methods may be embarrassed to have a pelvic examination (105) or may not know how to locate a physician on their own, since a pediatrician is probably the only doctor many teenagers have seen on a regular basis.

* More than a quarter of private doctors who write pill prescriptions will not do so for a minor without her parent's consent (106)--a restriction that inhibits some young people from seeking sensitive health care. (107)

Services at family planning clinics, community health centers and other publicly supported clinics are the easiest for teenagers to obtain. Family planning clinics, for example, rarely require parental consent, although clinicians strongly urge young women, especially very young teenagers, to talk with their parents. (108) In addition, many clinics provide services and pills to young women without charge; when they do charge, clinics' fees are generally lower than those of private practitioners, (100) who typically charge $55-$89 for a new patient visit, not including laboratory fees. (110) Clinics are also more likely than private doctors to have evening and weekend hours, and to see patients without an appointment. In addition, they are substantially more likely to serve a woman who cannot pay.(111) Between 1980 and 1992, however, funding for the Title X family planning program, which provides crucial support for clinics, declined 72% (adjusted for inflation).(112) As a consequence, some clinics have been forced to charge higher fees, cut back their hours of operation or reduce education and outreach efforts--changes that make services less accessible to teenagers.(113)

In recent years, in an effort to make services more accessible to young people, a number of school-based and school-linked clinics have opened, and condom distribution programs have been implemented in some schools. Only a third of these clinics dispense contraceptives on site,(114) however, and only a handful of schools have established condom distribution programs.(115)

Contraceptive Use Among Sexually Experienced Teenagers

Despite the barriers, most sexually experienced teenagers use contraceptives.

* Contraceptive use among teenagers, particularly condom use, increased considerably between 1982 and 1988.(116)

* Many young people use two methods--one to protect themselves or their partners against pregnancy and another to prevent STD transmission (although it is not clear from the data available how many use both methods simultaneously). A quarter of the 1.7 million teenagers who use the pill, for example, also use condoms. Of men aged 15-19 who use condoms, a quarter use them in combination with a female method.(117)

Use at First Intercourse. Two-thirds of adolescents use some method of contraception--usually the male condom--the first time they have sexual intercourse.(118)

* The older a teenager is at first intercourse, the more likely she or he is to use a contraceptive.(119)

* Whites are substantially more likely than blacks or Hispanics, and higher income teenagers are more likely than poor or low-income adolescents, to use a method the first time they have sex.(120)

* The prevalence of condom use at first intercourse among women aged 15-19 jumped from 23% to 48% between 1982 and 1988; the increase occurred among young women of all races, ethnic groups and income levels(121) (Figure 22, page 33).

* Even so, white and higher income teenagers are more likely than others to use condoms at first intercourse.(122)

Delay in Seeking Medical Services. It is important for sexually experienced teenagers, especially young women, to visit a clinic or doctor not only to obtain more effective contraceptives, but also to undergo periodic STD screening and, if necessary, treatment. Most sexually experienced teenagers who use birth control, however, rely on over-the-counter methods, such as the condom, for a considerable period before they consult a medical professional. (123)

* Only 40% of sexually experienced teenage women visit a doctor or clinic for contraceptives within 12 months of beginning intercourse (Figure 23, page 33).

* Black teenagers and adolescents from poor families make a family planning visit sooner than whites or Hispanics and teenagers from higher income families. (124)

* Women who are older when they first have intercourse are more likely than younger teenagers to make a family planning visit soon after they first have sex (although they are no more likely to go to a clinic or doctor for contraceptives before the month in which they first have sex). (125)

Two-thirds of all adolescent women, and even higher proportions of those who are poor or who begin sex at an early age, first seek medical contraceptive services from a family planning clinic. (126)

* Clinics continue to be the most common source of medical services well after the first visit.

* In 1988, a clinic was the most recent source of services for almost two-thirds of women aged 15-19, including three-quarters of those who were poor.

Current Contraceptive Use. At any given time, three-quarters of adolescent women who have had sex are at risk of unintended pregnancy. (127) Most at-risk teenagers use contraceptives. (128)

* Some 72% of 15-17-year-old women at risk and 84% of 18-19-year-olds use some method of contraception, as do 88% of women aged 20-24 (Figure 24, page 34).

* In general, pill use increases and condom use declines with age; however, the reverse is true for Hispanic women.

* Black and Hispanic teenagers are less likely than white adolescents to use some method of contraception, although the difference between blacks and whites is small. Blacks, however, are more likely than whites to use the pill.

* Higher income teenagers are much more likely than low-income teenagers and somewhat more likely than poor adolescents to use contraceptives. Poor women, however, are slightly more likely than their more advantaged peers to use the pill.

* Differences in pill use by race and ethnicity and by income may reflect, at least in part, poor and black teenagers' tendency to visit a clinic or doctor for contraceptives relatively soon after they begin intercourse.

Less Than Perfect Use. Successful use of most reversible contraceptive methods requires both motivation and a constancy of attention and action that is difficult for married adults, let alone teenagers and others who are not in stable, long-term relationships, to maintain. (129)

* Among all women who rely on condoms, only eight in 10 used one at last intercourse; only two in 10 of those who rely on condoms solely for protection against STDs used one the last time they had sex.

* Teenage women who use condoms to prevent an unintended pregnancy are as likely to have used one at last intercourse as are older women with similar numbers of partners, income and race or ethnicity.

Successful use of condoms and pills, as well as of other reversible methods, generally requires adherence to certain steps. Most women who use condoms or the pill do not follow all of these steps; teenage women do about as well as older women in this regard (130) (Figures 25 and 26, pages 35 and 36).

Teenagers' Success in Avoiding Pregnancy

Even though their use is not always perfect, a large majority of never-married adolescents who use contraceptives succeed in avoiding unintended pregnancy. Indeed, they do at least as well as older women (131) (Figure 27, page 37).

* Never-married teenagers are slightly more successful than never-married women aged 20--24 in preventing an accidental pregnancy in the first 12 months of pill or condom use.

* Teenagers are about as likely to prevent an unintended pregnancy as are never-married women aged 25--29 using the same contraceptives.

* The relatively low rate of unintended pregnancies among never-married adolescents using the pill and condoms may reflect, in part, that they have intercourse less frequently than older never-married women.

At all ages, women who are poor or low-income have more difficulty than higher income women in using contraceptives effectively: Unintended pregnancy rates among pill and condom users who are poor or low-income are about twice those among higher income women. (132)

In contrast to the fairly small differences in unintended pregnancy rates among never-married women of various ages, there are strong age differences among reversible contraceptive users who have ever been married. Rates are about twice as high for ever-married teenage users as they are for never-married adolescent women, while pregnancy rates for users aged 20-24 do not vary substantially by marital status. In fact, ever-married adolescents have the highest unintended pregnancy rates, regardless of whether they use the pill or the condom and regardless of their poverty status. (133) The higher rates among younger married users may reflect weaker motivation to delay pregnancy, greater frequency of intercourse, higher fertility or selection of women more likely to have accidental pregnancies into earlier marriage.

Contraceptives can significantly reduce the risk of becoming pregnant or of acquiring an STD--in some cases, virtually to zero. Although contraceptives can be difficult for teenagers to obtain and to use, most sexually experienced adolescents try to behave responsibly by protecting themselves and their partners from disease and unintended pregnancy. In general, teenagers use contraceptives as effectively as, or even better than, unmarried adults. For adolescents who are not effective users or who do not use a method, however, the consequences can be serious.

(84.) Leridon, 1977.

(85.) Harlap, Kost and Forrest, 1991, p. 36.

(86.) Mosher, 1982, p.24.

(87.) Atwater, 1992, pp. 61, 64; Bongaarts and Potter, 1988.

(88.) Donovan, 1993, pp. 18-24; Harlap, Kost and Forrest, 1991, pp. 42-44.

(89.) AGI, 1993b; Kost and Forrest, 1992, p. 248, Table 3.

(90.) Kost and Forrest, 1992, Table 5, p.250; Figure 1, p. 247.

(91.) Moscicki et al., 1989; Ostergard, 1977, p. 59; Shafer and Sweet, 1990.

(92.) Shafer and Sweet, 1990, p, 550.

(93.) Polyurethane condoms may be at least as effective as latex condoms, although a final determination must await further study.

(94.) Kestelman and Trussell, 1991; Roper, Peterson and Curran, 1990; Saracco et al., 1993, p. 500.

Young men aged 15-19 are more likely to use condoms consistently if they are concerned about preventing pregnancy, are worried about getting AIDS or think their partners would appreciate condom use. They are less likely to use condoms if they are embarrassed or concerned about condoms' reducing sexual pleasure. (Pleck, Sonenstein, and Ku, 1991.)

(95.) See Figure 25 for the steps entailed in "perfect" condom use.

(96.) Cates and Stone, 1992a; Cates and Stone, 1992b.

(97.) Cates and Stone, 1992b, Table 7, p. 125.

(98.) Cassell, 1984.

(99.) AGI, 1993d.

(100.) Ku, Sonenstein and Pleck, 1993.

(101.) The pill must be taken daily; the injectable provides protection for three months; and the implant lasts for five years.

(102.) Harlap, Kost and Forrest, 1991, pp. 45-48.

(103.) Grady et al., 1993, p.67; Table 2, p. 70. Overall, 27% of men aged 20-39 say they are embarrassed buying condoms.

(104.) Levenson, Morrow and Pfefferbaum, 1984.

(105.) The Food and Drug Administration (FDA) has lift-edits recommendation that a woman always have a pelvic examination before her initial prescription for oral contraceptives. Following the FDA's action, Title X family planning clinics were notified by the government that the examination may be deferred if a clinician determines that the woman has no indications of medical risk and has been counseled about the need to use protection against STD transmission. (Bennett, 1993.)

(106.) Forrest, Gold and Kenney, 1989, p.36.

(107.) Chamie et al., 1982; Cheng et al., 1993.

(108.) Dryfoos, 1988, p. 198.

(109.) Henshaw and Torres, 1994.

Women under age 18 are not charged or are charged at a reduced rate for their initial visit in about 54% of family planning clinics and can get pills without charge or at a reduced rate at 62% of these clinics. When publicly funded clinics do not reduce fees, a routine first visit averages $50, and pills cost an average of $7 per cycle.

Contraceptive implants are generally available to those who can pay the full cost, including the cost of insertion, which typically runs shout $500 in a family planning clinic (Frost, 1994, Table 5, pp. 9-10) They are also available to low-income, unmarried mothers who qualify for welfare and therefore are eligible for Medicaid. Teenage daughters in families covered by Medicaid can have their service fees covered by Medicaid.

(110.) Chapin, 1993.

(111.) Silverman and Torres, 1987, Table 25, pp. 145-147.

Some 54% of clinics, but only 32% of private doctors, see clients in the evening; 29% and 13%, respectively, have weekend hours. Some 31% of clinics will see women for routine care without an appointment, compared with only 15% of private physicians. Only 8% of clinics will refuse to serve a woman who cannot pay, compared with 38% of physicians. The average wait for an appointment at a clinic or private physician's office is 6-7 days.

(112.) Daley and Gold, 1993, p. 248.

(113.) Henshaw and Torres, 1994.

(114.) McKinney and Peak, 1994.

(115.) Leitman, Kramer and Taylor, 1993.

(116.) Forrest and Singh, 1990; Sonenstein, Pleck and Ku, 1989.

(117.) AGI, 1993b; Sonenstein, Pleck and Ku, 1989, p. 154.

(118.) Forrest and Singh, 1990, Table 5, p. 209; Hollmann, 1998, Table 1, p. 10; Sonenstein, Pleck, and Ku, 1989, Table 5, p. 155.

(119.) AGI, 1993b; Sonenstein, Pleck and Ku, 1989. In 1988, for example, 77% of adolescent women who had been 18-19 at first intercourse reported that they or their partner had used a method at that time, compared with 68% of those who had first had sex between the ages of 15 and 17, and 52% of those who had begun intercourse before age 15.

(120.) Forrest and Singh, 1990, Table 5, p. 209; Sonenstein, Pleck and Ku, 1989, Table 5, p. 155. Some 69% of white women and 60% of white men aged 15-19 in 1988 had used a method at first intercourse, compared with 49-57% of black and Hispanic men and women. Similarly, 73% of teenage women from higher income families had used a method at first intercourse, compared with 58% of poor and low-income teenagers.

(121.) Forrest and Singh, 1990, Table 5, p.209.

(122.) Forrest and Singh, 1990, Table 5, p.209.

(123.) AGI, 1993b.

(124.) AGI, 1993b.

Some 37% of black teenagers make a visit within three months, compared with 20% of Hispanic and white teenagers. Among women from poor families, 27% make a visit within three months, compared with 19% and 23%, respectively, of low-income and higher income teens.

(125.) AGI, 1993b.

Overall, 42% of women aged 18-19 at first intercourse visit a clinic or doctor for family planning within three months of starting intercourse, compared with 23% of those aged 15-17 and 18% of those under age 15.

(126.) AGI, 1993b.

Of those who first have sex before age 15,74% go to a clinic for medical family planning services, compared with 68% of women aged 15-17 and 58% of those aged 18-19.

(127.) Forrest and Singh, 1990, p.211.

(128.) AGI, 1993b.

(129.) Kost and Forrest, 1992, pp.252,253.

(130.) Oakley, 1993.

(131.) Jones and Forrest, 1992, p. 13; Table 3, p. 16.

When these data were obtained, the contraceptive implant and the injection were not available, and rates for the IUD could not be calculated.

(132.) Emans et al., 1987; Jones and Forrest, 1992, Table 2, p. 15.

(133.) Jones and Forrest, 1992, Table 2, p. 15.

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FIGURE 19

RISK OF PREGNANCY

A sexually active teenage woman using no contraceptive over the course
of a year has a 90% chance of becoming pregnant.


 Estimated % of women be-
 coming pregnant in one
 year of intercourse using
 no contraceptive method

15-19 90%
20-24 95%
25-29 90%
30-34 85%
35-39 80%
40-44 70%

Source: S. Harlap, K. Kost and J. D. Forrest, Preventing Pregnancy,
Protecting Health: A New Look at Birth Control Choices in the United
States, AGI, New York, 1991, Table 8.2, p. 121.

Note: Table made from bar graph
FIGURE 20

STD RISK, BY GENDER

Women are at least as likely as men to acquire certain STDs during a
single act of unprotected intercourse with an infected partner.

Estimated % risk of acquiring an STD in one act of unprotected
intercourse with an infected partner, all ages

 Women infected Men infected by
 by men women

Gonorrhea 50% 25%
Chlamydia 40% 20%
Genital herpes 30% 30%
HPV 10% 10%
HIV 1% .9%

Source: S. Harlap, K. Kost and J. D. Forrest, Preventing Pregnancy,
Protecting Health: A New Look at Birth Control Choices in the United
States, AGI, New York, 1991, Figure 6.4, p. 43.

Notes: HPV is human papillomavirus. HIV is human immunodeficiency virus.

Note: Table made from bar graph
FIGURE 21

MULTIPLE PARTNERS

Younger women are more likely than older women to have more than one
sexual partner in a short time period because most younger women are
unmarried. Among the inmarried only, age makes little difference in the
proportions with multiple sexual partners.

% of women sexually active in the last three months who had more than
one sexual partner in that time period, 1988

 All women Unmarried women

15-17 8% 8%
18-19 9% 11%
20-24 5% 11%
25-29 4% 12%
30-34 2% 8%
35-39 2% 10%
40-44 2% 12%

Sources: All women: K. Kost and J.D. Forrest, "American Women's Sexual
Behavior and Exposur to Risk of Sexually Transmitted Diseases," Family
Planning Perspectives, 24:244-254, 1992, Table 3, p. 248.

Unmarried women: AGI tabulations of data from the 1988 National Survey
of Family Growth.

Note: Unmarried women exlude those who are currently married and those
who are cohabiting.

Note: Table made from bar graph
FIGURE 22

GETTING BETTER AT PRECAUTIONS

Teenage women's contraceptive use at first intercourse rose from 48% in
1982 to 65% in 1988. Condom use doubled.

 Sexually experienced women
 aged 15-19 at interview,
 1982: 4,484,000

Condom 23%
Pill 8%
Withdrawal 13%
Other 4%
No method at
 first intercourse 52%

 Sexually experienced women
 aged 15-19 at interview,
 1988: 4,883,000

Condom 48%
Pill 8%
Withdrawal 8%
Other 1%
No method at
 first intercourse 35%

Source: J. D. Forrest and S. Singh, "The Sexual and Reproductive
Behavior of American Women, 1982-1988," Family Planning Perspectives,
22:206-214, 1990, Table 5, p.209.

Note: Table made from pie chart
FIGURE 23

DELAYS STILL COMMON

Most young women are sexually active for a substantial time before they
go to a doctor or a clinic; only 40% go for medical contraceptive
services within the first year after they begin intercourse.

 Sexually experienced women
 aged 15-19 who have been
 sexually active for at least
 a year, 1988: 3,650,000

Made medical visit before or
 in same month as first
 intercourse 12%
1-3 months after 11%
4-6 months after 5%
7-12 months after 12%
1 year or more after 29%
Made no visit by time of
 survey 31%

Source: AGI tabulations of data from the 1988 National Survey of Family
Growth.

Note: Table made from pie chart
FIGURE 24

TRYING TO AVOID PREGNANCY

On a ongoing basis, the majority of sexually experienced adolescent
women and their partners use a contraceptive, primarily the condom or
the pill.

% of women aged 15-19 at risk of unintended pregnancy who are using a
contraceptive, 1988

Age-group


 Condom Pill Other method

15-17 * 38 5 72%
18-19 24 52 8 84%
20-24 13 60 15 88%

Race and ethnicity


 Condom Pill Other method

Black * 58 2 77%
Hispanic 28 38 2 65%
White 28 45 8 81%

Income


 Condom Pill Other method

Poor * 50 6 78%
Low-income 27 41 3 71%
Higher income 27 47 9 83%

Source: AGI tabulations of data from the 1988 National Survey of Family
Growth.

Note: Data on age-groups only include 20-24-year-olds.

Note: Table made from bar graph

*[Unreadable in original source]
FIGURE 25

CONDOM USE NEEDS IMPROVEMENT AT ALL AGES.

Teenagers do almost as well as older women in trying to follow the
criteria for perfect condom use.

Average number and type of criteria met for good condom use out of
total of four

 Hold condom Withdraw Use a
 Put condom in place while penis condom during
 on prior to during is still every act of
 penetration withdrawal erect intercourse

Perfect use 1.00 1.00 1.00 1.00
14 and younger .73 .40 .20 .33
15-17 .77 .54 .35 .35
18-19 .73 .56 .40 .31
20-24 .79 .47 .41 .47
25-29 .80 .50 .28 .56
30 and older .78 .40 .40 .40






Perfect use
14 and younger 1.7
15-17 2.0
18-19 2.0
20-24 2.1
25-29 2.1
30 and older 2.0

Source: Tabulations by D. Oakley of data from the University of Michigan
longitudinal survey of initial clients at three family planning clinics
near Detroit, Feb. 1987-Apr. 1989.

Note: Condoms were the main Contraceptive method used for any study
month, and women were sexually active at least one of those months.

Note: Table made from bar graph
FIGURE 26

PILL USE COULD IMPROVE, TOO.

Teenagers do almost as well as older women in trying to follow the
criteria for perfect pill use.

Average number and type of criteria met for good pill use out of total
of six

 Take Take a pill Take
 a pill at same time pills in Take
 every day every day same order all pills

Perfect use 1.00 1.00 1.00 1.00
14 and younger .26 .96 .72 .41
15-17 .40 .98 .87 .60
18-19 .41 1.00 .89 .62
20-24 .44 .98 .93 .62
25-29 .46 .96 .90 .62
30 and older .59 .98 .93 .78

 Use a backup Take
 method if only own
 forget pill pills

Perfect use 1.00
14 and younger .96 3.5
15-17 .99 4.0
18-19 .98 4.1
20-24 1.00 4.2
25-29 1.00 4.2
30 and older .98 4.5

Source: Tabulations by D. Oakley of data from University of Michigan
longitudinal survey of initial clients at three family planning clinics
near Detroit, Feb. 1987-Apr. 1989. See D. Oakley, S. Sereika and E.-L.
Bogue, "Oral Contraceptive Pill Use After an Initial Visit to the Family
Planning clinic," Family Planning Perspectives, 23:150-154, 1991.

Note: Oral contraceptives were the main contmceptive used for any study
month, and women were sexually active at least one of those months.

Note: Table made from bar graph
FIGURE 27

TEENAGERS' SUCCESS IN PREGNANCY PREVENTION

Unmarried teenagers are less likely to have a contraceptive failure than
are unmarried women in their early 20s. Overall, those who are higher
income and those relying on pills have the lowest accidental pregnancy
rates.

% of never-married women pregnant in first year of condom or pill use,
1984-1987

Poor and low-income

 Condom Pill

19 and younger 27 13
20-24 31 15
25-29 27 13
30 and older 21 10

Higher income

 Condom Pill

19 and younger 13 6
20-24 15 7
25-29 13 6
30 and older 10 4

Source: E. F. Jones and J.D. Forrest, "Contraceptive Failure Rates Based
on the 1988 NSFG," Family Planning Perspectives, 24:12-19, 1992, Table
2, p. 15.

Note: Table made from bar graph
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Date:Jan 1, 1994
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