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Article American Academy of Nursing on Policy| Volume 60, ISSUE 3, P163-164.e1, May 2012

Women’s health in jeopardy: Failure to curb unintended pregnancies

A statement from the AAN Women’s Health Expert Panel
DOI:https://doi.org/10.1016/j.outlook.2012.03.001
Women’s health in jeopardy: Failure to curb unintended pregnancies
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      Care of and access to health care for women across the age span has always been at the forefront of nursing’s advocacy through education, practice, and research. One well-recognized method to improve the health status of women and children lies in managing unintended pregnancies; however, evidence shows that little progress has been made on this front. Threatening to roll back what little progress has been made, as well as the potential to achieve better management of unintended pregnancies, contemporary health policy fails to consistently ensure access to high-quality reproductive health care for all women in the United States. Further, research has not been focused sufficiently on identifying key factors that hinder reducing unintended pregnancies. Therefore, the Women’s Health Expert Panel of the American Academy of Nursing urgently calls nurses individually, and the nursing profession as a whole, to support:
      • 1.
        Governmental and private funding for pregnancy preventive services directed to and self-selected by women, including access to assistance with fertility protection and prevention, reproductive health promotion, health care provider and consumer education, access to affordable insurance, and inclusion of reproductive services in primary care insurance benefits.
      • 2.
        Governmental and private funding for research directed at clarifying and eliminating factors contributing to unintended pregnancy and development and testing of innovative and novel preventive services for girls and women.

      Background

      Importantly, unintended pregnancies create a large social and economic burden to society. Mistimed or unplanned pregnancies result in delays in pregnancy care, poor mental health, poor mother-child relationship quality, and children with reduced mental and physical health and difficulties in school.

      Logan C, Holcombe E, Manlove J, et al. The consequences of unintended childbearing: A white paper, 2007. Washington, DC: Child Trends and The National Campaign to Prevent Teen and Unplanned Pregnancy.

      Unintended pregnancies are associated with significant costs to the health care system.
      • Trussel J.
      • Lalla A.
      • Doan Q.
      • et al.
      Cost effectiveness of contraceptives in the United States.
      Contraception. 2009; 79: 5-14
      Based on 2002 National Survey of Family Growth data, direct medical costs associated with unintended pregnancies were estimated to be $5 billion annually, whereas when contraception was available and used, a savings of about $19 billion was calculated.
      • Trussell J.
      The cost of unintended pregnancy in the United States.
      Contraception. 2007; 75: 168-170
      The economic value of investing in prevention of unintended pregnancy is clear: a cost-benefit analysis showed that for every $1 spent by publicly funded family planning clinics, $4 is saved.
      • Frost J.J.
      • Finer L.B.
      • Tapales A.
      The impact of publicly funded family planning clinic services on unintended pregnancies 387 and government cost savings.
      J Health Care Poor Underserv. 2008; 19: 778-796
      According to the collaboratively created National Women’s Law Center and the Oregon Health Sciences University 2010 Health Care Report Card (http://hrc.nwlc.org/), the majority of states consistently fail to protect the reproductive health of women. Nationally, the US has failed to meet most goals for women’s health as proposed by Healthy People 2010.

      National Women’s Law Center. The past and future in women’s health: A ten-year review and the promise of the Affordable Care Act and other federal initiatives. 2010a. Available at: http://hrc.nwlc.org/past-and-future. Accessed March 30, 2012.

      As highlighted in a 2010 Institute of Medicine (IOM) report (Women’s Health Research: Progress, Pitfalls, and Promise),
      Institute of Medicine
      Women’s health research: Progress, pitfalls, and promise.
      The National Academies Press, Washington, DC2010
      little progress or improvement of health outcomes has been made for 2 pregnancy-related conditions: reducing unintended pregnancy and reduction of maternal morbidity and mortality.
      Although national health goals as outlined in Healthy People

      Healthy People 2000. Available at: http://www.cdc.gov/nchs/healthy_people/hp2000.htm. Accessed March 30, 2012.

      , 

      Healthy People 2010. Available at: http://www.cdc.gov/nchs/healthy_people/hp2010.htm. Accessed March 30, 2012.

      stipulate reducing the rate of unintended pregnancies from 50% to 30%, we have not made substantial progress by our own benchmarks. Compared with other developed countries, we have much higher rates of unintended pregnancy. Especially troubling is the unequal burden of unplanned pregnancies in this country among disadvantaged women and women of color.
      • Dehlendorf C.
      • Rodriguez M.I.
      • Levy K.
      • et al.
      Disparities in family planning.
      Am J Obstet Gynecol. 2010; 202: 214-220
      , 
      • Finer L.
      • Henshaw S.
      Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
      Perspect Sex Reprod Health. 2006; 38: 90-96
      Although reducing unintended pregnancies remains a national health goal in Healthy People 2020,

      Family Planning-Healthy People 2020. Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/overv8iew.aspx?topicid=13. Accessed March 11, 2011

      the target rate has been reset to a disappointing 44% in the next 10 years (from 30%)! Moreover, recent congressional actions threaten to jeopardize current gains, instead of accelerating progress to attain goals.

      Challenges to Progress

      Although safe and effective prevention strategies for unintended pregnancies are available, a fragmented system to deliver reproductive health services combined with social and political dynamics to cut off some options continue to hinder access to these services
      Institute of Medicine
      Women’s health research: Progress, pitfalls, and promise.
      The National Academies Press, Washington, DC2010
      and threaten women’s access to care and health status. A recent example is the position of some lawmakers to oppose spending encompassed in Title X, a $327 million federal program that funds contraception, sexually transmitted infection (STI) treatment, and cancer screening, among other women’s health services.

      Bendavid N. GOP Spending Plan: X-ing Title X Family Planning Funds. 2011. Available at: http://blogs.wsj.com/washwire/2011/02/09/gop-spending-plan-x-ing-out-title-x-family-pla. Accessed March 11, 2011.

      Cuts to Title X mean that agencies such as Planned Parenthood health centers would no longer have federal dollar support for contraceptive services, STI testing, pregnancy testing, cancer screening, and other services. This would particularly deprive low-income women or working women without health insurance from accessing such health services. This alarming trend toward discontinuing, or severely limiting, reproductive health services further jeopardizes meeting national health goals and threatens to widen disparities in health status across groups of women unjustifiably and it must be turned around.
      Not all health policies place limitations on prevention strategies for unintended pregnancies. We note that the proposed list of required preventive services in the Affordable Healthcare Act were recently bolstered by important new guidelines issued by the U.S. Department of Health and Human Services that embrace recommendations from the Institute of Medicine to cover women’s preventive services. These include well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance, or deductible. Health plans will need to include these services without cost sharing for insurance policies that begin on or after August 1, 2012.

      HHS Press Office. Affordable care act ensures women receive preventive services at no additional cost. 2011. Available at: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. Accessed September 18, 2011.

      , 

      HealthCare.gov. Newsroom: Affordable Care Act rules on expanding access to preventive services for women. 2011. Available at: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. Accessed September 18, 2011.

      Although these new guidelines are a result of the IOM report, they are based on the work of independent physicians, nurses, scientists, and other experts who examined scientific evidence to determine recommended preventive services.

      HHS Press Office. Affordable care act ensures women receive preventive services at no additional cost. 2011. Available at: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. Accessed September 18, 2011.

      In addition to legislative and regulatory revisioning, research is critically needed that extends beyond simply studying access to services. We need research that will illuminate other salient underlying causes for high rates of unintended pregnancy. Such knowledge will lead to novel, more personalized, and culturally sensitive interventions for helping women choose fertility options, apply them to their particular life circumstances, and prevent unwanted and therefore high-risk pregnancies. Also essential is determining how to promote rapid translation of existing evidence into clinical education and practice. For example, normalizing unintended pregnancy prevention into primary care and public health models of care, as well as clinical practice guidelines using an organized system of primary, secondary, and tertiary prevention strategies, has been proposed.
      • Dunlop A.L.
      • Logue K.M.
      • Miranda M.C.
      • et al.
      Integrating reproductive planning with primary health care: An exploration among low-income, minority women and men.
      Sex Reprod Healthcare. 2010; 1: 37-43
      , 

      Levi A, Dau KQ. Meeting the national health goal to reduce unintended pregnancy. J Obstet Gynecol Neonat Nurs (in press)

      , 
      • Moos M.K.
      Unintended pregnancies a call for nursing action.
      Am J Matern Child Nurs. 2003; 28: 24-31
      , 
      • Moos M.K.
      From concept to practice: Reflection on the preconception health agenda.
      J Womens Health. 2010; 19: 561-567
      , 
      • Taylor D.
      • Levi A.
      • Simmonds K.
      Reframing unintended pregnancy prevention: A public health model.
      Contraception. 2010; 81: 363-366
      , 

      Taylor D, James EA. An evidence-based blueprint for unintended pregnancy prevention guidelines. J Obstet Gynecol Neonat Nurs (in press)

      , 

      World Health Organization. Sexual and reproductive health core competencies in reducing unintended pregnancy primary care: attitudes, knowledge, ethics, human rights, leadership, management, teamwork, community work, education, counselling, clinical settings, service, provision. 2011. Available at: http://whqlibdoc.who.int/publications/2011/9789241501002_eng.pdf. Accessed March 30, 2012.

      Only a combination of ready access to coordinated reproductive health services, new information about root contributors to unintended pregnancy, and integration of such resources into improved education for both women and their providers can move us toward achieving women’s national health goals.

      A Call to Action

      As Fellows and members of the AAN Women’s Health Expert Panel, we urge our nursing and interprofessional colleagues to actively support renewed and expanded efforts to curb unintended pregnancies. As a profession that is predominantly comprised of women and is highly trusted by the public, who better than nurses (with our colleagues of like mind) to advocate for women’s health? We must raise our voices to educate and advocate for the kind of policy, research, and practices that will preserve and advance reproductive health for women. We urge you to be vigilant in tracking policy that will hinder women’s access to or choices for services and actively work to oppose such policies. Draft new policies and speak out in support of policies that will ensure women have full access to reproductive health services and facilitate expansion of knowledge related to preventing unintended pregnancies.

      References

      1. Logan C, Holcombe E, Manlove J, et al. The consequences of unintended childbearing: A white paper, 2007. Washington, DC: Child Trends and The National Campaign to Prevent Teen and Unplanned Pregnancy.

        View in Article
        • Trussel J.
        • Lalla A.
        • Doan Q.
        • et al.
        Cost effectiveness of contraceptives in the United States.
        Contraception. 2009; 79: 5-14
        View in Article
        • Trussell J.
        The cost of unintended pregnancy in the United States.
        Contraception. 2007; 75: 168-170
        View in Article
        • Frost J.J.
        • Finer L.B.
        • Tapales A.
        The impact of publicly funded family planning clinic services on unintended pregnancies 387 and government cost savings.
        J Health Care Poor Underserv. 2008; 19: 778-796
        View in Article

      5. National Women’s Law Center. The past and future in women’s health: A ten-year review and the promise of the Affordable Care Act and other federal initiatives. 2010a. Available at: http://hrc.nwlc.org/past-and-future. Accessed March 30, 2012.

        View in Article
        • Institute of Medicine
        Women’s health research: Progress, pitfalls, and promise.
        The National Academies Press, Washington, DC2010
        View in Article

      7. Healthy People 2000. Available at: http://www.cdc.gov/nchs/healthy_people/hp2000.htm. Accessed March 30, 2012.

        View in Article

      8. Healthy People 2010. Available at: http://www.cdc.gov/nchs/healthy_people/hp2010.htm. Accessed March 30, 2012.

        View in Article
        • Dehlendorf C.
        • Rodriguez M.I.
        • Levy K.
        • et al.
        Disparities in family planning.
        Am J Obstet Gynecol. 2010; 202: 214-220
        View in Article
        • Finer L.
        • Henshaw S.
        Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
        Perspect Sex Reprod Health. 2006; 38: 90-96
        View in Article

      11. Family Planning-Healthy People 2020. Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/overv8iew.aspx?topicid=13. Accessed March 11, 2011

        View in Article

      12. Bendavid N. GOP Spending Plan: X-ing Title X Family Planning Funds. 2011. Available at: http://blogs.wsj.com/washwire/2011/02/09/gop-spending-plan-x-ing-out-title-x-family-pla. Accessed March 11, 2011.

        View in Article

      13. HHS Press Office. Affordable care act ensures women receive preventive services at no additional cost. 2011. Available at: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. Accessed September 18, 2011.

        View in Article

      14. HealthCare.gov. Newsroom: Affordable Care Act rules on expanding access to preventive services for women. 2011. Available at: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. Accessed September 18, 2011.

        View in Article
        • Dunlop A.L.
        • Logue K.M.
        • Miranda M.C.
        • et al.
        Integrating reproductive planning with primary health care: An exploration among low-income, minority women and men.
        Sex Reprod Healthcare. 2010; 1: 37-43
        View in Article

      16. Levi A, Dau KQ. Meeting the national health goal to reduce unintended pregnancy. J Obstet Gynecol Neonat Nurs (in press)

        View in Article
        • Moos M.K.
        Unintended pregnancies a call for nursing action.
        Am J Matern Child Nurs. 2003; 28: 24-31
        View in Article
        • Moos M.K.
        From concept to practice: Reflection on the preconception health agenda.
        J Womens Health. 2010; 19: 561-567
        View in Article
        • Taylor D.
        • Levi A.
        • Simmonds K.
        Reframing unintended pregnancy prevention: A public health model.
        Contraception. 2010; 81: 363-366
        View in Article

      20. Taylor D, James EA. An evidence-based blueprint for unintended pregnancy prevention guidelines. J Obstet Gynecol Neonat Nurs (in press)

        View in Article

      21. World Health Organization. Sexual and reproductive health core competencies in reducing unintended pregnancy primary care: attitudes, knowledge, ethics, human rights, leadership, management, teamwork, community work, education, counselling, clinical settings, service, provision. 2011. Available at: http://whqlibdoc.who.int/publications/2011/9789241501002_eng.pdf. Accessed March 30, 2012.

        View in Article

      Article info

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      DOI: https://doi.org/10.1016/j.outlook.2012.03.001

      Copyright

      © 2012 Published by Elsevier Inc. All rights reserved.

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