From: HADCRJAM@admin.uh.edu (MILLER, JIMMY A.)
Subject: Re: CONTRACEPTIVE FAILURE RATES (long)
Organization: University of Houston Administrative Computing
Date: Sun, 30 Aug 1992 21:29:40 GMT
X-News-Reader: VMS NEWS 1.20

>   I have (among others) maintained that improved education and contraceptive
> availability could do much to lower the number of unwanted pregnancies, and
> thus, the number of abortions.  Early on in my participation in this group
> Adreinne Regard disagreed and via use of known failure rates for perfect
> use of contraception produced figures that indicated even perfect use would
> do very little for the overall figures.  I disagreed, but until fairly
> recently was unable to substantiate this feeling.  My case is significantly
> improved by the following post, which indicates contraceptive failure is
> far above that obtained through consistently correct use.
> 
> The following data and commentary is from "Contraceptive Failure Rates Based
> on the 1988 NSFG", by Elise Jones and Jacqueline Forrest of the  Alan 
> Guttmacher Institute, from the January 1992 issue of _Family Planning Per-
> spectives_, pages 12-18.  Much of the data used in the article was derived
> from the National Survey of Family Growth (NSFG) conducted periodically by
> the National Center for Health Statistics.  The data was obtained via inter-
> views with a probability sample of 8,540 US women aged 15-44 of all marital
> statuses.  The latest NSFG figures are from 1988.  The Institute undertook
> a study in 1987 of 9,480 abortion patients to determine contraceptive use
> among those obtaining abortions.  This was done largely to correct what the
> Institute saw as possible underreporting in the 1982 NSFG of abortions, and
> thus of contraceptive failure.  If I insert any comments not found in the 
> article, I will denote them with brackets [like so].
> 
> begin article
> ******************************************************************************
> [I find it important to note that the authors feel that failure rates, and 
>  indeed, even contraceptive use itself may have been overreported by the 
>  interviewees.  They express this concern at length while discussing the methods
>  used to reach their conclusions.]
> 
> Table 1. % of women experiencing contraceptive failure during the 1st 12 months
> of use, uncorrected and corrected for underreporting of abortion, by method,
> NFSG, 1988
> -------------------------------------------------------------------------------
> method		uncorrected,	corrected,	corrected,
> 		unstandardized  unstandardized  standardized
> -------------------------------------------------------------------------------
> pill		5.1		8.3		7.3
> condom		7.2		14.8		15.8
> diaphragm	10.4		15.9		22.0
> periodic
> abstinence	20.9		25.6		31.4
> sponge		14.5		*		*
> spermicides	13.4		25.2		30.2
> other		13.3		27.8		26.2
> 
> * not shown; correction based on 1987 and not representative of sponge use 
> during the whole observation period.
> 
>   "The probability of failure varies not only by method but also by char-
> aceristics of the user, such as age and marital status."
> 
> Table 2.  % of women experiencing contraceptive failure during the first 12
> months of use, corrected for underreporting of abortion, by marital status,
> poverty status and age, according to method, 1988 NSFG
> ----------------------------------------------------------------------------
> Marital status,		pill	condom	diaphragm  spermicide	other 	
> poverty status					   
> and age
> ----------------------------------------------------------------------------
> NEVER MARRIED
> <200% POVERTY
> <20			12.9	27.3	37.3		49.8	43.7
> 20-24			15	31.1	42.1		55.4	49.1
> 25-29			12.8	27.0	36.9		49.4	43.5
> >29			9.6	20.8	*		39.6	*
> 
> >200% POVERTY
> <20			5.9	13.2	*		26.3	22.5
> 20-24			6.9	15.2	21.4		30.0	25.8
> 25-29			5.9	13.0	18.4		26.0	22.3
> >29			4.4	9.8	14.0		*	*
> 
> EVER MARRIED
> <200% POVERTY
> <20			26.8	51.3	*		*	*
> 20-24			14.0	29.3	39.8		52.8	46.6
> 25-29			8.8	19.0	26.6		36.7	31.8
> >29			6.2	13.8	19.5		27.5	23.6	
> 
> >200% POVERTY
> <20			12.9	*	*		*	*
> 20-24			6.4	14.2	20.1		28.2	24.2
> 25-29			4.0	8.9	12.8		18.3	15.5
> >29			2.8	6.4	9.1		13.2	11.2
> 
> * indicates subgroups represented in the NSFG by fewer than 5 use intervals
> 
> [I left out the data on periodic abstinence for space.  It ranged from a high
>  of 57.3 for never-married 20-24 yr olds <200% of poverty to a low of 13.9 for
>  ever-married >29 year-olds >200% of poverty] 
> 
>   "The chances of failure vary widely among different subgroups of women.[...]
> Although the overall level of failure differs markedly from method to method,
> ...the pattern of variation by marital status, poverty status, and age is not
> significantly different among the methods."
> 
>   Women who were previously married but currently single had a much higher rate
> of failure than married and never-married women, for all age groups.
> 
>   Religion seemed to little over-all effect on contraceptive use, but was a 
> marked predictor among lower-income women.
> 
> CONCLUSIONS OF THE AUTHORS
> 
>  [the authors spend a paragraph warning of possible biases due to underreport-
> ing of abortion and other factors which might lead to the over-estimation of 
> the failure rates.  I think this well-founded, but agree with them that certain
> trends are fairly clear]
> 
>   "In spite of such qualifications, some general conclusions are clear.  Contr-
> aceptive failure rates in the United States continue to be much higher than
> they need be, contributing substantially to high levels of unintended preg-
> nancy and abortion.  For example, if all those choosing to use oral contracep-
> tives used the method perfectly (that is, correctly and consistently), it is
> estimated only one per 1,000 would become pregnant within the first year of
> use.  The results here indicate that, among women using the pill during the
> late 1980's as many as 80 per 1,000 actually became pregnant.  Similarly,
> estimated failure rates for those using condoms perfectly are 20 per 1,000,
> yet 150 per 1,000 couples actually using condoms apparently experience an
> unplanned pregnancy during the first 12 months of use.
>   Comparisons of results based on the 1982 and 1988 surveys indicate that
> contraceptive failure rates are not declining, and that indeed, rates for the
> pill and periodic abstinence appear to have risen."
> 
>   The authors go on to make some other comparisons, and make a call for better,
> simpler methods, improved education on those existing, and more studies on
> contributing factors [all of which I concur with whole-heartedly].
> ***************************************************************************
> end article
> 
> 
> semper fi,
> 
> Jammer Jim Miller 
> Texas A&M University '89 and '91
> ********************************************************************************
> * Aggie in Cougarland -- I just work here.				       *
> * Speak for my employers?  They don't even know I exist!		       *
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> *             *********************************************		       *
> * "Power finds its way to those who take a stand.  Stand up, Ordinary Man."    *
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