A Literature Review of Articles Discussing the Problems Associated with Lack of Family

Planning Education

Lori Hartley

Health Communication and Advocacy HLTH 634

April 9, 2016

This literature review is broken down into 3 parts including: Introduction, Body of
Evidence, and the Summary and Conclusions. Only research articles discussing the problems
associated with unintended pregnancies were selected in this review.

Introduction:
The purpose for this review is to create a summary of recent literature that identifies
underlying problems associated with lack of family planning education and access in certain
ethnic cultures, specifically the African American population. Studies show underuse and
inconsistent use of contraceptives are two contributing factors in the continued high rate of
unintended pregnancy in the United States.1 Moreover, research shows significant racial
disparities exist in the United States including unplanned pregnancy rates, especially with lowincome, African American women.2 These disparities, in addition to a couples inability to
control their fertility, contributes to the continuation of the cycle that passes from one generation
to the next. By taking a deeper look at past research, we are able to see its strengths and
weaknesses and better plan for future studies. Health care providers and policy makers will then
be able to use the information to create programs that promote better outcomes for women from
all racial, ethnic and socioeconomic backgrounds.

Body of Evidence:
There is a growing need for research in the area of family planning, especially with
adolescence. According to the literature, the age in which sexually activity begins is shortening.
A 2005 study of sexual behavior in different regions of the world found that by age 15, nine to 21
percent of girls had had sex, compared to 12 to 31 percent of boys. By age 18, this had increased
to 41 to 59 percent for girls and 40 to 73 percent for boys. By age 20, the vast majority of both

young women (61 to 77 percent) and young men (61 to 87) had had sex, regardless of marital
status.3 The average age of first sexual encounter coupled with health disparities associated with
unplanned pregnancy is creating the need for programs that focus on family planning.
One particular group of researchers collected and evaluated data from a statewiderepresentative mail and telephone survey of postpartum women in California. The purpose was
to look for possible associations between unintended pregnancy and race/ethnicity. The
ethnicities studied included African American, Asian or Pacific Islander, U.S.-born Latina,
foreign-born Latina, European and Middle Eastern.4 According to Cubbin, et al, poverty status,
maternal education, and paternal education were linked to unintended pregnancy rate; therefore
suggesting possible directions for policies and programs to help reduce social disparities in
unintended pregnancy among childbearing women.5 Alternatively, another survey of black girls
and women between the ages of 13-19 years found that motherhood was perceived to have many
positive aspects, including closer relationships with families and partners, and that these
affirmative attitudes predicted having an unintended teenage pregnancy.2
According to Finer, the incidence of unintended pregnancy is among the most essential
health status indicators in the field of reproductive health. One ongoing goal of the US
Department of Health and Human Services is to reduce unintended pregnancy, but the national
rate has not been estimated since 2001.6 In his study, he combined data on women's pregnancy
intentions from the 2006-2008 and 2002 National Survey of Family Growth with a 2008 national
survey of abortion patients and data on births from the National Center for Health Statistics,
induced abortions from a national abortion provider census, miscarriages estimated from the
National Survey of Family Growth and population data from the US Census Bureau. 6 He found
nearly half (49%) of pregnancies were unintended in 2006, up slightly from 2001 (48%) and the

unintended pregnancy rate increased to 52 per 1000 women aged 15-44 years in 2006 from 50 in
2001.6 A common denominator to other studies was found in that unintended pregnancy rates
among subgroups persisted and in some cases increased, and women who were 18-24 years old,
poor or cohabiting had rates two to three times the national rate. 6 His results also suggest
unintended pregnancy rates declined notably for teens 15-17 years old and the proportion of
unintended pregnancies ending in abortion decreased from 47% in 2001 to 43% in 2006;
unintended birth rate increased from 23 to 25 per 1000 women 15-44 years old. 6 He concludes
since 2001, the United States has not made progress in reducing unintended pregnancy and
efforts to help women and couples plan their pregnancies, such as increasing access to effective
contraceptives, should focus on groups at greatest risk for unintended pregnancy, particularly
poor and cohabiting women.6
One particular study found young women are more likely to initiate contraceptive use
promptly if they lived with their mothers only, had no older sisters, and perceived their mothers
as approving of their engaging in intercourse.7 Another study suggests pregnancy-related
mortality ratios are up to three times higher in black women compared with non-hispanic white
women, with the risk of severe maternal morbidity also significantly higher in black and hispanic
women.8 The study goes on to suggest unintended pregnancy is twice as likely in minority
women and insurance status, socioeconomic status, and broader social determinants of health are
implicated in these disparities.8 Mehta suggests coverage changes associated with the
Affordable Care Act may provide some opportunities to reach communities most at risk.
Delivery innovation, payment reform, and further public financing of key services are examples
of further management approaches that can be used to address reproductive health disparities.8

In yet another study, racial and ethnic disparities were found to be associated with
unplanned pregnancy; however, this study focused on the risk of abortion and the health
disparities associated with ending a pregnancy. Abortion was associated with small to moderate
increases in risks of anxiety, alcohol misuse, illicit drug use/misuse, and suicidal behaviour.9
In the last article review, a prospective cohort study was done to determine if giving free
long-acting reversible contraceptives (LARC) such as an IUD or implant would ultimately
decrease the number of unintended pregnancies and abortion. Participants were recruited from
two abortion clinics in the St. Louis region and through provider referral, advertisements, and
word of mouth.10 Counseling included information on all reversible methods, but emphasized the
superior effectiveness of LARC methods. All participants received the reversible contraceptive
method of their choice at no cost. Results of this study showed a significant reduction in abortion
rates, repeat abortions, and teenage birth. The noted decline in the rate of teenage birth within
the CHOICE cohort was 6.3 per 1,000, compared to the U.S. rate of 34.1 per 1,000.10

Summary and Conclusions

This review of literature shows mostly consistent data regarding the need for more
studies pertaining to health issues caused from unintended pregnancies. Lower socioeconomic
status has been shown many times to be associated with earlier initiation of sexual intercourse
and with adolescent pregnancy and childbirth.4 While family planning disparities are similar to
disparities in other areas of health, multiple studies have shown poor and minority women tend
to experience worse outcomes. Moreover, the health disparities associated with unintended and
teen pregnancy requires special attention to cultural issues including attitudes towards pregnancy
and beliefs about contraception and abortion. In addition, while disparities of unplanned
pregnancies are the focus of this paper, it is essential to acknowledge that disparities in access to

desired fertility have and continue to play an important role in the issue of family planning
disparities.1

References:

1. Dehlendorf C, Rodriguez MI, Levy K, Borrero S, Steinauer J. Disparities in Family Planning.

American journal of obstetrics and gynecology. 2010;202(3):214-220.
doi:10.1016/j.ajog.2009.08.022.
2. Hodgson E, Collier C, Hayes L, Curry L, Fraenkel L. Family planning and contraceptive
decision-making by economically disadvantaged, AfricanAmerican women. Contraception
[serial online]. August 2013;88(2):289-296. Available from: Academic Search Complete,
Ipswich, MA. Accessed March 30, 2016.
3. Glinski A, Sexton M, Petroni S. Understanding the Adolescent Family Planning Evidence Base.
International Center for Research on Women. July 2014.Dehlendorf C, Kimport K, Levy K,
Steinauer J. A Qualitative Analysis of Approaches To Contraceptive Counseling.Perspectives On
Sexual & Reproductive Health [serial online]. December 2014;46(4):233-240. Available from:
Academic Search Complete, Ipswich, MA. Accessed March 30, 2016.
4. Dehlendorf C, Marchi K, Vittinghoff E, Braveman P. Sociocultural Determinants of Teenage
Childbearing Among Latinas in California. Matern Child Health J. 2009
5. Cubbin C, Braveman P, Marchi K, Chavez G, Santelli J, Gilbert B. Socioeconomic and
racial/ethnic disparities in unintended pregnancy among postpartum women in California.
Maternal & Child Health Journal [serial online]. December 2002;6(4):237-246 10p. Available
from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 10, 2016.
6. Finer L, Zolna M. Unintended pregnancy in the United States: incidence and disparities, 2006.
Contraception [serial online]. November 2011;84(5):478-485. Available from: MEDLINE with
Full Text, Ipswich, MA. Accessed April 10, 2016.
7. White J. Influence of parents, peers, and problem-solving on contraceptive use. Pediatric
Nursing [serial online]. September 1987;13(5):317-360 6p. Available from: CINAHL Plus with
Full Text, Ipswich, MA. Accessed April 10, 2016.
8. Mehta P. Addressing reproductive health disparities as a healthcare management priority:
pursuing equity in the era of the Affordable Care Act. Current Opinion In Obstetrics &
Gynecology [serial online]. December 2014;26(6):531-538. Available from: MEDLINE with Full
Text, Ipswich, MA. Accessed April 10, 2016.
9. Fergusson D, Horwood L, Boden J. Does abortion reduce the mental health risks of unwanted or
unintended pregnancy? A re-appraisal of the evidence. Australian & New Zealand Journal Of
Psychiatry [serial online]. September 2013;47(9):819-827. Available from: Psychology and
Behavioral Sciences Collection, Ipswich, MA. Accessed April 10, 2016.
10. Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing Unintended Pregnancies by
Providing No-Cost Contraception. Obstetrics and gynecology. 2012;120(6):1291-1297.