Fecundity,

infertility, and

Reproductive

Health in the

United States, 1982

Statistics, based on data collected in 1982,

are presented on fecundity status and

infertility status, and related factors including

spontaneous pregnancy loss, treatment for

pelvic inflammatory disease, cesarean

section, and smoking and drinking during

pregnancy. The statistics are shown for

women 15-44 years of age, according to

race, age, marital status, and selected

socioeconomic characteristics.

Data From the National Survey of

Family Growth

Series 23, No. 14

DHHS Publication No. (PHS) 87–1990

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

May 1987
Ccl$yi?$m Im%ma.timl

All material appwmng m this report IS m the puhhc domain and may be

reproduced or copied without permssion, cdatIQn as Itf source, h@:w.w, is

appreciated

SiKggmled Ckitkm

Natmnal Center for Health Stabs.t!cs, W D Moshe?r Jf)d W F Pratt Fe wnchty

Infertility, and reproductive health m the United States, 1982 b’Ifa/ and /-%?akh

SLXMCS Sent% 23, No. 14 D!+IS Pub No (F’HS) 87-1992 Putk Fk@th

Service Washington U S Government Prmtmg Office May 1987

Mosher, VWham D,

Fecunddy, mfwhhty, and reproductwe health m the United Sta!es, 198’2

(Series 23, Data from the National Survey d Faml y Growth no 14)

(DHHS publication , no. (FWS) 87-1990)

Written by William D. hlosher and William F Prafi

Blbhogrsphy p

1, Infertility, Female-Umted Sttates—Statwhcs 2 ~Women-Diw+aaesUmted States—StatkWcs 3 FertMy, tiuman-Ur,lted Stat6s—Slat@cs

4 Health survey s-Un@d States—Stat!stlcs 5 Umtecl States—Statisbcs,

Medical, 1. Pratt, Wllllam F II Nahonal Center tor Health Statistic.s (U S )

Ill. Series Vital and health statistic% Series 23, Dats from the nawmal survey

of famdy growlh : no 14. IV Series DFIHS publlcotmr no IPHS) 37-1990

[DNLM’ 1 Abortion-occurrence-United States 2 Fedll!ty—s!at!stics—United

States. 3. lnfertWy--occurrence-Umted States 4 %?gnancy Campllcatmnsoccurcenc+Unded States

W2 N148vvJ no. 23]

F!G201 ,M65 1g87 362.1 ‘982’0973021 8633145

ISBN 0-84064363-0

IT(orsalr? hy the Su],crint!.adent of rmcumrnts, U.S. GIIJernmmt Printing Oflice, Wsshin,:ton, D,C. 20402
National Center for Health Statistics

Manning Feinleib, M. D., Dr. P. H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Director for Analysis and

Epidemiology

Gail F. Fisher, Ph. D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health Statistics

Systems

Stephen E. Nieberding, Associate Director for Management

George A. Schnack, Associate Director for Data Processing and

Services

Monroe G. Sirken, Ph. D., Associate Director for Research and

Methodology

Sandra S. Smith, Information Officer

Division of Vial Statistics

John E. Patterson, Director

James A. Weed, Ph. D., Deputy Director

William F. Pratt, Ph. D., Chief, Family Growth Survey Branch

Joseph D. Farrell, Chief Systems and Programming Branch

Mabel G. Smith, Chief, Statistical Resources Branch

Cooperating Agencies

Cycle 111of the National Survey of FanuIy Growth, 19S2, was supported in part

by the National Institute of Child Health and Human Development, National Institutes

of Health, and the Office of Population Affairs, Office of the Assistant Secretmy of

Health. Both of these agencies also participated in the questionnaire and sumey

design.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Summaryofprincipalfindings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Sourceandlimitationsofthedata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...6

Classificationbyfecunditystatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7

Contraceptivelysterile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Surgicallysterile, noncontraceptive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7

Nonsurgicallysterile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7

Subfecund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Longinterval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Impairedfecundity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8

Fecund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8

Comparisonswithotherdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9

Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Fecunditystatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Impairedfecundityandthedesire forchildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13

Surgicalsterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . 15

Pelvic inflammatorydisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . 16

Spontaneouspregnancyloss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...17

Cesareansection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Smokingandalcoholduringpregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Listofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Appendixes

1. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . 39

11. Conceptsanddefinitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

III, Accuracyandcompletenessofrep+xting . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . 48

IV. Items on the 1982 National Survey of Family Growth questionnaire relatedto fecundity, infertility, and reproductive

health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

List oftext figures

1. Number of women who had impaired fecundity, by parity and whether or not they wanted a future birth: United

States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...2

2. Percent of women (excluding the surgically sterile) who had impaired fecundity, by age: United States, 1982 . . . . 2

3. Percent of currently married women 15-44 years ofage (excluding the surgically sterile) who had impaired fecundity, andpercentinfertile, byage: UnitedStates,1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4, Percent of currently married couples (excluding the surgically sterile) who were infertile, by race: United States,

1965, 1976, and1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3

5. Percent of women 154.4 years of age (or their current husbands) who were surgically sterile, by age and marital

status: UnitedStates,1982. . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

..

Ill
6. Percent of women 15-44 years of age who had ever been treated for pelvic inflammatory disease, by age and race:

United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Percent of births to women 15-44 years of age that were delivered by cesarean section, by age of mother at delivery:

United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Percent of women ever pregnant 15-44 years of age who smoked or drank alcoholic beverages, or both, during their

most recent pregnancy, by race and origin: United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of text tables

A.

B.

c.

D.

E.

F.

G.

H,

J.

K,

Percent of women 15-44 years of age with impaired fecundity, by marital status and age, for all women and those

whowere notsurgically sterile: United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of women 15-44 years of age who were not surgically sterile who had impaired fecundity, by parity,

marital status, andage: United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of currently married women (excluding the surgically sterile) who had impaired fecundity, by parity and

age: United States, 1976and 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of currently married women (excluding the surgically sterile) who had impaired fecundity, by race and

age: United States, 1976and 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of women (excluding the surgically sterile) who had impaired fecundity, by race, marital status, and parity:

United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of currently married women 15J14 years of age who had impaired fecundity, were infertile, both, or either,

byparity andrace: United States, 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of currently married women 1544 years of age by infertility status, according to age, parity,

andrace: United States, 1965,1976, and 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of currently married women 15-44 years of age (excluding the surgically sterile) who were infertile, by

age, parity, andrace: United States, 1965, 1976, and 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of currently married women and currently mirried women ever pregnant 15-44 years of age who had ever

had 1 or more pregnancy losses, by age and race: United States, 1976 and 1982 . . . . . . . . . . . . . . . . . .

Percent of pregnancies to currently married women 1544 years of age that ended in a pregnancy loss, by age at

pregnancy outcome: United States, 1976 and 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

5

5

11

11

12

12

13

14

14

15

17

17

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision (30-percent

or more relative standard error)
Fecundity, Infertility,

and Reproductive

Health in the

United States, 1982

by William D. Mosher, Ph.D., and William F. Pratt, Ph.D.,

Division of Vital Statistics

Introduction

The National Survey of Family Growth, a periodic survey

conducted by the National Center for Health Statistics, is

designed to provide information on fertility, family planning,

and aspects of maternal and child health that are closely related

to childbearing. One of these factors is fecundity—the physical

ability to have children. Fecundity is measured in two ways:

fecundity impairments, or conditions that make it difficult

or impossible to have children; and infertility, the inability

to conceive after a year or more of unprotected intercourse.

This report contains a wide range of information on fecundity,

infertility, and related topics, including the following:

● Fecundity impairments and infertility among married

couples from national surveys conducted in 1965, 1976,

and 1982.

. New data on fecundity impairments among unmarried

as well as married women for 1982.

. Characteristics of sterilized women and their husbands.

. Pelvic inflammatory disease.

● Spontaneous pregnancy loss.

● Cesarean section.

● Smoking and drinking during pregnancy.

Taken together, this wide range of information probably makes

this the most comprehensive set of national estimates on fecundity, infertility, and related topics available for the United

States.

Two classification schemes are used here to measure reproductive impairments: fecundity status, which is a demographic

concept and makes more complete use of the data available

in the survey; and infertility status, which is a medical concept,

and permits comparable measurement of trends between 1965

and 1982.

Interest in fecundity impairments and infertility has been

growing in recent years, as indicated by a large number of

popular and scientific reports on the subject. Many of the

popular articles on infertility have focused on improved techniques of medical treatment. 14 Others have attempted to assess

the causes of fecundity impairments and their impact on birth

rates ‘7 Closely related issues include the rise in delayed

childbearing since the early 1970’s.8We will not focus directly

on these issues in this report, but they have guided our choice

of variables and tables, and the data in this report should

shed light on many of them. The effects of fecundity impairments and infertility are of considerable interest for a number

of reasons:9

. Birth rates have been below replacement in the United

States since the early 1970’s.

. Infertility has increased among young women since

1965.10’1]

. New technologies for treating infertility problems have

been widely publicized.

. More physicians are practicing in the field of infertility.g

. There are fewer adoptable babies because of more effective

contraception, sterilization, and abortion.

As a result, men and women are mhing an increasing number

of visits to doctors each year for fecundity and infertility

problems. 1”13

Data on fecundity and infertility maybe useful to evaluate

birth expectations and birth rate projections, to explain trends

and differences in childlessness, to assess the demand for

adoption, and to estimate the number of couples in need

of medical treatment for fecundi~ impairments or infertilityy.
Summary of principal findings

The following summary is limited to a discussion of the

findings of the present report. Citations of related literature

may be found in the detailed discussions of the findings.

“Fecundity status” is a characteristic of a woman (or

couple if she is married) at the date the woman was interviewed.

As in past cycles of the survey, a married couple is classified

as sterile if either partner is sterile, and as subfecund if either

partner is subfecund. Sterility may stem from a hysterectomy,

tubal ligation, vasectomy, or other operation, or from an

inability to conceive, whether of known or unknown origin.

In this report, for convenience in writing, w.4 sometimes refer

to “women,” but it is important to emphasize that we mean

“women or their current husbands if they are married. ” Unless

classified by parity, each category of fecundity status or infertility includes women (or couples) with any number of children.

Fecundity status is a demographic concept which makes use

of all of the data on fecundity in the 1982 National Survey

of Family Growth (NSFG). Of women aged 15-44 in 1982,

18 percent (9.5 million) were contraceptively sterile—that

is, they or their husbands had been sterilized because they

had all the children they wanted, Another 8 percent (4.2

million) were surgically sterile for other (noncontraceptive)

reasons. About 8 percent (4.5 million) had impaired fecundity-that is, it was difficult or dangerous for them to conceive

or carry a baby to term. The remaining 66 percent were

apparently fecund, or able to have a future baby.

Not all women with impaired fecundity were childless:

Of the 4.5 million women with impaired fecundity, 1.9 million

were childless; the other 2.6 million had one or more children.

Most but not all women with fecundity impairments wanted

children in the future: about 1.6 million childless women

and 1.2 million ,women with children had fecundity impairments and wanted to have children in the future (figure 1).

Another 4.2 million women were surgically sterile for noncontraceptive reasons; of those, 2.4 million would have liked

to have more children.

The literature on age and fecundity suggests that fecundity

impairments increase with age. When the surgically sterile

are excluded from the calculations, the percent with impaired

fecundity increases markedly with age, especially after age

35 (figure 2), particularly among childless women.

The NSFG is also the only reliable national source of

data on infertility among married couples, A couple is infertile

if neither spouse is surgically sterile and if they have had

at least 12 months of unprotected intercourse without a pregnancy. Infertility is a medical concept, used for diagnosis:

if a couple is infertile, it means that they should be treated;

2

5.0

;,,

4,56

4.5 ❑ Oid not want a birth

4.0

m 3.5

c

0

~

: 3.0

.-

C

2

s

2.5

5

~

2.0

E

3

1.5

1.0

0.5

0

2.74

All parities

■ Wanted a birth

2.64

1.92 r–

r 1 I

b

1.18

Parity O Parity 1

(childless) or more

—

Fgure 1. Nwnber of women who had impaired fecund~, by parity and

whether or not they wanted a future birth: United Statea, 19W2

30

25

20

‘F

al

s 15

!$!

10

5

0

1 28

15

13

7

2

I

28

.—

—

1E-19 20-24 2S-29 30-34 35-39 40-44

years years years years yeara years

Age

Fiiure 2. Peroent of wornen (excluding the aurgiaaliy sterile) ‘who had

irnpairad fecundity, by age United Statea, 1982

—.—-. ——.—
[mDaired

fecundity 40

30

10

0

34

35

17

12

10

6

I

15-19 2C-24 25-29 30-34 35-39

years yeara yeara years years

27

25

14

11

9

2

40+4 1!5-19 20-24 25-29 30-34 3539 40-44

years yeara years yeara years years years

Age

Figure 3. Percent of currently married women 15-44 yeara of age (excluding the surgicaNysterile) who had impaired feutnd~, and percent infertiie, by

age United State& 1982

it does not necessarily mean that they are sterile. After surgically sterile couples are excluded, about 1 in 7 couples was

infertile in 1965, 1976, and 1982. Thus, overall, infertility

was not increasing significantly. Among couples aged 20-24,

however, the percent infertile increased from 4 percent in

1965 to 11 percent in 1982. Infertility increased nonsignificantly among childless couples and those 35–39 years of

age, and decreased nonsignificantly among couples with 1

or more children. When the surgically sterile are excluded,

infertility also increases with age, especially after age 35

(figure 3). Among black couples, infertility was about 1Y2

times as high as among white couples in 1965, 1976, and

1982 (figure 4). In contrast, the race difference in impaired

fecundity among married couples was very small in 1982

because 1-year and 2-year infertility was higher among black

wives, but 3-year infertility (or long intervals) was only slightly

more common among black wives.

Surgical sterilization for contraceptive reasons is the leading method of birth control in the United States; other sterilization operations are done for noncontraceptive (or health)

reasons. About 1 in 4 women 1544 years of age (or their

current husbands) had had at least one sterilization operation:

14 percent had tubal ligations, 5 percent hysterectomies, and

6 percent vasectomies. By age 40-44, 61 percent (or their

current husbands) had been surgically sterilized (figure 5).

Among married couples, 39 percent had been sterilized, including 20 percent with tubal Iigations, 7 percent with hysterectomies, and 11 percent with vasectomies. Only 2 percent

of black married couples, compared with 12 percent of white

married couples, had had a vasectomy by 1982. The average

age of women at tubal ligation was about 30, and about

32 at hysterectomy. Black women were about 2 years younger

at tubal ligation than white women. Women had had an average

of 2.6 children when they were surgically sterilized. About

10 percent of hysterectomies occurred to childless women.

Black women had had more children (3.3) on average than

white women (2.5), when sterilized.

23

r

13 I

1976

❑ Black

■ White

—

Fi9LHtr4. Percent of surrentfy married couples (excluding the surgioSty

sterile) who were inferti@ by racw United State~ l= 1976, and 1982

Approximately 1 in 7 women aged 1544 had ever been

treated for peIvic inflammatory disease, or PID: 1 in 25 in

a hospital and 1 in 10 only in non-hospital settings. The

percent who had been treated increased until age 30-34, and

then leveled off (figure 6). Black women were about twice

as likely to have been treated for PID as white women (23

versus 13percent).

Pregnancy loss is a common occurrence in the United

States; 1 in 6 women had had at least one pregnancy loss;

by age 40-44, the figure was 1 in 4. About 16 percent of

pregnancies (excluding induced abortions) ended in miscarriage or stillbirth; the fetal loss rate was higher for older

mothers (3544) and for those who had had PID.

3

.
80 *

70

60 -

50 -

40 -

30 -

20 -

25

10

0L1.544

All marital statuses

37

16

4

0

I

15-19 2C-24 25-29 30-34

years years years years years

54

61

35-39 40-44

Currently married

58

39

20

-LI8

0

44

years years

Age

15-44 15-19 20-24 25-29

years years years years

67

,—

3C-34 35-39 40-44

years years years

Figure 5. Percent of women 15-44 years of age (or their current husbands) who were surgically sterile, by age and marital statu.% United Statea, 1982

25

20

15

10

5

0

/ 13

III 3

20

I

15

18 —

1

13

23 —

15-19 2(!-24 25-29 3G34 35-39 40-44 White Black

years years years years years years

Age Race

Fiiura 6. Percent of women 1544 yeara of age who had ever been

treated for pelvic inflammatory disease, by age and race

United Statea, 1982

4
About 7 percent of women had had at least one delivery

by cesarean section. Delivery by cesarean section was more

common among older mothers: Only 6 percent of births to

teenage mothers had been delivered by cesarean section, compared with 20 percent of births to mothers 3544 years of

age (figure 7).

Studies have shown that smoking and drinking during

pregnancy can have adverse effects on fertility and pregnancy

outcome. It is therefore interesting to note that 60 percent

smoked, drank, or both during their most recent pregnancy:

Looking at mothers of pregnancies excluding induced abortion,

it was found that 15 percent smoked only, 29 percent drank

only, and 16 percent did both. Drinking during pregnancy

was less common among black women than white women.

Hispanic women were less likely than others to both smoke

and drink during pregnancy (figure 8).

20

15

10

10

9

8

—

6

5

0

14

—

—

20

—

15-44 15-19 20-24 25-29 30-34 35-39

years years years years years years

Age of mother at deiivey

■ Smoked only

❑ Drank only

70.- -

60

50

40

30

20

10

0

63

Ill

R Both

62

r45

All White Black Hispanic Nonraces’ Hwpamc

Race Origin

‘Includeswhite,black,and otherraces

Fgure 8. Percent of women ever pregnant 1644 yearn of age who

smoked or drank slcohdii beverages or lmtfL during their most recent

pregnanoy, by race and origin: United States, 1982

Fgure 7. Percent of births to women l&14 yeara of age that were

daKverad by ceaaraan section, by age of mother at cfafivery

United Stste~ 1982

5
Source and limitations of

the data

Cycle 111of the National Survey of Family Growth (NSFG)

was based on personal interviews with a multistage area probability sample of 7,969 women 15-44 years of age in the

noninstitutional population of the conterminous United States.

For the first time, women were eligible for interview regardless

of their marital status.

Between August of 1982 and February of 1983, 4,577

white, 3,201 black, and 191 women of other races were

interviewed. Black women and women 15–1 9 years of age

were sampled at higher rates than others, to increase the

reliability of statistics for these groups. The interview was

conducted in person and focused on the respondents’ marital

and pregnancy histories, their use of contraception, whether

each pregnancy was planned at the time of conception, their

use of family planning and infertility services, their physical

ability to bear children, and a wide range of social and

economic characteristics. Interviews were conducted by trained

female interviewers and lasted an average of 1 hour.

Characteristics such as age, race, Hispanic origin, parity,

education, geographic region, labor force status, and religion

are reported for the women interviewed. For convenience

in writing, in this report expressions such as “black couples”

refer to couples with black wives and “couples 30-44 years

of age” refers to couples with wives 30-44 years of age,

regardless of the race or age of the husbands in those couples.

The statistics are estimates for the national population

from which the sample was drawn. Because the estimates

are based on a sample, they are subject to sampling variability.

Also, nonsampling errors may have been introduced during

data collection, processing, and analysis, although quality

control measures were used at each stage to minimize error.

Further discussion of the survey design, definition of terms,

and sampling variability can be found both in the appendixes

and in a detailed report on the design of the survey. 14

The term “similar” means that any observed difference

between two estimates being compared is not statistically

significant; terms such as “greater,” “less,” “larger,” and

“smaller” indicate that the observed differences are statistically

significant at the 5-percent level using a 2-tailed t-test with

39 degrees of freedom. Statements about differences that are

qualified in some way (for example, “the data suggest” or

“some evidence”) indicate that the difference is significant

at the 10-percent level but not at the 5-percent level.

The following sections include a description of how

women (or couples, if married) were classified by fecundity

status, comparisons with other data, a detailed discussion

of findings on fecundhy status, infertility, the characteristics

of surgically sterilized women (or their husbands), pregnancy

loss, and other selected topics. Appendixes I–IV contain technical notes, definitions of terms, an assessment of the quality

of the data on infertility, and the 1982 survey questions on

reproductive impairments.
Classification by fecundity

status

Fecundity status was measured by a series of questions.

All women (or couples, if the woman was currently married)

were classified into one of six categories of fecundity status:

contraceptive] y sterile, surgically sterile for noncontraceptive

reasons, nonsurgically sterile, subfecund, long interval, or

fecund. In some tables and charts of this report the nonsurgically sterile, the subfecund, and those with a “long interval”

since marriage or last pregnancy have been grouped into the

overall category of “impaired fecundity .“

The data were obtained by asking respondents whether

it was possible or impossible, and difilcult or not difficult,

for them to have a baby or another baby. If the respondent

said it was impossible or difficult, she was asked why. With

a few exceptions (explained below), respondents who said

that it was impossible for them to conceive a baby or another

baby were classified as sterile, and those who said it was

difficult or dangerous were classified as sub~ecund. The first

question on fecundity impairments was the following:

h is ph-vsicalty impossiblefor some couplesto have children.

As far as you know, is it possible or impossible for you (and

yourhusband)to conceivea(nother)baby,thatis,to get pregnant

(again)?

The phrase “and your husband” was read if the woman was

currently married at the date of interview.

Respondents who replied that it was impossible for them

(or their husbands) to have a baby or another baby were

asked:

Have you (or your husband) had an operation, or more than

one operation, that makes it impossible for you to conceive

a baby?

If her response was affirmative, she was then asked:

Wasone reasonforthe operationbecauseyouhadallthechildren

youwanted?

Contraceptiveiy sterile

This category consisted of women or their current husbands who had sterilizing operations at least partly because

they had all the children they wanted. In 1982, about 18 percent of all women aged 1544 (9.5 million) were classified

as contraceptive] y sterile (table 1 and figure 1). For this report,

these women (or couples) are not considered to have impaired

fecundity because they have ended their fecundity voluntarily—that is, as a method of family limitation. However, they

must be classified separately because their status is in most

cases irreversible, and although some of them may later wish

the decision were reversed, most will not be able to have

more children.

Surgically sterile, noncontraceptive

This category consists of women or their current husbands

who had a surgical sterilization (such as a hysterectomy),

but not because they had had all the children they wanted.

About 4.2 million women, or 8 percent, were classified as

surgically sterile for noncontraceptive reasons in 1982.

Nonsurgically sterile

This category is composed of women or their current

husbands who said it was impossible for them to have a

baby or another baby for some reason other than a surgical

sterilization such as accident or illness. About 0.9 million

women (2 percent) were nonsurgically sterile in 1982.

Subfecund

For women (or couples) in this category, it is difficult

but it may be possible to conceive or carry a pregnancy

to term. Most women classified as subfecund responded

affirmatively to the following question:

Some people are able to have a(nother) baby, but they have

dificulty getting pregnant or holding onto the baby. As far

as you know, is there any problem or difficulty for you and

your husband to conceive or deliver a(nother) baby?

A few women were classified as subfecund because a physician

told them never to become pregnant again, and they said

they would have a sterilization operation or abortion for health

reasons if they ever became pregnant again. An estimated

3.0 million women, or 6 percent, were classified as subfecund

in 1982 (table 1).

Long interval

Couples who were not surgically sterile, who did not

report any difficulty conceiving, and who, during the 3 years

of continuous marriage before the interview, did not use contraception and did not have a pregnancy, were classified as

having a long interval. Most of these couples were probably

sterile, but a few might conceive in the future.’5 In 1982,

about 0.6 million couples (1 percent) were classified as having

7
a long interval (table 1). Although it is logically possible Fecund

that a few married women may be classified as having long

intervals because of underreporting of either contraceptive

In tables 1-6 of this report “fecund” means that there

use or pregnancies, appendix III shows that underreporting

was no evidence at the time of the interview that the woman

of pregnancies did not occur among married white women

(or couple, if married) had a problem in conceiving or deliverand was small among other married women.

ing a baby. The women interviewed reported no impairments

and stated that it was possible for them to have a baby,

that they had no difficulty conceiving or carrying to term,

Impaired fecundity and that they had used contraception or been pregnant some

For some purposes, it is useful to combine women classitime in the 3 years of continuous marriage preceding the

fied as nonsurgically sterile, subfecund, or long interval; this

interview. About 35.9 million women, or 66 percent, were

combination is referred to as “impaired fecundity .“ In 1982

classified as fecund in 1982 (table 1).

about 4.5 million women had impaired fecundity

8
Comparisons with other data

The data on fecundity status and infertility in the 1976

National Survey of Family Growth were reported previously

in Series 23 of Vital and Health Statistics and in a related

article. ]6>17Both of those analyses, however, were limited

to currently married couples. The data for currently married

women in the present report are comparable to the data in

those analyses, and many comparisons of these data are included in this report.

Studies conducted in 1955 and 1960 included information

on fecundity impairments. 1g.19Although they were @)OItanL

path-breaking analyses, the statistics they contained cannot

be considered comparable to the statistics in this report. (The

measurement of trends is discussed later, in the section on

infertility. ) Comparisons of those data with the present report

are difficult because (1) different questions on fecundity were

asked and different classification schemes were used; and

(2) the samples in the earlier studies were more limited in

scope than in the National Survey of Family Growth (NSFG).

Other factors that may affect these comparisons include

changes in the timing of first use of contraception, changes

in the age and marital status composition of the female population 1544 years of age, and the dramatic increase in the

use of contraceptive sterilization in the 1960’s and 1970’s.

The increase in sterilization prevents couples from discovering

impairments, especially at age 30 and over. It is important

to note that the term “subfecund” in the earlier studies included

all couples not classified as fecund. That meaning of “subfecund” included all impaired fecundity plus all surgical sterility, both contraceptive and noncontraceptive. As explained

earlier, the term “subfecund” is used in a much more limited

sense in this report.

McFalls has published three very useful secondary

analyses of the extensive literature on reproductive impairments, which he calls “subfecundity.’’6}2020In McFalls’ usage,

“subfecundity” is usually equivalent to the sum of the

categories “impaired fecundity” and “noncontraceptive surgical

sterility” in this report.

Another source of related data is the Hospital Discharge

Survey of the National Center for Health Statistics, which

samples records of patients discharged from non-Federal shortstay hospitals and classifies the sampled records by diagnosis,

includlng “inflammatory disease of female pelvic organs,”

“complications of pregnancy,” sterilization, normal (vaginal)

delivery and cesarean section, and other conditions.21-25These

data differ from those in the NSFG because not all such

conditions require hospitalization, and not all affect fecundity.

Also, the data in the NSFG are not medical diagnoses; they

are self-reported. FlnaIly the Hospital Discharge Survey data

are incidence estimates (the number of cases occurring in

a particular year), while the NSFG data in this report are

prevalence estimates (the number of cases in the population

as of 1982, regardless of when they first occurred).

For several decades, the National Vital Statistics system

has included reports of registered fetal deaths. 26 Although

reporting requirements for fetal deaths have varied over time

and still differ among the States, most statistics in the most

recent reports axe shown for fetal deaths of 20 weeks or

over gestation. The registered data show about 30,000 fetal

deaths of 20 weeks or over gestation per year.26 This is

much too small a number to estimate reliably from the NSFG.

In contrast, NSFG &ta refer to all spontaneous losses of

recognized pregnancies. Because the rate of pregnancy loss

is highest at the earliest gestations and decreases as gestation

increases,27 most pregnancy losses in the NSFG are for gestations shorter than 20 weeks. These are called miscamiages

by most NSFG respondents. In general, the registered fetal

death data refer to late fetal deaths, which are called stillbirths

by most NSFG respondents. Therefore, the NSFG data allow

complete estimates of fetal 10SSto recognized pregnancies,

while the registered data on fetal deaths include those at

20 weeks or over gestation, which are too rare to measure

reliably from the NSFG.

An extension of the data on registered fetal deaths is

found in the 1980 National Fetal Mortality Survey (NFMS),

which was based on a sample of about 6,300 reports of fetal

deaths of 28 weeks or over gestation or 1,000 grams or more

in weight; about 19,000 fetal deaths meeting these criteria

occurred in 1980.28 The NFMS allows detailed study of the

correlates of fetal deaths after 20 weeks gestation; these are

too rare to study in the NSFG.

..
Fecundity status

The 1982 NSFG makes it possible for the first time to

classify all women of childbearing age regardless of marital

status, by fecundity status at the date of interview (tables 1-6). The parity groups represent childless women (panty

O) and those with 1 or more children (parity 1 or more),

an important distinction for medical practitioners and others.

In 1982, 18 percent of all women 1544 years of age

were contraceptively sterile, including 1 percent of never married women, 28 percent of currently married women (or their

husbands), and 20 percent of formerly married women (table 1). As might be expected, in each marital status category,

the percent contraceptively sterilized was much higher for

women with children (parity 1 or more) than for childless

women (parity O).

About 8 percent (or 4.2 million) were surgically sterile

for noncontraceptive reasons, including 1 percent of never

married women, 11 percent of currently married women (or

their current husbands), and 14 percent of formerly married

women. The percent sterilized for noncontraceptive reasons

was also higher for women with children than for childless

women.

In 1982, 6 percent of women (or 3.0 million) were classified as subfecund, including 3 percent of never married,

7 percent of currently married, and 9 percent of formerly

married women (table 1).

Couples who were continuously married (either formally

or informally), who did not use contraception, and who did

not become pregnant for 36 months or more immediately

before the interview were classified as having a “long interval.”

Although these women reported no !-mown physical problems,

they were well beyond any normal period for conception,

indicating some impairment to childbeming and possibly sterility. As of 1982, 1 percent of all women (0.6 million) had

a long interval.

The category “impaired fecundity” includes women who

were classified as nonsurgically sterile, subfecund, or having

a “long interval” since their last pregnancy. About 4.5 million

women, or 8 percent, had impaired fecundity. Of these, about

1.9 million were childless and 2.6 million had 1 or more

children (figure 1, calculated from table 1).

“Fecund” is a residual category-that is, it includes

women (or couples) who were not surgically sterile and did

not have impaired fecundity. In table 1, 94 percent of never

married women were classified as fecund, compared with

about 50 percent of currently married couples and 55 percent

of formerly married women. There are two mainl reasons

for this large difference between never married and ever married women: never married women are younger onl average

than ever married women; and most never married women

have never been pregnant or tried to become pregnant. As

a result, never married women are much less likely to be

surgically sterile than ever married women, and have had

less chance to develop or discover any fecundity problems.

Differences between the age groups in table 2 reflect

differences between age groups in marital status, in the number

of children they have had, and in other factors. The percent

Contraceptively sterile increased sharply with age, from

4 percent at ages 20-24 to 39 percent at ages 40-44. The

proportion noncontraceptively sterile also rose with age, especially after age 30. The percent with impaired fecundity ranged

from 2 percent at ages 15–19 to 13 percent at ages 35–39.

The percent fecund declined from 98 among teenagers to

28 among women 40-44 years of age, because both surgical

sterility and impaired fecundity were more common at the

older ages.

The literature on age and fecundity8’29’30 would lead us

to expect the percent with impaired fecundity to increase

with age, but there were two nonsignificant decreases in the

percents between adjacent 5-year age groups in table 2. However, this was an artifact of the very large increases with

age in surgical sterilization: the percent with impaired fecundhy

increased in each age group (although not always significantly)

when the surgically sterile were removed from the denominator

(table A and figure 2). When the percents were based on

all women, the range by age was from 2 to 13 percent;

when they were based on women who are not surgically

sterile, the range by age was from 2 to 28 percent (table A and figure 2).

Table 2 also contains data by marital status and age.

Among never married women, those 20-44 were more likely

to have impaired fecundity than teenagers (6 percent versus

2 percent), and less likely to be fecund (90 versus 98 percent).

Among widowed, divorced, and separated women, the percent

with impaired fecundity was nonsignificantly lower at ages

30-44 than at age 15–29 (10 versus 14 percent), but this

was an artifact of the larger percent surgically sterile at ages

3044. When impaired fecundity was computed as a percent

of women who were not surgically sterile, the proportion

was 16 percent at ages 15–29 and 17 at ages 30-44.

10
Table A. Peroent of women 15-44 years of age with impairwl feound~,

by marital status and age, for all women and those who were not

surgodty sterie: United Ststesj 1982

[Statistksare baaed on a sample of the household population of the rmnterrninous

Umted States, See appendixes for dissuasion of the sample design, estimates of sampling

vanabifity, and definitions of terms]

All marital statuses’ Currently married

Not Not

All surgically All surgically

Age women2 sterles women 2 stenYes

Percent

15-Myears . . . . . . . . 8.4 11.3 10.8 17.7

15-19 years . . . . . . . . “2.1 ‘2.1 6.1 ●6.1

2C-24 years . . . . . . . . 6.4 6.7 9.2 ‘1 0.0

25-29 years . . . . . . . . 10.6 12.5 10.0 12.5

30-34 years . . . . . . . . 9.3 14.6 9.4 16.7

35-S9years . . . . . . . . 13.0 27.9 14.3 34.1

4C-44years . . . . . . . . 11.0 28.2 11.6 34.6

‘Includes currently married, never marded, and formerly married.

2Numb%r of women with impaired fscundlty divided by number of women with impaired

fecundity plus number of fecund women plus surgically sterile women. See texi or

appendix 11for definitions.

3Number of women with impaired fecundity divided by number of women with impaired

fscundl~ plus number of fecund women, see text or appandlx H for definitions.

Among currently married couples, 39 percent—nearIy2

in5—were surgically sterile in 1982, andthepercent surgically

sterile reached 67 percent at ages 40-44. As a result, the

percents of married couples with impaired fecundity did not

tise steadily with age (table 2). However, when surgically

sterile couples were excluded from the denominator (table A and figure 3), the percent with impaired fecundity

rose in each age group (although the differences were not

all significant). Among both all women (figure 2) and married

women (figure 3), the percent with impaired fecundity approximately doubled after age 35.6Tg’29

Impaired fecundity and the desire

for children

Fecundity impairments in themselves are important for

demographic and public health reasons. For other uses, however, it may be important to define a population that may

need medical treatment to help them have children, or more

children—including couples who have difficulty conceiving,

those who have a high risk of miscarriage, and those for

whom pregnancy may be dangerous to the woman’s life or

health. One way to define the population that may need medical

treatment to help them have children is illustrated in table 3: the percent with impaired fecundity who would like

to have a baby at sometime in the future.

About 2.7 million women, or 60 percent of those with

impaired fecundity, wanted to have a baby (or another baby).

Of these, 1.6 million were childless and the other 1.2 million

had one or more children (figure 1). The proportion of those

with impaired fecundity who wanted to have a future baby

decreased with age, from 80 percent of those aged 15-24

to 33 percent of those 3544. This proportion also decreased

with panty, from 81 percent of childless couples with impaired

fecundity to 28 percent of those with three or more children.

The percent of women with impaired fecundity who wanted

a baby did not differ significantly by race or Hispanic origin.

TableB. Percent of wornen 1= years of age who were not surgicdy

sterile who had impaired feoundity, by P+=@, m=itsl - and w

United States 1982

[Sfafiska are baaad on a sample of the household pqulat!on of the eonterminous

United States. See appendixes for dlacuasion of the sample design, estimates of sampling

variabiiii, and definitkms of terme]

Panty

Marital status and age All parities Panty O 1 or more

All marital statuses’ Percent 2

1544years . . . . . . . . . 11.3 S.6 14.5

15-24 years . . . . . . . . . 4.4 4.1 5.6

25-34 years . . . . . . . . . 13.4 15.5 12.3

35-44 yeara . . . . . . . . . 28.0 33.4 26.5

Currently married

15-44 years . . . . . . . . . 17.7 24.1 15.4

15-24 yeare . . . . . . . . . 9.5 11.1 ●8.2

25-34 years . . . . . . . . . 14.2 23.4 11.5

35-t4years . . . . . . . . . 34.4 71.7 28.2

1includes currently reamed, never married, and forrnarly married.

2Numbar of woman wfh im~ired facunditj, dnkfad by number of women witi impaired

fecunditj plus number of fecund women. Sea text or appmdix II for definitions.

About 1.8 million cumently married women had impaired

fecundi~ and wanted children in 1982, including about 0.9

million childless couples and 0.9 million couples with 1 or

more children. The comparable figures for 1976 were simila~

2.0 million women had impaired fecundity and wanted children, including 0.8 million childless women and 1.2 million

with children. As for all women. the percent of wives who

wanted more children decreased as age and parity increased,

and did not differ significantly by race or Hispanic origin.

Women who were surgically sterile for noncontraceptive

reasons (table 3) were asked:

Even though it is unlikely or impossible for you to have a(nother)

baby, would you Me to have a(nother) baby?

About 56 percent of these women, or 2.4 million, would

have liked to have a baby; only 0.2 million of these were

childless, and 2.2 million had one or more children.

Because age and parity are correlated it is useful to

examine the relationship between age and fecundity status

separately for childless women and for those with children

(table 4). The percent surgically sterile increased markedly

with age—from 2 percent at ages 15–24 to 57 percent at

ages 35-44. As a result, far fewer women at the older ages

were at risk of infertility than at the younger ages because

they attribute their sterility to the operation. Thus the increase

of impaired fecundity with age was greatly diminished. To

adjust for this, table B shows the results of table 4 with

the “surgically sterile” removed. In each of the six groups,

the percent with impaired fecundity increases with age. In

each case, the percent at least doubles between the age groups

25–34 and 354.4. For example, among all women, 14 percent

of those 25–34 and 28 percent of those 3544 had impaired

fecundity. Among currently married childless women 35-44

years of age, 72 percent had impaired fecundity.

Comparable data on fecundity status were collected from

currently married couples in 1976 and 1982, and these data

permit a look at trends and differentials in those years among

married couples who are not surgically sterile (table C). As

11
Tabfe C. Percent of currently married women (excluding the surgically sterile) who had unpaired fecundity, by parity and age:

United Statea, 1976 and 1982

[Statistics are based on a sample of the household population of the conterminous United States. See appendixes for discussion of the sample design, estimatea of sampling variabilii, and

defmitiona of term]

All parities Parity O Parity 1 or more

Age 1982 1976 1982 1976 1982 1976

Percent’

15-44 years . . . . . . . . . . . . . . . . . . . . 17.7 21.8 24.1 22.7 15.4 21.5

15-24 years . . . . . . . . . . . . . . . . . . . 9.5 11.2 11.1 11.1 “8.2 11.9

25-34 years . . . . . . . . . . . . . . . . . . . 14.2 20.9 23.4 29.1 11.5 18.7

35-44 years . . . . . . . . . . . . 34.4 36.0 71.7 75.7 28.2 32.4

~Numtwrof women with impairaC fecundtydrwded by number of women with impamed fecundity plus numbaroffscund women. Seetesi or appendix Ilfor de finitiona

for all women, the percent with impaired fecundity increased

with age, and approximately doubled from 25–34 to 35-44

years of age (table C). The increase with age was particularly

sharp among childless couples; the percent with impaired

fecundity at ages 3544 exceeded 70 percent in both 1976

and 1982 (table C). The overall percent with impaired fecundity

declined from 22 percent in 1976 to 18 percent in 1982;

this 18 percent decline compares with a 31 percent decline

(16 to 11 percent) when the surgically sterile are included.

There were significant declines overall, at ages 25–34, and

among women with children between 1976 and 1982. However, at ages 15–24 and 35-44 and among childless couples,

there were no significant changes in the percent with impaired

fecundity.

One might hypothesize, however, that couples who already had, or who would later discover fecundity impairments

may become sterilized for rzorzcontraceptive reasons. If that

is true, it is useful to examine the trends in another way.

If we exclude contraceptively sterile couples entirely, and

divide the number of couples who are impaired plus noncontraceptively sterile by the number of impaired plus noncontraceptively sterile plus fecund, we obtain the following percents who had fecundity impairments:

Percent with

fecurrdi~ impairments

Couples 1976 1982

All . . . . . . . . . . . . . . . . . . 31.1 30.2

Childless . . . . . . . . . . . . . . . 25.9 28.3

Parifyl or more . . . . . . . . . . . ,. 32.6 30.9

White . . . . . . . . . . . . . . . . . ,, 30.5 29.9

Black . . . . . . . . . . . . . . . . . 36.0 33.6

This simple adjustment virtually wipes out the apparent

decrease in fecundity impairments: 31 percent of couples (excluding the contraceptively sterile) had fecundity impairments

in 1976, and 30 percent in 1982 (not a significant difference).

Among childless couples, an insignificant increase (from 26

to 28 percent) is found, and among couples with children

(parity 1 or more), an insignificant decrease (from 33 to

31 percent). In addition, the changes for white and black

couples were not significant either. Thus, the percent classified

as fecund declined between 1976 and 1982, but this decline

was a result of the dramatic increase in contraceptive sterilization. The underlying proportions fecund and with impaired

fecundity have not changed significantly.

By 1982, contraceptive sterilization was the leading

method of contraception among married couples. 3‘ Contraceptive sterilization was also occurring at earlier ages and lower

parities, and this also reduced the percent of wives who reported fecundity impairments because women who might have

developed or discovered impairments at later ages were among

those who were sterilized at earlier ages. It is possible that

women who had completed their families and had fecundity

impairments were turning increasingly to sterilization. This

hypothesis cannot be tested directly because we do not know

if surgically sterile women had fecundity impairments before

their operation. Data to test this hypothesis would be valuable

in the next cycle of the survey.

In the 1976 NSFG, black couples were consistently more

likely to have impaired fecundity than white couples, primarily

because black couples were more likely to be classified as

having a long interval: in 1976, 23 percent of black and

15 percent of white couples had impaired fecundity. 16 In

1982, 13 percent of black and 11 percent of white couples

had impaired fecundity (table 5). When the percent with impaired fecundity was computed with the surgically sterile removed from the denominator, as in table D, the proportions

were 29 percent among black and 21 percent among white

couples in 1976, and 20 percent among black and 18 percent

among white couples in 1982. According to these two measTable D. Percent of currently married women (excluding the surgically

sterile) who had impaired fecundfiy, by race and age United States, 1976

and 1982

[Statistics are based on a sample of the household population of the ocnterminous

Unitad States. See appendixes for discussion of the sample design, estimatea of sampling

variability, and definitions of terms]

Race

White Black

Aae 1982 1976 1982 1976

Percent’

15-44 years . . . . . . . . . 17.6 21.0 19.9 28.7

15-19 years . . . . . . . . . ‘5.s S.6 ‘0.0 ‘1 4.4

2C-24 years . . . . . . . . . 9.0 10.4 “11.2 22.9

25-29 years . . . . . . . . . 12.4 17.7 ‘1 2.9 15.8

30-34 years . . . . . . . . . 16.8 24.8 ‘1 7.6 30.0

35-39 years . . . . . . . . . 34.9 33.1 31.7 40.9

4044years . . . . . . . . . 34.3 37.1 47.0 53.8

15-24 years . . . . . . . . . *9.3 10.1 ●9.9 21.1

25-34 years . . . . . . . . . 14.2 20.5 15.0 22.2

35-44 years . . . . . . . . . 34.7 35.0 38.1 47.4

‘Number of women with impairad fecundity divided by number of women wdh Impaired

fecundily plus number of fecund women. See texi or appendix II for defintimns.

12
ures, the difference by race in impaired fecundity among

married couples narrowed substantially between 1976 and

1982. However, the race differential can also be measured,

as above, by excluding the contraceptively sterile and dividing

the number of impaired plus noncontraceptively sterile by

the number of impaired plus noncontraceptively sterile plus

fecund. This procedure reveals the following results for currently married couples:

Couples 1976 7982

All 31.1 30.2

White::::::::::::::::: ;; 30.5 29.9

Black . . . . . . . . . . . . . . . . . . . 36.0 33.6

Using this measure, black wives were more likely to have

impaired fecundity than white wives in both 1976 and 1982;

the difference was significant in 1976 but not in 1982. The

difference by race narrowed from 5.5 percentage points in

1976t03.7in 1982.

The difference in surgical sterilization by race has also

narrowed: in 1976, 29 percent of white and 22 percent of

black couples were surgically sterile; in 1982 these proportions

were 39 and 36 percent respectively (table 5). In both years,

the differential in surgical sterility was about the same size

as the differential in impaired fecundity. These two facts

may be causally related, but the nature of the connection

is not clear. And in both years, the percent of currently married

couples who were fecund was about the same for both races.

In 1982, none of the differences by race (table 5 and

table D) in impaired fecundity was statistically significant

at the 5 percent level. How did these changes occur’?Declines

in the percent with impaired fecundity apparently occurred

at ages 25–34 among white couples, and at 2544 among

black couples, although these declines were not all statistically

significant. The data in table D can also be looked at in

cohort terms. For example, if a woman was 22 years of

age in 1976 (20-24), she would be 28 (25–29) in 1982.

Looking at changes within cohorts, few were statistically significant, and most were small, but the data suggest that there

was a decline among black couples who were 20-24 in 1976

and 25–29 in 1982.

The primaty cause of the race differential in impaired

fecundity in 1976 and in 1982 was the long interval category:

black wives were substantially more likely to have 3-year

“long intervals” in 1976, but not in 1982. That maybe related

to the increase in surgical sterilization in the period 1976-82,

which was especially rapid among black wives. 10The data

on age at tubal ligation in a later section of this report also

support this interpretation. It is possible that black wives

with long intervals may have had surgical sterilizations at

a greater rate than white wives. This is a subject that merits

further investigation.

Among women of all marital status groups in 1982, few

of the differences by race were statistically significant; overall

and at ages 35-44, white women were more likely to be

contraceptively sterile than black women were. Black women

35-44 years of age were more likely to be surgically sterile

for noncontraceptive reasons and more likely to have impaired

fecundity than white women aged 3544.

In previous NSFG reports, parity and race were found

Table E. Percentof women (excluding the surgidy sterile) who had

~@fed fecundity, by race, marital ststuq and parity

United State~ 19S2

[Statistics are bask on a sample of the household population of the omtermirmus

United States. See appendixes for discuaati of the sample design,estimatesof sampling

variabilii, and derinitiins of terms]

Marital status and parity All races’ White Black

All marital statuses2 PercenF

All parities . . . . . . . . . . . . . . . 11.3 11.4 11.0

Parity O . . . . . . . . . . . . . . . . 8.6 8.7 7.8

Parity l ormore . . . . . . . . . . . 14.5 14.9 13.5

Currently married

All parities . . . . . . . . . . . . . . . 17.7 17.6 19.9

Parity O . . . . . . . . . . . . . . . . 24.1 23.5 31.0

Parity lormore . . . . . . . . . . . 15.4 15.4 17.7

1Ircludes whte, blsek, and other races.

‘Includes currently mam”ed, never marriad, and formeriy msmfed.

‘Number of women wth impamed feeundrty divided by number of women with impaired

fecundity plus number of fecund women. Sea text or appendix II for definitions.

to be strongly associated with fecundity status. 1]‘’6 With respect to parity, there was no significant difference between

childless women and those with children in the proportion

with impaired fecundity (8 versus 9 percent for all races,

white, and black, in table 6), but when the surgically sterile

were excluded, those with one or more children were more

likely to have impaired fecundity (15 versus 9 percent, table E). Among currently married women, however, the childless were more likely to have impaired fecundity (24 versus

15 percent, table E). This pattern apparently was the result

of different selection effects: among all women, the childless

were more likely to be younger and never married, and among

married women, the childless were more likely to have remained childless because they had fecundity impairments.

Infeftilii

The fecundity status measures we have used thus far

were derived from a series of questions which was not asked

in surveys conducted before 1976. Therefore if we wish to

show the trends in fecundhy otier the past 2 decades, we

need a measure that does not depend on that series of questions.

Infertility status (tables 7 and 8) is a measure that allows

us to look at trends for all married women aged 15-44 since

1965.’ Infertility is a medical concept, used for diagnosis:

couples are considered to need infertility screening and treatment if they are not surgically sterile and have not been

able to conceive after a year or more of unprotected intercourse.

Infertility is considered a screening device, used to isolate

a high-risk group who may need treatment; it is not considered

proof of sterility .32-35

Infertility and impaired fecundity are related concepts,

but they differ in at least two principal ways: First, infertility

measures only dlficulty in conceiving, while impaired fecundity includes difficulty in conceiving and diftlcuhy or danger

in carrying a pregnancy to term. Therefore the percent of

mamied couples with impaired fecundity (10.8 in table 4)

Comparable data on fecundity status cannot be obtained from the 1965

or 1970surveys because the necessary questions were not asked. See references

16and 17.

13
was greater than the percent infertile (8.5 percent in table 7). Second, while the purpose of the impaired fecundity

measure is demographic—to measure the proportion of couples

for whom future childbearing is unlikely—the purpose of the

infertility measure is diagnostic, as explained above.

Although there is substantial overlap between the

categories “infertile” and “impaired fecundity” (table F), some

small groups are in one and not the other. Couples with

impaired fecundity who are not infertile include those who

are currently using contraception to avoid pregnancy because

a pregnancy or birth would be dangerous to their health;

and those who were married or remarried, were pregnant,

or have used contraception within the last 12 months. Couples

who are infertile but do not report impaired fecundity have

been infertile an average (median) of 19 months, and they

reported that it was possible for them to have a baby as

far as they knew, or that they were not sure. In short, these

couples have not yet concluded that they have a fecundity

impairment, but they have longer than normal waiting times

to conception.

It is logically possible that wives may be erroneously

classified as infertile if they underreport pregnancies. However, that was not a problem among white wives; it was

a potential problem, but probably not a major one, among

black wives (see appendix III; see also reference 11).

Tabte F. Percent of currentiy married women 1544 yeare of age who

had impaired fecund@, were infertile, both, or either, by parity and race

United Statea, 1982

[Statisbca are based on a sample of the household populabon of the conterminous

United States. See appendixes for discussion of the sample design, estimates of sampling

variability, and definitions of terms]

Impaired

Parity and race fecundity Infertile Both Either

Percent

Total’ . . . . . . . . . . . . . I 0.8 8.5 6.7 12.6

Parity

Parity O . . . . . . . . . . . . 21.7 19.6 16.5 24.8

Parity lor more . 8.4 6.0 4.5 10.0

Race

White . . . . . . . . . . . . . 10.8 6.1 6,6 12.3

Black . . . . . . . . . . . . . 12.7 13.1 9.4 16.4

‘Includes white, black, and other races.

The trend in infertility was strongly affected by trends

in sterilization, as was the trend in fecundity status. 1‘’‘6’17

The percent surgically sterile more than doubled between 1965

and 1982, from 16 percent to 39 percent (table G). In fact,

the proportion surgically sterile at least doubled in all age

categories except 15–1 9 and in all parity categories except

parity O. For example, at ages 40-44 years, 27 percent of

Table G. Percent dietributiin of currently married women 1544 yeare of age by infertilii etatua, according to age, parity, and race

United States 19851976, and 1982

[Statistics are based on a sample of the household population of the conterminous Unded States. See appendixes for discussion of the sample design, eafimates of sampling variability, and

definitions of terms]

/nferti/ity status

Surgically sterile Infertile Fecund’

Age, parity, and race Total 1982 1976 1965 1982 1976 1965 1982 1976 1965

TotalZ . . . . . . . . . . . . . . . . .

Age

15-19 years . . . . . . . . . . . . .

2C-24years . . . . . . . . . . . . . .

2E-29years . . . . . . . . . . . . .

30-34 years . . . . . . . . . . . . .

35-39 years . . . . . . . . . . . . .

4044years . . . . . . . . . . . . . . .

Parity

Parity O . . . . . . . . . . . . . . . . .

Parify l.............,,.

Parity . . . . . . . . . . . . . . . . . .

Parity 30r more.......,,.. . .

Race and age

White

15-M years . . . . . . . . . . . . .

15-29 years . . . . . . . . . . . . .

30-44 years . . . . . . . . . . . . .

Black

15-44 years . . . . . . . . . . . .

1$29 years . . . . . . . . . . . . .

30-t4 years . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1000

100.0

100.0

100.0

100.0

100.0

38.9

‘0.3

“8.2

19.6

43.6

58.1

66.7

9.9

17.7

46.9

63.3

38.9

13.7

55.5

36.3

19,7

47.5

28.2

‘1.0

4.5

16.6

36.2

45.3

49.0

5.6

8.8

32.3

49.8

29.0

10.7

44.1

21,6

9.2

32.1

15.8

‘0.6

3.1

9.5

17.0

22.6

26.6

7.3

7.5

14.2

21.5

15.9

5.5

22.3

14.2

6.6

20.6

Percent distribution

8.5 10.3

‘2.1 ‘2.1

9.7 6.4

7.0 9.0

7.7 10.s

10.3 12.5

9.0 15.9

19.6 18.1

10.6 12.4

5.0 6.0

3.8 7.9

8.1 9.4

7.4 6.7

S.6 11.6

13.1 18.1

10.9 12.1

14.6 23.2

11.2

“0.6

*3.5

6.5

11.6

14.2

20.2

14.5

17.2

9.3

9.4

10.5

4.4

14.3

16.3

4.5

26.1

52.6

97.7

82.1

73.4

46.7

31.6

24.3

70.5

71.7

48.1

32.9

53.0

76.6

35.9

50.6

69.4

37.9

61.6

96.9

69.2

74.4

53.5

42.2

35.2

76.3

78.8

61.7

42.3

61.6

82.6

44.3

60.3

78.7

44.7

73.0

98.9

93.4

84.0

71.3

63.0

52.9

78.2

75.3

76.6

69.0

73.6

90.1

63.3

69.5

88.9

53.3

“’Facund” has a d!fferent maaning in this table than in tables 1-6. See appendix II

‘Includes white, black, and other races.

14
couples were surgically sterile in 1965; by 1982 the proportion

had more than doubled, to 67 percent. Because of these large

increases in surgical sterility, far fewer couples were exposed

to the risk of being classified as infertile in 1982 than in

earlier years, especially at the older ages and higher parities.

The overall proportion infertile was 9 percent in 1982,

down significantly since 1965, when it was 11 percent, and

from 10 percent in 1976. Between 1976 and 1982 there were

nonsignificant decreases in the percents infertile at the ages

25-39, and a significant decrease at ages 40-44.

The decline in infertility among older women and overall

was the result of the large increase in surgical sterilizations.

It is possible that more women who knew they were infertile

had surgical sterilizations, or that the increasing use of contraceptive sterilizations reduced the proportions of women

who would otherwise subsequently find themselves infertile

at age 30 and older.

From 1965 to 1982 the proportion infertile at ages 20-24

increased significantly, however, from 4 percent in 1965 to

10 percent in 1982 (table G). Among childless wives of all

ages (parity Oin table G) the increase in the proportion infertile

from 15 percent in 1965 to 20 percent in 1982 was not statistically significant. Among wives with 1 or more children, however, the percent infertile decreased significantly at each parity

from 1965 to 1982, probably because of the increases in

surgical sterility.

The large increases in surgical sterility between 1965

and 1982 reduced the proportion of women who were classified

as infertile. To adjust the proportions infertile for this trend,

we excluded the surgically sterile and recomputed the percent

of married couples who were infertile (table H). When surgically sterile couples were excluded, the percent infertile did

not change significantly between 1965 (13 percent) and 1982

(14 percent) (table H). Among couples who were not surgically

sterile, for those with wives aged 20-24 years, the percent

infertile increased from 4 percent in 1965 to 11 percent in

1982. This was the only statistically significant change in

any age or parity group in table H. This was, however, an

important age group, because 1 of 3 births in the United

States occurred to women 20-24 years of age in 1981, and

that was more than in any other 5-year age group.sb The

increase among childless couples, from 16 to 22 percent,

was not statistically significant. The increase among couples

35–39 years of age, from 18 percent in 1965 to 25 percent

in 1982, was also not statistically significant.

Infertility increased with age in all three survey years,

as expected.s” 7’29’30The largest absolute increase in the percent infertile between adjacent age groups was from ages

35–39 to ages 40-44 in 1965 (from 18 to 28 percent) and

in 1976 (23 to 31 percent), but from ages 30-34 to ages

35–39 in 1982 (from 14 to 25 percent). The increase in infertility with age was less pronounced and less regular than the

increase in impaired fecundity with age, perhaps because impaired fecundity includes more types of fecundity problems

than infertility does (figure 3).

In our earlier discussion of trends in fecundity status

by race, we speculated that the rise in surgical sterilization

among black wives might reduce the number classified as

Table H. Percent of currenfjy married wornen 1644 years of age

(exohding the surgicdiy sterie) who were infertile,by age, parity, and

race United Stste~ 1865, 1976, and 1982

[Statistics are baaed on a sample of the household population of the conterminous

United States. See appendixes for dkcussion of the sample design, estimates of sampling

variability, and definitions of terms]

Age, parity, and race 1982 1976 1965

Percent’

TotalZ . . . . . . . . . . . . . . . . . . . . . 13.9 14.3

Age

15-19 years . . . . . . . . . . . . . . . . . “2.1 “2. 1

20-24 years . . . . . . . . . . . . . . . . . 10.6 6.7

25-29 years . . . . . . . . . . . . . . . . . 8.7 10.8

30-34 years . . . . . . . . . . . . . . . . . 13.6 16.1

35-39 years . . . . . . . . . . . . . . . . 24.6 22.8

40-44 years . . . . . . . . . . . . . . . . . 27.2 31.1

Pari!y

Parity O . . . . . . . . . . . . . . . . . . . . 21.8 19.2

Parity . . . . . . . . . . . . . . . . . . . . 13.1 13.6

Parity 2 . . . . . . . . . . . . . . . . . . . 9.3 8.9

Parity 30r more . . . . . . . . . . . . . . . ‘1O.3 15.8

Race and age

White

15-44 years . . . . . . . . . . . . . . . . 13.3 13.3

15-29 years . . . . . . . . . . . . . . . . . 8.6 7.5

30-44 years . . . . . . . . . . . . . . . 19.3 20.8

Black

15-44 years . . . . . . . . . . . . . . . . . 20.6 23.1

15-29 years . . . . . . . . . . . . . 13.6 13.3

30-44 years . . . . . . . . . . . . . . . . . 27.8 34.1

13.3

“0.6

‘3.6

7.2

14.0

18.4

27.7

15.6

18.6

10.8

12.0

12.5

4.7

18.4

19.0

4.8

32.9

lNumber of infertile women dwided by number of inferhle women plus fecund wcmen

‘Includes white, black, and other races.

having a long interval. Infertility status should be less affected

by the trend in sterilization, because it uses only a l-year

interval. This hypothesis is supported by the data by race

in table H: the percent of black couples classified as infertile

was about 1‘/z times as high as that of white couples in

1965, 1976, and 1982. In 1982, about 21 percent of black

and 13 percent of white couples were infertile. excluding

the surgically sterile. The percent infertile increased among

white and black couples aged 15–29 from 1965 to 1976;

the increase was from 5 to 8 percent among white and from

5 to 13 percent among young black couples. The causes

of the higher percents infertile among young black couples

in 1976 and 1982 are unknown, but it has been shown that

higher proportions of black wives have had pelvic inflammatory disease or PID, a major cause of infertility.~’ Two risk

factors in PID have been shown to be higher in young black

than white women in the mid- 1970’s: use of the IUD, or

intrauterine device, and gonorrhea. 38

Surgical sterilization

We have discussed the importance and high prevalence

of surgical sterility as a factor in the study of impaired fecundity

and infertility. But surgical sterilization, regardless of the

intent at the time of the operation, does prevent future

childbearing. So whether it is a method of family limitation,

15
a measure to reduce the health risk of future pregnancies,

or a medically remedial procedure, it is important in this

context to describe how common it is and when it occurs

in various groups in the population.

The statistics on surgical sterilization in tables 9–11 refer

to operations to women aged 15-44 and, if they are currently

married, to their current husband. Therefore, in this section,

when we use the term “women” we are referring to “women

and their current husbands, if they are married.” If both the

husband and wife had had an operation, the female operation

was used in tables 9–1 1. If the man or woman had two

sterilizing operations, the earlier operation was used.

About one in four women (or their husbands) aged 1544

had at least one sterilization operation. About 14 percent

had tubal ligations, 5 percent hysterectomies, 6 percent vasectomies, and 0.3 percent other operations, The percent with

a sterilization operation increased sharply with increasing age,

from 4 percent at age 20-24 to 61 percent at age 40-44

(figure 5). At age 4044, 28 percent of women had tubal

ligations, 18 percent had hysterectomies, and 14 percent had

husbands who had vasectomies. The percent with each type

of operation increased with age in all 24 panels of table 9, except for tubal Iigations and vasectomies among black

couples.

Among currently married couples, vasectomies affected

only 2 percent of black couples, compared with 12 percent

of white couples. White couples were more likely to have

had vasectomies than black couples, overall and in every

age group except teenagers.

white women were more likely to be affected by a sterilization operation (26 versus 22 percent) than black women,

but that was primarily a result of the difference in vasectomies,

discussed earlier. The differences in tubal ligation and hysterectomy by race were small.

Both overall and for married women, the only significant

difference by race was in tubal ligations at ages 25–29: black

women 25–29 were more likely to have had a tubal ligation

by this age than white women, suggesting that black women

have those operations at a younger age than white women.

At what age do sterilization operations occur? Overall,

the mean (average) age of the woman at sterilization was

30 years-slightly older (32 years) for hysterectomy and

slightly younger (29 years) for vasectomy (table 10). The

variation in mean ages at sterilization was not marked, but

some patterns are clear.

Black women were about 2 years younger on average

than white women at tubal ligation (28 versus 30 respectively)

and a year older at hysterectomy than white women (32 versus

31 respectively). The average age at hysterectomy and tubal

ligation was higher in the Northeast than in the other regions.

The age of the woman at sterilization also tended to increase

with her education, especially for vasectomy. Catholic women

were older at hysterectomy than Protestant women. For tubal

ligation and vasectomy, those with higher incomes were

slightly older at sterilization than those with lower incomes.

Finally, those who lived with both parents at age 14 had

hysterectomies and tubal ligations at older ages than those

who lived with one or neither parent.

To assess the effects of sterilization on family size and

provide a clue to its motivation, it is helpful to know the

number of children women had when they or their husbands

had the operation. The mean number of children ever born

at sterilization was 2.6 (table 11). The mean for hysterectomies

was 2.6, for tubal ligations 2.8, and for vasectomy, 2.2.

Hysterectomies and vasectomies were more likely thlan tubal

ligations to occur to childless women (or their husbands):

10 percent of hysterectomies and 2 percent of tubal ligations

were to women with no children, and 8 percent of vasectomies

were performed on the husbands of childless women.

Black women had substantially more children on average

when sterilized (3.3) than white women (2.5). This was true

for each type of operation, but the difference was largest

(0.8) for tubal ligation. About 30 percent of hysterectomies

to black women were to those with four or more children,

compared with 19 percent of hysterectomies to white women.

White women were more likely than black women to have

tubal Iigations when they had one or two children, but less

likely when they had four or more. There were no significant

race differences in the parity distributions for vasectomies.

All results were similar for currently married couples; sterilizations to currently married couples accounted for 80 percent

of all sterilizations.

Pelvic inflammatory disease

Pelvic inflammatory disease, or PID, is thought by physicians to be a common cause of tubal blockage, infertility,

chronic pain, and further PID infections. Its causes include

gonorrhea, chlamydia, and other factors,5’39q3

Until the 1982 NSFG, the prevalence of pelvic inflammatory disease in the U.S. population was unknown. Women

in the survey were asked:

Have you ever been treated in a doctor’s office, clinic, or

emergency room for an infection in your fallopian tubes, womb,

or ovaries, also called a pelvic infection, pelvic inflammatory

disease, or PID?

About one in seven women, or 14 percent, had been

treated for PID at least once in their lives; 4 percent in a

hospital and 10 percent in nonhospital (ambulatory) settings

(table 12). The percent ever treated for PID increased with

age, from 3 percent at ages 15–19, to 20 percent at ages

30-34, and then leveled off (figure 6). The decline from

20 percent at ages 30-34 to 18 percent at ages 40-44 was

not statistically significant. Similar patterns by age were found

for ambulatory and hospital PID separately: an increase to

a peak in the 30’s followed by a nonsignificant decline to

ages 40-44.

Differences in the percent treated for PID by income

were not statistically significant. Women in the highest education group were less likely than women with high, school

educations to have ever been treated for PID. The data suggest

that non-Hispanic women were more likely to have been treated

for PID than Hispanic women (14 versus 10 percent) and

about twice as likely to have been hospitalized as Hispanic

women (4 percent compared with 2 percent).

16
The differences by marital status may also reflect differences in age and the number of sexual partners women had

had.37Formerly married women (22 percent) were more likely

to have been treated for PID than never mamied women (6

percent), or currently married women (17percent).

Black women were nearly twice as likely as white women

(23 versus 13 percent) to have been treated for PID (figure 6). The race difference was largest among formerly married

women, as shown in another analysis. 37 The high percent

of black women who had had PID was consistent with their

higher percent infertile. 37’38However, the effect of PID on

infertili~ is a complex topic that is being investigated elsewhere.43

Spontaneous pregnancy loss

In 1981 about 750,000 spontaneous pregnancy losses occurred to women with recognized pregnancies in the United

States.% They therefore had a substantial impact on the U.S.

birthrate. Women in the survey were asked the outcome of

each pregnancy, and those outcomes were classified as live

birth, induced abortion, miscarriage, and stillbirth. Miscarriages and stillbirths are termed “pregnancy losses” in this

report and in a previous analysis. 16Pregnancy loss may be

analyzed in terms of its impact on women, on pregnancies,

or both.

The impact of pregnancy loss on women is substantial.

About one of six women (17 percent), and one of four ever

pregnant women (26 percent) had had one or more pregnancy

losses by the time of the interview in 1982 (table 13). The

percent with one or more losses increased sharply with age

among all women, from 2 percent at ages 15-19 to 29 percent

at 35–39. The increase with age among women who had

ever been pregnant was not as marked-from 13 to 32 percent

in the same age groups. Black women (20 percent) were

more likely to have had a pregnancy loss than white women

(16 percent), but that is at least partly because they were

more likely to have been pregnant: the difference was smaller

and not significant for women who had ever been pregnant

(28 compared with 25 percent). Differences by Hispanic origin

were not statistically significant.

The statistics for currently married women in table 13

are comparable to data previously published from the 1976

NSFG. 16The findings are very similar to those in the 1976

survey (table J). In fact, none of the changes among currently

married women in table J was statistically significant.

Pregnancy loss rates—the percent of pregnancies ending

in a pregnancy loss—provide insights into the causes and

correlates of pregnancy loss, and suggest its impact on fertility

in various subgroups of the population. The reporting of spontaneous pregnancy losses in the Family Growth survey was

comparable to that in other surveys of the same type: Leridon

has reported the results of a number of surveys of women

in the reproductive ages in various parts of the world.’7 The

results from the NSFG were similar to those summarized

by Lendon: About 16 percent of pregnancies (excluding induced abortions) ended in a pregnancy loss; and there was

an increase in the pregnancy loss rate with the increasing

age of the mother, especially after the age of 35 (table 14).

Table J. Percent of currerttfy merrfed woman and currenlfy married

women ever pregnant 1S-44 yeara of age who had ever had 1 or more

pregnanoy loss+ by age and rsee United Ststeej 1976 and 1862

[Statisf@sare based on a sample of the household populaticmof the wnterminous

United States. See appendixes for dwusabn of the sample cWgn, estlmatea of sampfirg

varisbifiry, and definitkms of terms]

Women

All women ever pregnant

Age and race 1982 1976 1982 1976

Percent

Total~ . . . . . . . . . . . . . . . . 23.4 21.8 26.6

Age

15-19 years . . . . . . . . . . . . “11.3 12.1 ●13.8

20-24 years . . . . . . . . . . . . 14.4 11.5 20.4

26-29 years . . . . . . . . . . . . 19.9 15.0 23.5

3C-34 years . . . . . . . . . . . . 23.4 25.0 25.4

35-39 yeare . . . . . . . . . . . . 31.2 29.4 33.5

40-44 years . . . . . . . . . . . . 28.0 33.0 29.3

Race

White . . . . . . . . . . . . . . . . 22.8 21.6 26.2

Black . . . . . . . . . . . . . . . . 26.1 24.1 27.7

25.9

23.0

18.1

18.4

27.0

30.7

34.6

25.9

26.3

‘Includes wfme, black. and other races,

Table K. Percent of pregnanaes to currentiy married women 1544

yeare of age that ended in a pregnaney bee, by age at pregnancy

outoormx United Steteq 1976 and 1982

[Statistics are based em a sample of the household population of the contermirwus

Unitad States. See appendixes for diacvssion of the sample design, estimatea of samplmg

variabihtf, and defmitmns of telms]

Aqe at oregnancy oufcome 1982 1976

Percent’

15-44 years . . . . . . . . . . . . . . . . . . . . . . . 15.5 14.1

15-24 years . . . . . . . . . . . . . . . . . . . . . . 14.2 12.7

25-34 yeara . . . . . . . . ...<.. . . . . . . . 16.5 14.3

35+4years . . . . . . . . . . . . . . . . . . . . . . . 30.8 17.4

‘Exclwlmg induced a!xrkns

Pregnancy loss rates were calculated from the 1976 NSFG

for cumently married women. The loss rate for married women

from the 1976 survey was 14.1 percent; in 1982 it was 15.5

percent, not a significant difference (table K). The increases

at ages 15–24 and 25–34 were not statistically significant.

The increase at ages 354-4 years, although based on a small

number of sample cases, approaches statistical significance:

In 1976, 17 percent of pregnancies to married women 35-44

years of age had ended in pregnancy loss, compared with

31 percent in 1982.

The pregnancy loss rate in 1982 for women aged 3544

(31 percent, table 14) was significantly higher than for women

aged 15–24 (15 percent). Similarly, the loss rate for third

and later pregnancies (2 I percent ) was higher than for first

pregnancies (12 percent). Differences by marital status and

race were not significant.

The pregnancy loss rate for women who had been treated

for PID (20 percent) was higher than for those who had

never been treated (15 percent, table 14). This difference

was significant at the 5-percent level for white women (21

versus 15 percent), and at the 10-percent level for cumently

married women (20 versus 15 percent). The other 9 differences

in fetal loss rates by PID were not statistically significant,

17
but all suggested that fetal loss rates were higher for women

with a history of PID.

Cesarean section

Textbooks of obstetrics and gynecology list a number

of indications for cesarean section delivery, including late

pregnancy bleeding (placenta previa or abruptio placentae),

unproductive labor (cervical dystocia), cervical cancer, malpresentation (transverse, brow, face, or breech presentation),

severe toxemia, diabetes mellitus, and previous cesarean delivery $5’46Cesarean delivery tends to reduce subsequent fertility

by increasing the chances of sterilization and by making subsequent pregnancies more difficult ?2-25‘47’48These and other

health implications of cesarean delivery have prompted studies

of its prevalence; about 1 of 5 births in the United States

in 1981 was delivered by cesarean section .25

About 7 percent of women 1544 years of age in 1982

had had at least one cesarean section, and 3 percent had

had 2 or more (table 15). About 9 percent of all the births

to women 1544 years of age in 1982 had been delivered

by cesarean section (table 15). The proportion of births delivered by cesarean section increased with the age of the mother

at delivery, from 6 percent among teenage mothers to 20 percent among mothers aged 3544 (figure 7).

The proportion of women who had ever had at least

one cesarean section rose with age at interview, from 1 percent

at 15–19 years of age to 12 percent at 30-34 years of age,

and then declined to 8 percent at 40-44 years of age. The

probable reason for the decline at the older ages is that a

much smaller proportion of births were delivered by cesarean

section (about 5 percent) when these older women were having

most of their births than in recent years, when the rate has

exceeded 15 percent. 25

The proportion of births delivered by cesarean section

was identical by race. However, because black women have

had more births than white women, the data suggest that

black women were more likely to have had a cesarean delivery

(9 percent) than white women (7 percent). Differences by

education were not significant.

Women surgically sterile for noncontraceptive reasons

(16 percent) and women with impaired fecundity (12 percent)

were more likely than fecund women (5 percent) to have

had at least one cesarean section. In contrast, the differences

by infertility status were much smaller and not significant,

because cesarean section increases the risk of carrying future

pregnancies to term, but has no known effect on difficulty

in conceiving .47-48

Smoking and alcohol during pregnancy

The Surgeon General has issued the following warning

about smoking and drinking during pregnancy :49

Smoking slows fetal growth, doubles the chance of low birth

weight, and increases the risk of stillbirth. Recent studks suggest

that smoking may be a significant factor in 20 to 40 percent

of low weight infants born in the United States and Canada.

Studies also indicate that infants of mothers consuming large

amounts of alcohol may suffer from low birth weight, birth

defects, and/or mental retardation.

It is therefore worthwhile to estimate the extent of smoking

and drinking among pregnant women in the United States.

Two recent reports based on data from the 1980 National

Natality Survey (NNS) showed the percent of mamied mothers

who had births in 1980 who smoked or drank during the

pregnancy ?O’5]

The data in tables 16 and 17 refer to the most recent

pregnancies of women who were 15-44 years of age in 1982,

regardless of when the pregnancies occurred or of how they

ended. Despite these differences in the marital status of

mothers, the time periods included, and the coverage of pregnancy losses, the percents smoking and drinking during pregnancy were similar in the NSFG and NNS, and the differences

by race, age, Hispanic origin, and education were also in

the same direction in both surveys .50This increases confidence

in the results of both sources of data.

Tables 16 and 17 differ in one respect: table 16 includes

all recent pregnancies, while table 17 excludes induced abortions and includes only live births, miscarriages, and stillbirths.

The findings are very similar, so only table 17 is discussed

here.

About 40 percent of women abstained from both smoking

and drinking during their last pregnancies (table 17). About

15 percent smoked only, 29 percent drank only, and 16 percent

both smoked and drank. The propo~ion abstaining from both

was much lower for white women (37 percent) than for black

women (53 percent). This difference reflects the fact that

black women were much less likely to drink during pregnancy

than white women were (figure 8). For example, 17 percent

of black women and 31 percent of white women used alcohol

(but did not smoke) during their most recent pregnancies.

Hispanic women were also much more likely to be abstainers (55 percent) than non-Hispanic women were (38 percent),

but for a different reason: Hispanic women were only one-third

as likely to both smoke and drink during pregnancy as nonHispanic women were (5 versus 17 percent, figure 8).

Differences by education in the percent who neither

smoked nor drank were small and not significant. However,

this occurred because “smoking only” was much more common

in the lowest education group (26 percent) than in the highest

(7 percent), while “drinking only” was much more common

in the highest (41 versus 13 percent). A similar pattern, although less pronounced, was found by poverty level. Differences by marital status and pregnancy order were not consistent

or strong.

18
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20
List of detailed tables

1. Number of women 1544 years of age and percent distribu- at sterilization, by type of operation and selected charactenstion by fecundity status, according to marital status and tics: United States, 1982 . . . . . . . . . . . . . . . .

parity :United States, 1982.... . . . . . . . . ...22 11. Number of surgically sterile women (or their current hus2. Number of women 15-44 years of age and percent distribu- bands), percent distribution by parity, and mean parity at

tion by fecundity status, according to marital status and sterilization, according to marital status, race, and type

age: United States, 1982... . . . . . . . . . . ...22 of operation: United States, 1982 . . . . . . . . . . .

3. Number of women 1544 years of age who had impaired 12. Number of women 15+4 years of age and percent ever

fecundity or were surgically sterile for noncontraceptive treated for pelvic inflarnmato~ disease, by selected characreasons, and percent who wanted a baby or another baby, teristics: United States, 1982 . . . . . . . . . . . . . .

by marital status and selected characteristics: United 13. Number of women 15-44 years of age and percent of

States, 1982 . . . . . . . . . . . . . . . . . . . ...23 women who ever had 1 or more pregnancy losses, by

4. Number of women 1544 years of age and percent distnbu- pregnancy history and selected characteristics: United

tion by fecundity status, according to marital status, parity, States, 1982 . . . . . . . . . . . . . . . . . . . . . .

and age: United States, 1982 . . . . . . . . . . . . . 24 14. Number of pregnancies and rate of pregnancy losses, by

5. Number of women 1544 years of age and percent distribu- treatment for pelvic inflammatory dksease and selected

tion by fecundity status, according to marital status, race, characteristics: United States, 1982 . . . . . . . . . . .

and age: United States, 1982 . . . . . . . . . . . . . 25 15. Num&r of women 15-44 years of age and percent with

6. Number of women 1544 years of age and percent distribu- 1 or more or 2 or more live births delivered by cesarean

tion by fecundity status, according to marital status, parity, section, and number of births and percent delivered by

and race: United States, 1982 . . . . . . . . . . . . . 26 cesarean section, by selected characteristics: United

7. Number of currently married women 15-44 years of age States, 1982 . . . . . . . . . . . . . . . . . . . . . .

and percent distribution by infertility status, according to 16. Number of women ever pregnant 1544 years of age and

race, age, and parity United States, 1982 . . . . . . 27 percent distribution by whether or not they smoked or

8. Number of currenlly married women 1544 years of age drank aIcohoIic beverages during their most recent pregand percent distribution by infertility status, according nancy, according to selected characteristics: United

to parity and age: United States, 1982 . . . . . . . . 28 States, 1982 . . . . . . . . . . . . . . . . . . . . . .

9. Number of women 1544 years of age and percent of 17. Number of women ever pregn$int 1544 years of age

women (or their cument husbands) who have had a sterilizing whose most recent pregnancy ended in live birth or sponoperation, by type of operation, marital status, race, and taneous pregnancy 10SS, and percent distribution by

age: United States, 1982,.. . . . . . . . . . . ...29 whether or not they smoked or drank alcoholic beverages

10. Number of women 15-44 years of age (or their current

during their most recent pregnancy, according to selected

husbands) who were surgically sterilized, and mean age

characteristics: United States, 1982 . . . . . . . . . . .

30

31

32

33

34

35

36

37

21
Tabfe 1. Number of women 15-44 years of sge and percent distribution by fecund@ statuq according to marital status and pa~ United Ststeq 1982

[Statistms are based on a sample of the household populatmn of the conterminous United Ststes. See appendixes for discussion of the sample design, estimates of sampling variability, and

definitions of terms]

Fecundity status

Number of Surgically sterile Impaired fecundity

women in Contra- Noncontra- A\l Nonsurgical/y Long

Marital status and parity thousands Total ceptive ceptive impaired sterile Subfecund irr/erva/ Fecund

All marital statuses

All parties.. . . . . . . . . . . .

Parify O . . . . . . . . . . . . . . . .

Parity l or more . . . . . . . . . . .

Never married

All parities . . . . . . . . . .

Parity O . . . . . . . . . . . . . . . . .

Pafifyl or more . . . . . . . . . .

Currently married

All parities . . . . . . . . . . . . . . . .

Parity O . . . . . . . . . . . . . . . . .

Parity l or more . . . . . . . . . . .

Formerly married

All parities . . . . . . . . . . . . . . .

Parity O . . . . . . . . . . . . . . . . .

Parity l or more . . . . . . . . . . . .

54,099

22,941

31,158

19,164

16,695

2,469

28,231

5,098

23,134

6,704

1,146

5,556

Percent distribution

100.0 17.5 7.8 8.4 1.7 5.6 1.1 66.3

100.0 14 1.7 8.4 2.5 5.2 ‘0.7 88.5

100.0 29,3 12.4 8.5 1.1 5.9 1.5 49.9

100.0 1.3 “0.8 4.1 ●1.0 3.0 “0.1 93.8

100.0 ‘0.3 “0.4 3.7 “1.0 2.6 ●o.1 95.6

100.0 “7,9 “3.8 “6.4 “0.8 ‘5.6 ‘0.0 81.8

100.0 27.8 11.0 10.8 2.0 6.7 2.1 50.3

100.0 4.6 5.3 21.7 7.2 11.8 *2.6 68.4

100.0 33.0 12.3 8.4 “0.9 5.5 2.0 46.3

100.0 20.0 14.5 10.8 ‘1.9 8.9 ‘0.0 54.8

100.0 “4.2 “4.2 ●16.6 “2.1 “14.4 ‘0.0 75.0

100.0 23.2 16.6 9.6 *1.8 7.8 ‘0.0 50.6

Table 2. Number of women 1544 years of age and percent distnbti”on by fecund~ ststu~ according to marital statua and ag~ United State;), 1982

[StWaticaare based on a sample of the household population of the corderminous Unilad States, See appendixes for diaoussion of the sample design, estimates of sampling variability, and

definitions of terms]

Fecunditv status

Number of Surgically sterile Impaired fecundity

women in Contra- Nonwntra- A// Nonsurgically Long

Marital status and age thousands Total ceptive cerXive imgaired sterile Subfecund interval Fecund

All marital statuses

15-44 years . . . . . . . . . . . .

15-19 years . . . . . . . . . . .

2C-24years . . . . . . . . . . . . .

25-29 yeara . . . . . . . . . . . . .

30-34 years . . . . . . . . . . . . .

35-39 years . . . . . . . . . . . . . .

40-44 years . . . . . . . . . . . . . .

Never married

lW14 years . . . . . . . . . . . . . .

15-19 years . . . . . . . . . . . . . .

20-44 years . . . . . . . . . . . .

Currently married

15-44years . . . . . . . . . . .

15-19years . . . . . . . . . . ,,..

2C-24years . . . . . . . . . . . . . .

25-29years . . . . . . . . . . .

30-34years . . . . . . . . . . . . .

35-39years . . . . . . . . . . . .

40-44yesrs . . . . . . . . . . .

Formerly married

15-44years, . . . . . . . . . . . .

15--29 years . . . . . . . . . . .

W-44years . . . . . . . . . . . .

54,099

9,521

10,629

10,263

9,361

7,893

6,412

19,164

8,839

10,325

28,231

612

4,130

6,442

6,482

5,783

4,763

6,704

2,095

4,609

Percent distribution

100.0 17.5 7.8 8.4 1.7 5.6 1.1 66.3

100.0 0.0 ‘0.0 ●2.1 “0.5 ‘1.6 0.0 97.9

100.0 3.7 “0.6 6.4 “0.9 5.3 “0.2 69.4

100.0 12.1 3.7 10.6 ‘1.5 8.0 ‘1.0 73.6

100.0 26.6 10.1 9.3 “1.7 6.6 “1.1 53.8

100.0 35.2 18.4 13.0 3.1 7.3 “2.5 33.5

100.0 39.4 21.6 11.0 ‘3.0 4.9 ‘3.1 27.9

100.0 1.3 “0.6 4.1 “1.0 3.0 “o.1 93.8

100.0 0.0 ‘0.0 ‘1.8 “0.5 91.3 0.0 98.2

100.0 2.3 “1.5 6.0 ‘1.4 4.4 ‘0.2 90.1

100.0 27.8 11.0 10.6 2.0 6.7 2.1 50.3

100.0 0.0 “0.3 “6.1 “0.3 ‘5.9 0.0 93.6

100.0 7.5 ‘0.6 9.2 ‘1.2 7.5 “0.5 82.6

100.0 15,4 4.2 10.0 “1.5 7.2 ‘1.4 70.4

100.0 32.3 11.3 9.4 “1.3 6.6 ‘1.5 47.0

100.0 39.5 18.6 14.3 *3.1 7.9 “3.4 27.6

100.0 45.5 21.2 11.6 “3.4 “4.0 “4.1 21.7

100.0 20.0 14.5 10.8 “1.9 8.9 ‘0.0 54.6

100.0 ‘9.3 “3.4 “13.7 “2.2 ‘11.5 0.0 73.6

100.0 24.6 19.5 9.5 “1.7 ‘7.7 “0.1 46.2

22
T##s 3. Number of women 1544 years of age who had ‘knpairedfacund~ or were surgically sterile for noncontracepthre reaaon$ and percent who

wantad a baby or another baby, by marital status and aeleotad characterfa6cs: United Stateq 1982

[Statisticsare basedon a sampleofthe householdpopulationofthe mntenninousUnitedSfstes,See appendicesfor dw,cussbn of the sample design, estimates of ssmpfing variahlity, and

definitions of terms]

Woman who wanted a baby

Surgically or another baby

Women with sterile, All Surgically

impaired norrcorrtraceptive impaired sterile,

Characteristic fecundity women fecundity noncorrtraceptive

ALL MARITAL STATUSES’ Number in thousands Percent

Allwomen2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,560 4,241 60.1 56.3

Age

15-24 years . . . . . . . . . . . . . . . . .

25-S4years . . . . . . . . . . . . . . . . .

3544yeara . . . . . . . . . . . . . . . . .

875 ’65

1,959 1,327

1,725 2,849

79.9

74.8

33.4

86.4

72.8

47.8

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

Parity

Parity O . . . . . . . . . . . . . . . . . . . .

Parity I . . . . . . . . . . . . . . . . . . . .

Parify2 . . . . . . . . . . . . . . . . . . . .

Parity 30r more . . . . . . . . . . . . . . .

1,917 362

1,115 557

865 1,445

662 1.858

81.2

57.9

40.9

27.9

63.0

76.1

53.5

51.0

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . .

3,848 3,537

599 509

60.6

53.5

56.1

55.3

. . . . . . . . . .

. . . . . . . . . .

Origin

Hispanic . . . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . . . . .

534 267

4,026 3,974

68.9

59.2

“46.2

56.9

. . . . . . . . . .

. . . . . . . . . .

CURRENTLY MARRIED

All women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,055 3,116 59.1 54.4

Age

lS24years . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . .

“418 *28

1,257 999

1,380 2,089

84.9 99.9

78.5 68.9

35.5 46.8

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

Parity

Panty O . . . . . . . . . . . . . . . . . . . .

Parify l . . . . . . . . . . . . . . . . . . . .

Parily2 . . . . . . . . . . . . . . . . . . . .

Parity 30rrnore . . . . . . . . . . . . . . .

1,105 “272

748 ‘m

690 1,082

512 1,393

62.6 64.5

E41.6 71.1

40.4 49.9

“30.9 51.2

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

Race

Whtie . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . .

2,714 2,702

270 279

59.8 53.7

49.5 57.6

. . . . . . . . . .

. . . . . . . . . .

Origin

Hispanic . . . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . . . . .

’381 ●145

2,694 2,970

62.6 “29.8

58.6 55.6

. . . . . . . . . .

. . . . . . . . . .

llnc!udes current fy married, never matied, and formerly marrfed.

‘Inoludeswhite, black, and other races.

23
Table 4. Number of women 15-44 years of sge and percent distribution by fecund~ status, ascording to marital status, parity, and age

United States, 1982

[Statlstcs are based on a sample of the hou?.ehcddpepulatmn of the conterminous United States See appendixes for dtscussicmof the sample design, estimates of sampling varfabihly, and

definitions of terms]

Fecwrddy status

Number of Surgically sterile

women in Norrcontra- Impaired

Marital status, parity, and age thousands Total Contraceptive ceptive fecundity Fecund

1544 years

15-24 years

25-34 years

3W4 years

15-44years

1.5-24 years

25-34 years

35-44 years

1.544years

15-24 years

25-34 yeara

3544 years

1544 years

16-24 years

25-34 years

3544 years

1544 years

1524 years

25-34 years

3544 years

1544 years

15-24 years

2%34 years

35-44 years

ALL MARITAL STATUSES1

All panbes

... ,. . . . . . ,,

.

... ,. . .,,

Parity O

. . .,

. . . . . . . . .

. . . . . . .

. . . . . .

Parity 1 or more

. . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . .

CURRENTLY MARRIED

All parities

. . . . . . . . . . . .

. . . . . . . .

. . . . . . . . . . . . . . .

. . . . . . . . . . . .

Parity O

. . . . . . . . . . . . . . .

. . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . . .

Parity 1 or more

. . . . . . . . . . .

. . ... ,, . . . . . . .

. . . . . . . . . . . . .

. . ,, . . . . . . . .

54,099

20,150

19,644

14,305

22,941

15,547

5,626

1,766

31,158

4,603

14,016

12.539

28,231

4,741

12,924

10,566

5,096

1,989

2,256

853

23,134

2,752

10,668

9,713

Percent distribution

100.0 17.5 7.8 6.4 66.3

100.0 1.9 ‘0.3 4.3 93.4

100.0 19.1 6.6 10.0 64.2

100.0 37.1 19.9 12.1 31.0

100.0 1.4 1.7 8.4 88.5

100.0 “0.1 ‘0.0 4.1 95.8

100.0 “3.3 “1.6 14.7 80.2

100.0 “7.4 15.7 25.7 51.3

100.0 29.3 12.4 8.5 49.9

100.0 6.3 “1.3 5.2 85.2

100.0 25.4 8.7 8.1 57.6

100.0 41.3 20.5 10.1 28.1

100.0

100.0

100.0

100.0

27.8

6.6

23.9

42.2

11.0

‘0.6

7.7

19.8

10.8

8.8

9.7

13.1

50.3

64.0

58.6

24.9

100.0 4.6 5.3 21.7 68.4

100.0 0.0 ‘0.1 11.1 88.8

100.0 “6.2 “3.5 21.1 69.2

100.0 “1O.8 22.5 47.8 ‘1 8.9

100.0 33.0 12.3 8.4 46.3

100.0 11.3 “1.0 ‘7.2 80.6

100.0 27.7 8.6 7.3 56.4

100.0 45.0 19.5 10.0 25.5

Ilncludes currently married, never married, and formerly marriad

24
Table 5. Number of women 1544 years of age and percent distribution by feound~ sta% aooording to marital ststusj raoe, and age

United Ststeq j982

[Statmtka are basad on a sample of the household population of the conterminous United States. See appendixes for discussion of the sample design, est!mates of sampling variability, and

definitions of terms]

Feundity status

Number of Surgically stenk

women in Noncontra- Impaired

Marital status, race, and age thousands Total Contraceptive ceptive fecundity Fecund

ALL MARITAL STATUSES’

All racesz Percent distribution

15-44years 100.0 17.5 7.8 8.4 66.3

15-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40-44 yeara

54,099

9,521

10,629

10,263

9,381

7,893

6,412

. . . . . . . . . . . . . . . . . . . . . . .

100.0 “0.0 “2.1 97.9

100.0 3.7 “0.6 6.4 89.4

100.0 12.1 3.7 10.6 73.6

100.0 26.8 10.1 9.3 53.8

100.0 35.2 18.4 13.0 33.5

100.0 39.4 21.8 11.0 27.9

White

15-44 years

15-24 years

25-34 years

35+4 years

45,367 100.0 17.9 7.8 8.5 65.9

100.0 1.9 “0.3 4.4 93.4

100.0 18.7 7.0 10.0 64.3

100.0 38.4 19.2 12.0 30.4

. . . . . . . . . . . . . . . . . . . . . . .

16,670

16,465

12.212

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

Black

15-44years

15-24 yeare

25-34 yeare

35-44 years

. . . . . . . . . . . . . . . . . . . . . . . 6,965 100.0 14.8 7.3 8.8 69.3

2,868

2,479

1,616

100.0 “2.2 “0.8 3.7 93.3

100.0 20.8 5.2 10.0 63.9

1OQ.O 28.2 22.0 15.0 34.8

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

CURRENTLY MARRIED

All racesz

15-44 years

15-19 years

20-24 years

26-29 years

3C-34 years

35-39 yeare

40-44 yeare

28,231 100.0 27.8 11.0 10.8

“6.1

9.2

10.0

9.4

14.3

11.6

50.3

93.6

82.6

70.4

47.0

27.6

21.7

. . . . . . . . . . . . . . . . . . . . . . .

612

4,130

6,442

6,482

5,783

4,783

100.0

100.0

100.0

100.0

100.0

100.0

‘0.3

0.6

4.2

11.3

78.6

21.2

7.5

15.4

32.3

39.5

45.5

White

15-44 years

15-24 years

25-34 years

35-44 yeare

25,195 100.0 28.2

6.7

23.6

43.5

. . . . . . . . . . . . . . . . . . . . . . . 10.7 10.8 50.4

4,323

11,457

9,414

1W.o

100.0

100.0

“0.6

7.9

18.8

8.6

9.7

13.1

64.1

58.8

24.6

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

Black

15-14yeare

15-24 yeare

25-34 years

35-44 years

. . . . . . . . . . . . . . . . . . . . . . . 2,13a 1C(IO 23.1 13.1 12.7 51.1

328

1,025

778

1W.o “6.7 “0.7 “9.2 63.4

100.0 25.2 6.6 10.2 58.0

100.0 27.2 26.9 17.4 26.5

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

7Inciudes currentiy married, never reamed, awl formerfy married,

‘includes white, black, and other races.

25
Table 6. Number of women 16-44 years of age and percent distribution by feound~ status, according to marital status, parity, and ratxx

United States, 1982

[StatMms are baaed on a sample of the household population of the conterminous United States See appendixes for discussion of the sample design, est!mates of sampling variabllii, and

definitions of terms]

Fecundity status

Number of Surgically sterile

women in Noncontra- Impaired

Marital status, race, and parity thousands Total Contraceptive ceptive fecundity Fecund

ALL MARITAL STATUSES’

All racesz

Parity O.. . . . . . . . .

Parity l or more . . . . . . . . . .

White

Parity O . . . . . . . . . . . . . . . . . . .

Parity l or more . . . . . . . . . . . . .

Black

Parity O . . . . . . . . . . . . . . . . . . . . . . . . . .

Parity l ormore . . . . . . . . . . . . . .

CURRENTLY MARRIED

All racesz

Parity O . . . . . . . . . . . . . . . . . . . . . . . .

Parity l ormore . . . . . . . . . . . . . . . .

White

ParityO . . . . . . . . . . . . . . . . . . . .

Parity lormore . . . . . . . . . . . . . . . . . . . . .

Black

ParityO . . . . . . . . . . . . . . . . . . . . . . . . . .

Parity lormore . . . . . . . . . . . . . . .

Percent distribution

22,941

31,158

100.0

100.0

1.4

29.3

1.7

12.4

8.4

8.5

88.5

49.9

19,720

25,647

100.0

100.0

1.6

30.4

1.5

12.6

8.4

8.5

66.5

48.5

2,447

4,538

100.0

100.0

‘0.2

22.7

‘2.6

9.8

7.6

9.1

89.6

58.3

5,098

23,134

100.0

100.0

4.6

33.0

5.3

12.3

21.7

8.4

68.4

46.3

4,678

20,517

100.0

100.0

“4.7

33.5

5.1

12.0

21.2

8.4

69.0

46.1

62.0

49.6

252

1,878

100.0

100.0

“0.5

26.1

“9.5

13.6

27.9

10.7

~lncludes currently married, never married, and formerly married.

‘Includes white, black, and other racss.

.

26
Tabte 7. Number of currently married women 15-44 years of age and peroent dmtributionby infertiKtyatatq according to race, age, and parily

United States 1982

[Statisticsare based on a sample of the household populaticm of the conterrninous United States. See appendixes for discussion of the sample design, estimates of sampling variability, and

definitions of terms]

Number of Infertility status

wmen in Surgically

Race, age, and pariW thousands Total sterile infertile Fecund 7

All races=

15-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1$19 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-29years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4C-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

White

15-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-19years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-29years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3C-34yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-39yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black

l%44years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-19years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2C-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2S29years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3C-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40-t4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parity

ParityO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parity I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Panty30rmore . . . . . . . . . . . . . . . . . . . . . . . . . . .

28,231

612

4,130

6,442

6,482

5,783

4,783

25,195

561

3,762

5,682

5,775

5,098

4,319

2,130

35

292

531

494

424

354

5,098

5,891

9,042

8,201

Percent distribution

100.0 38.9 8.5

100.0 “0.3 “2.1

100.0 “8.2 9.7

100.0 19.6 7.0

100.0 43.6 7.7

100.0 58.1 10.3

100.0 66.7 9.0

100.0 3s.9 8.1

100.0 “0.3 ‘0.8

100.0 ‘8.3 ‘9.0

100.0 18.7 ‘7.0

100.0 44.2 ‘7.1

100.0 57.8 10.6

100.0 67.7 ‘8.4

100.0 36.2 13.1

100.0

100.0 “8.3 “13.3

100.0 27.2 *1O.3

100.0 36.7 12.8

100.0 50.1 ‘13.7

100.0 58.8 18.0

100.0 9.9 19.6

100.0 17.7 10.8

100.0 46.9 5.0

100.0 63.3 ‘3.8

52.6

97.7

82.1

73.4

48.7

31.6

24.3

53.0

98.9

82.6

74.4

48.8

31.6

23.9

50.7

100.0

78.3

62.5

50.5

36.1

23.2

70.5

71.6

48.1

32.9

j"F=und"h~a tiffermt meani~in tilst&le thmin tables i_& SmSPpendIXK

‘Includes white, black, and other races.

27
Table 8. Number of currently married women 1544 years of age and percent distribution by inferfilii atstu~ according to parity and age

United Statea,,1 982

[Statistics are baaed on a sample of the housahold population of the cwterminous Umted States, See appendixes for discusaton of the sample design, estimates of sampling variability, and

definitions of terms]

Number of /rrferti/ity status

women in Surgically

Parity and age thousands Total sterile infertile Fecund’

All parities Percent distribution

15-44 years . . . . . . . . . . . . . . . . . . . . . . . . . .

15-29 years . . . . . . . . . . . . . . . . . . .

30-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parity C-1

1544 years . . . . . . . . . . . . . . . . .

15-29 years . . . . . . . . . . . . . . . .

3044years . . . . . . . . . . . . . . . . . . . . . . .

Parity 2

lE-44years . . . . . . . . . . . . . . . .

15-29years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-44years . . . . . . . . . . . . . . . . . . .

Parity30r more

15-44years . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-29years . . . . . . . . . . . . . . . . . .

30-44years . . . . . . . . . . . . . . .

28,231

11,183

17,048

10,989

7,087

3,921

9,042

2,819

6,223

8,201

1,297

6,904

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

38.9

14.3

55.0

14.1

‘5.4

29.8

46.9

26.4

56.2

63.3

37.0

68.2

8.5

7.7

8.9

14.9

9.5

24.5

5.0

‘3.7

“5.5

‘3.6

‘7.0

‘3.2

52.6

77.9

36.1

71.1

85.2

45.7

48.1

69.9

38.3

32.9

56.1

28.6

I. Facu”d has adlfierentmemi”g i“ rk+t ablethan in tables 1-6. See appendix II

28
Tsbhs9. Numbrof~n lWy-m M~and~nnt &wen(or Wwtihu*b) wb-Ma S*g-mn, @~d

-n, IWfkd statt% race, and agw United Ststeg 1962

[Statistksare basedon a sampleofthe householdpopulationofthe conterrnirmusUnitedStates.Sae appendixesfordiscussionof the sarnp!edesign,estimatesof sampling vsriabilrty, and

definitions of terms]

Number of Tjpa of operation

women in All Tubal

Marital status, race, and age thousands operations’ ligation Hysterectomy Vasectomy

ALL MARITAL STATUSES*

All races3 Percent

15-44 yeare

15-19 years

20-24 years

25-29 years

30-34 years

3S39 years

4044 years

54,088

9,521

10,629

10,263

9,381

7,893

6,412

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.3 13.6 5.3 6.0

“0.0

4.3

15.8

36.8

53.6

61.2

‘0.0

2.7

10.2

21.6

27.6

28.3

“0.1 “1.5

3.7

9.5

11.9

13.8

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

●1.7

5.1

13.3

18.3

White

15-44 years

15-19 years

20-24 years

25-29 years

30-34 years

3E-39 years

40-44 years

45,367

7,815

8,855

8,569

7,916

6,697

5,515

25.6

“0.0

4.1

14.7

37.6

54.0

62.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.2 5.3 6.8

‘2.3

8.6

20.8

27.1

28.8

‘1.8

4.2

10.7

13.3

15.2

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

‘1.7

5.5

12.9

17.3

Black

1E-14 years

15-19 yeara

20-24 years

25-29 years

30-34 yeare

35-39 years

40-44 years

6,985

1,416

1,472

1,335

1,144

864

734

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 15.5 5.4 “0.7

“0.1

5.8

21.0

31.9

45.5

55.9

“0.1

5.2

18.5

26.9

28.5

27.1

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

“0.4 ‘0.1

‘1.5 ‘0.9

*3.4 ‘0.7

13.1 “1.9

26.4 “1.3

CURRENTLY MARRIED

All races3

15-44 years 38.9 19.6 7.3 11.4

15-19 yeara

20-24 years

25-29 years

30-34 years

35-39 years

40-44 years

28,231

612

4,130

6,442

6,462

5,763

4,783

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“0.3

8.2

19.6

43.6

58.1

66.7

“4.6

12.0

23.5

27.5

30.4

‘0.0 ‘3.6

5.5

13.8

18.3

18.5

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

“1.9

5.6

13.5

16.8

White

15-44years

15-19 years

20-24 y8ars

25-29 years

3C-34 years

35-39 years

40+4 years

25,195

561

3,762

5,662

5,775

5,096

4,319

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.9 19.0 7.2 12.1

‘0.3

8.3

16.7

44.2

57.8

67.7

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

“4.4

10.6

22.9

26.6

31.1

‘3.9

5.9

14.6

17.5

19.4

●2.O

6.0

13.0

16.2

Black

15-44 yeare

15-19 years

2C-24 yeara

25-29 years

30-34 years

35-39 years

40-44 years

2,130

“35

292

531

494

424

354

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.2 23.6 9.2 ‘2.2

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

●8.3 7.6

27.2 23.0

36.7 29.8

50.1 26.6

56.8 25.7

“0.4

●2.1

‘3.8

15.0

28.6

“0.4

●2.2

●1.7

“4.0

‘2.7

‘includes sterilizing oparatiins of other or unknown iypes, not shown separately.

‘Includss currently married, never married, and forme$ marrisd.

31ncludes whtia, black, and ofher racaa.

29

— — -.—
Table 10. Number of women 16-44 years of age (or their current husbands) who were surgically sterftized, and mean age at sterilization, by type of

operation and selected characteristics: United State$ 1982

[Statstics are based on a sample of the household population of the contenmnous United States See appendixes for discussion of the sample design, estimates of samplmg vanabtily, and

definitions of terms]

Type of operation Type of opetation

All Tubal All Tubal

Characteristic operations’ Hysterectomy ligation Vasectomy operations’ Hysterectomy ligation Vasectomy

Number in thousands Mean age

Allwomen2 . . . . . . . . . . . . . . 13,684

11,636

1,545

796

12,885

2,289

3,684

4,837

2,695

2,731

6,205

4,747

9,362

3,362

2,955

10,729

6,388

10,326

3,358

2,880

2,399

374

172

2,708

375

660

1,197

648

731

1,262

887

2,702

683

593

2,287

1,439

2,128

752

7,351

5,969

1,084

534

6,817

1,402

2,130

2,667

1,152

1,680

3,296

2,375

4,984

1,814

1,919

5,432

2,933

5,413

1,939

3,258 30.0 31.5 29.8 29.2

29.1

29.7

30.7

29.2

30.4

29.7

28,8

28.6

26.1

28.8

30.4

29.2

29.5

27.8

29.4

29.7

29.3

28.9

Race

White . . . . . . . . . . . . .

Black. .

3,093

47

30.1

29.4

31.4

32.2

30.1

28.4

Orlgm

Hispamc. . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . .

92

3,166

30.2

30.0

30.9

31.6

29.9

29.8

Northeast . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . .

439

1,028

901

890

31.6

30.0

29.8

29.3

33.9

32.4

30.9

30.5

31.3

29.4

29.6

29.2

Education

Lesathan12yesrs

12years . . . . . . . .

13years or more

281

1,588

1,389

28.5

30.1

30.8

30.5

31.8

32.0

28.1

30.1

30.6

. . .

. . . . .

. . .

. . . .

. . . .

Religion

Protestant.

Cathodic . . . . . . . .

2,201 29.9

30.5

31.2

32.8

29.6

860 30.3

Poverty level income

149percentor less . . . . . . . . . .

150percentormore . . . . . .

300percentormore . . . .

375

2,883

1,950

28.8

30.4

30.7

31.2

31.6

31.6

28.1

30.4

31.0

Living arrangements at age 14

Living with both parents . . .

Living with one or

neitherparent . . . . . . . . . . . .

2,657

601

30.4

26.9

32.1

29.9

30.3

28.4

‘Includes tubal Hgation, hysterectomy, vasectomy, and sterilizing operations of other or unknown types.

21ncludes white, black, andother races; also includes Protestant, Catholic, other religions, and no religion

30

.. .
Tabks 11. Number of surgically sterile women (or their current husbands), percent distribution by parity, and mean parity at steritiz.atiortj according to

merftal ststq race, and type of operation: United Stete$ 1982

[Statistii are based on a sample of the household population of the contermino.s United States. See appendixes for dizcussbn of the sample design, eatlmates of sampling variabilii, and

definibons of terms]

Marital status, race, and Number fart~ Mean

type of operation in thousands Total o 1 2 3 4 or more parity

ALL MARITAL STATUSES

All races’

Alloperationsz . . . . . . . . . . . . . . . .

Hysterectomy . . . . . . . . . . . . . . . . .

Tubal ligation . . . . . . . . . . . . . . . . .

Vasectomy . . . . . . . . . . . . . . . . .

White

Alloperationsz . . . . . . . . . . . . . . . .

Hysterectomy . . . . . . . . . . . . . . . . .

Tubal ligafion . . . . . . . . . . . . . . . . .

Vasectomy . . . . . . . . . . . . . . . . . .

Black

Alloperationsz . . . . . . . . . . . . . . . .

Hysterectomy . . . . . . . . . . . . . . . . .

Tubal ligation . . . . . . . . . . . . . . . . .

Vasectomy . . . . . . . . . . . . . . . . . .

CURRENTLY MARRIED

All races’

Alloperations2 . . . . . . . . . . . . . . . .

Hysterectomy . . . . . . . . . . . . . . . . .

Tubal ligation . . . . . . . . . . . . . . . . .

Vasectomy . . . . . . . . . . . . . . . . . .

White

Alloperations2 . . . . . . . . . . . . . . . .

Hysterectomy . . . . . . . . . . . . . . . . .

Tubal ligation . . . . . . . . . . . . . . . . .

Vasectomy . . . . . . . . . . . . . . . . . .

Black

Alloperationsz . . . . . . . . . . . . . . . .

Hysterectomy . . . . . . . . . . . . . . . . .

Tubal figation . . . . . . . . . . . . . . . . .

Vasectomy . . . . . . . . . . . . . . . . . .

13,684

2,880

7,351

3,258

11,836

2,399

5,969

3,093

1,545

374

1,064

47

10,978

2,072

5,525

3,221

9,796

1,816

4,789

3,055

771

196

504

47

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

5.2

10.2

“2.1

7.8

5.2

9.4

‘2.3

7.9

4.4

‘12.1

“1.5

“2.8

4.6

‘9.8

“1.2

‘7.2

4.7

“9.8

“1.2

‘7.2

‘3.3

“7.7

“1.8

●2.8

9.6

9.6

7.3

14.0

10.3

“8.7

8.2

14.4

4.9

‘11.1

“2.6

‘2.3

9.5

“9.2

“6.4

14.2

9.9

“8.4

7.0

14.8

‘4.5

‘11.6

“1.8

“2.3

38.0

33.2

36.4

46.7

39.3

35.2

37.8

46.2

27.6

23.8

27.3

‘59.7

38.6

32.3

36.6

46.8

39.1

32.9

37.3

46.3

30.7

“25.9

29.5

‘59.7

28.7

25.9

33.6

20.6

28.6

27.5

33.5

20.3

28.1

23.0

30.9

“1 9.8

30.1

28.7

36.4

20.8

30.1

30.3

36.4

20.5

27.6

“22.8

31.2

●19.9

18.5

21.1

20.7

10.9

16.6

19.2

~8.1

11.3

35.0

30.0

37.5

“1 5.3

17.2

20.0

19.3

‘11 .0

16.2

‘1 8.6

18.0

‘11.4

33.9

31.9

35.8

‘15.3

2.56

2.55

2.79

2.15

2.50

2.51

2.68

2.14

3.27

2.90

3.44

2.57

2.54

2.53

2.77

2.16

2.51

2.49

2.74

2.16

3.10

2.99

3.18

2.57

llnd@eswhiie, black, and other races.

‘includes sterilizing operations of other or unknown types, not shown separately,

31

.—
Table 12. Number of women 15-44 years of age and peroent ever treated for pelvic inflammatory duase, by seieoted characteristics

United Steteq 1982

[Statistics are based on a sample of the household population of the contenmnous United States. See appendixes for discussion of the sample design, estimates of sampling variability, and

definitions of terms]

Number

of women

Ever treated for

pelvic inflammatory disease

Characteristic in thousands Total Ambulatory Hospitalized

Age

l%44yeara1 . . . . . . . . . . . . . . . .

15-19 years . . . . . . . . . . . . . .

2C-24 yeara . . . . . . . . . . . . . . . . . . . .

25-29 years . . . . . . . . . . . . . .

3C-34years . . . . . . . . . . . . . . .

35-39 yeare . . . . . . . . . . . . . .

40-44 yeara . . . . . . . . . . . . .

Poverty level income

149percent or less ...,..... . . .

150percentor more . . . .

300percent or more . . . . . . . . . .

Education

Lessthan 12 years . . . . . . . . . . . . . . . .

12years . . . . . . . . . . . . . . . . . . . . . . .

13yearsormore . . . . . . . . . . . . . .

Origin

Hispanic . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . .

Marital status

Nevermarried . . . . . . . . . . . . . . . . . . .

Currentlymarried . . . . . . . . . . . . .

Formerlymarried . . . . . . . . . . . . . . . . . .

Race

White. . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . .

. . . . .

.

. . . .

. . . . .

. . . .

. . . . .

. . . .

. . . . . .

. . . . . .

. . . . .

. . . . . . . .

. . . . .

. . . . .

. . . . . . . .

. . . . . . . . .

. . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . .

. . . . . . . . .

54,099

9,521

10,629

10,263

9,381

7,893

6,412

13,843

40,256

23,411

13,465

20,257

20,377

4,393

49,706

19,164

28,231

6,704

45,367

6,985

Percent

14.0 9.9 4.1

2.6 “2.4 “0.5

12.5 8.9 3.6

14.7 10.8 3.6

20.0 12.7 7.2

16.2 13.7 4.5

17.9 12.2 5.7

14.9 10.8 4.2

13.6 9.6 4.1

12.1 8.3 3.s

13.8 9.5 4.3

15.8 11.5 4.4

12.2 6.5 3.7

9.9 8.1 ‘1.8

14.3 10.0 4.3

6.4 4.5 1.9

17.2 12.5 4.7

21.7 14.1 7.6

12.6 8.9 3.7

23.2 16.7 6.5

Ilncludea whfie, black, and other races.

32
Teble 13. Numkrof wmnlWy-rs of~esnd pmntofmen Wever Mlwmm~ns~W byp~mn~-sMWti

cherecteristkx UnWfStateej 1982

[Statistii are based on a sample of the housefwld ppulation of the cursterrnineus Unitsd States. SEE appendixes for diacassion of the aamF+s design, esfimaIas of samplingvanabilii, and

definitions of terms]

All woman Wornan ever pregnant

Number of Percent wlh Number of Percent with

women in 1 or more women in 1 or more

Characteristic thousands pragnanoy losses thousands pregnancy losses

ALL MARITAL STATUSESI

Age

16-44 years2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54,099 16.8 34,969

15-19 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,521 “2.1 1,576

20-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,629 8.7 4,863

2&29years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,263 17.5 7,550

30-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,361 22.9 8,093

35-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,893 28.9 7,033

40+4yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,412 26.8 5,903

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45,367 16.1 28,645

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,985 19.9 5,019

Origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,393 15.3 3,153

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49,706 16.9 31,817

CURRENTLYMARRIED

Age

15-44yeara2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-19years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2C-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-29years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28,231

612

4,130

6,442

6,482

5,763

4,763

23.4

‘11.3

14,4

19.9

23.4

31.2

28.0

24,797

498

2,910

5,463

5,966

5,388

4,570

26,0

“12.9

19.1

23.8

26.7

32.4

29.1

25.4

27.7

21.4

26.4

26.6

“13.8

20.4

23.5

25.4

33.5

29.3

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,195 22.8 21,975 28.2

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,130 26.1 2,005 27.7

Origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,296 19.5 2,134 20.9

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,935 23.8 22,863 27.2

‘Includes currently marti, never mat-riad, and form%rlymarr’iad.

‘Includes white, black, md other race. %

33
Tsbte 14. Number of pregnancies snd rate of pregnanoy losses by treatment for pelvic inflammatorydisease and seleoted characteristics

United Ststeq 1982

[Statistics are based on a sample of the household population of the conterrnmous United States, See appendixes for discussion of the sample design, estimates of samphng variability, and

definitions of terms]

Treatment for pelvic inflammatory disease

Pregnancy losses

Pregnancies’ per 100 pregnancies=

All Ever Never All Ever Never

Characteristic pregnancies treated treated losses treated treated

Tota134. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age at pregnancy termination

15-24 years . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pregnancy order

First pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Second pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . .

Third or later pregnancy .,...... . . . . . . . . . . . . . . .

Marital status

Nevermarried . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Currently married . . . . . . . . . . . . . . . . . . . . . . . . . . .

Formerlymarried . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands Rate

83,721 18,160 65,561

52,092 12,263 39,630

29,709 5,444 24,264

1,657 344 1,313

31,059 5,692 25,167

24,360 5,005 19,375

28,262 7,263 21,020

5,275 1,039 4,237

62,670 12,690 49,981

15,775 4,432 11,344

68,235 13,213 55,022

12,900 4,292 6,606

16.1 19.8 15.1

15.1 17.6 14.2

16.6 21.9 15.4

30.8 ‘40.2 28.3

12.3 14.8 11.8

14.9 18.9 13.6

21.4 24.6 20.3

17.7 *22.6 16.5

15.6 19.5 14.6

17.6 20.1 16.6

16.2 20.7 15.1

14.4 14.9 14.2

lExcludes inducsd atmtitons,

‘Pregnancy Ioaaas, divided by pregnanoy losses plus hve births, multipked by 103,

31ncludes whfie, black, snd other races.

41ncludes pregnancies with mother’s ageatoutsome not ascertained, and those currently pregnant, not ahown separately by age at pregnancy outcome.

34
Table 15. Number of worrten 1S-44 years of age and percent with 1 or more or 2 or more live births delivered by ceserean section, and nurnlnx of births

and percent de~iered by oessrean seofion, by eeleoted chareoterfatics:United Sates+ 19S2

[Sfatisfii are basedon a sampleofthe householdpopulationofthe conterminousUmtedStatea.See appendixesfordiscussionofthe sampledesign,estimatesof samplingvariability,ati

definitionsofterms]

Women with cesarean sections Live births delivered

Characteristic Total 1 or more 2 or more by cesarean section

Percent

Number

in thousands in thousands Percent

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54,099 7.4 3.1 269,944 6.9

Age3

l&19years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2C-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-29 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4044years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9,521

10,629

10,263

9,361

7,693

6,412

“1.1

6.0

9.7

11.9

6.6

7.5

“0.0

‘1.5

4.6

5.4

4.0

3.8

14,679

29,212

18,546

6,119

1,146

6.1

8.0

10.3

13.7

! 9.9

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45,367

6,985

7.1

9.1

3.0

3.5

56,965

10,945

8.8

8.8

Lessthan 12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13yearsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13,465

20,257

20,377

7.5

7.4

7.4

3.1

3.2

3.1

16,333

29,405

22,207

6.6

6.1

10.3

Fecundity status

Surgically sterile

Contraceptive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Noncontraceptive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Impaired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fecund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9,442

4,241

4,560

35,655

10.1

15.7

11.6

5.2

6.9

6.5

‘3.0

1.8

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

Infertility status4

Surgicallysterile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infertile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fecund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10,978

2,391

14,662

11.8

9.3

11.2

6.9

‘2.5

3.9

. . .

. . .

,..

. . .

. . .

. . .

Poverty level income

149percentorless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

150percentormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

300percentormore . . . . . . . . . . . . . . . . . . . . . . . . . . ,

13,643

40,256

23,411

6.7

7.0

6.7

4.0

2.8

2,4

. . .

. . .

. . .

. . .

. . .

~lncludftswhie,Nack, andotherraces.

21ncludesbirthsforwilch mother’sage at outcomewas notascertained,andthosewhosemotherawere currentlypregnant,notshownseparatelyby age at pregnaneyoutmme

‘For the first3 columns,labeled“Womenwithcesareansections,””age”refersto the woman’s ageafffre dafeofmterwew, forthe last 2 columns,“age”refersto the woman%agezrfh?trme fhe

pregrrancyended.

‘Currentlymarriedwomenonly,See appendixII fordefinitionsoffecunditystatus,infertilitystatus,andofherterms

35
Table 16. Number ofwomen ever pregnant lWyeamof ageand~runt dstrib@on bywhether ornotthey smok#or dmnkalcohohc beveragea

dunngtheir most recent pregnancy, according toaelacted characteriat& United States, 1982

[StstisIIcsare baaed on a sample of the household population of the sonterminous United States. See appendixes for discussion of the sample design, estimatea of sampling variab!hly,and

definitions of terms]

Smoking and drinking during most recent pregnancy

Smoked or drank

Neither Drank Both

Number of smoked alcoholic smoked

women in nor Smoked beverages and

Characteristic thousands 7 Total drank Total only only drank

Percent distribution

Tota12,3 . . . . . . . . . . . . . .

Age at pregnancy outcome

15-19 years . . . . . . .

20-24 years . . . . . . . . . . . . .

25-29years . . . . . . . . . . ,..,

3C-34years . . . . . . . . . . . . . .

35-44years . . . . . . . . . . . ,..

Race

White . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . .

Origin

Hispanic . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . .

Education

Lessthan 12years . . . . . . . .

12years . . . . . . . . . . . . . . .

13yearsormore . . . . . . . . . . . .

Poverty level income

149percentorless . . . . . . . . . . .

150percentormore . . . . . . . . .

300percentormore . . . . .

Matital status

Nevermarried . . . . . . . . . . . ,,.

Currently married . . . . . .

Formerly married . . . . . . . . . .

Pregnancy order

Firstpregnancy . . . . . . . . . . . . .

Second pregnancy . . . .

Thirdpregnancy . . . . . . . . . . .

Fourth orlaterpregnancy. . . . .

34,970 100.0 39.5 60.5 14.8 28.7 17.1

17.4

18.1

17.2

16.1

15.4

17.5

16.2

●6. 1

1s.1

16.7

16.4

14.5

16.9

17.1

17.4

22.2

14.5

24.1

17.0

15.1

16,1

16.7

3,665

10,567

11,463

5,575

1,397

100.0

100.0

100.0

100.0

100.0

46.7

41.3

36.5

37.1

38.8

53.3

56.7

63.5

62.9

61.2

21.2

16.3

11.1

12.7

14.6

14.7

24.2

35.2

34.2

31.2

26,645

5,020

100.0

100.0

36.6

52.3

63.4

47.7

15.0

14.2

31.0

17.4

3,153

31,817

44.7

62.1

100.0

100.0

55.3

37.9

14.5

14.6

24.1

29.2

7,763

14,498

12,706

100.0

100.0

100.0

41.8

39.4

36.1

56.2

60.6

61.9

26.6

15.5

6.7

12.9

26.7

40.7

9,364

25,586

14,521

100.0

100.0

100.0

44.0

37.8

35.4

56.0

62.2

64.6

21.3

12.4

11.6

17.6

32.7

35.6

4,047

24,797

6.126

100.0

100.0

100.0

41.0

40.5

34.0

59.0

59.5

66.0

20.4

13.5

16.2

16.3

31.5

25.6

6,519

10,808

7,708

7,935

100.0

100.0

100.0

100.0

42.4

38.4

39.8

37.4

57.6

61.6

60.2

62.6

15.6

13.2

14.1

16.5

24.6

33.3

28,0

27.4

~Excludeswomen who have never been pregnant,

‘Includes white, black, and other rsces,

31ncludes pregnancies for which mother’s ageatoutsome was notaacetiain&, andthoae currently pregnant, notshown separately by age at pregnancy outcome,

36
Table 17. Number of wornen ever pregnant 1!5+4 years of age whose moat recent pregnanoy endad in Iiie bib or spontaneous pragnanoy ~ and

percent distributionby whether or not they smoked or drank dooholii beverages during their moat recent pregnanoy, according to selected

characteristioe:United Ststeq 1982

[Data exclude induced abortions. Statistics are based on a sample of the housahdd peculation of the ccmterminouaUnited States See appendices for discussion of tie sample design, estimates

of sampling variability, and definitions of terms]

Smoking and drinking during most recent pregnancy

Smoked or drank

Neither Drank Both

Number of smoked alcoholic smoked

women in nor Smoked beverages

Characteristic

and

thousands~ Total drank Total only only drank

Percent distribution

Tota12.3 . . . . . . . . . . . . . . . . .

Age at pregnancy outcome

15-19 years . . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . . .

2%29 years . . . . . . . . . . . . . .

3&34yeare . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . .

Origin

Hispanic . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . .

Education

Lessthan 12years . . . . . . . . . . .

12 years . . . . . . . . . . . . . . . . .

13years or more . . . . . . . . . . . .

Poverty level

149percent orless. . . . . . . . . . .

150percent or more . . . . . . . . . .

300percent or more . . . . . . . .

Marital status

Never married . . . . . . . . . . . . . .

Currently married . . . . . . .

Formerly married . . . . . . .

Pregnancy order

Frst pregnancy . . . . . . . . . . . . .

Second pregnancy . . . . . . . . . . .

Third pregnancy . . . . . . . . . . .

Fourth or later pregnancy. . .

31,599

2,933

9,511

10,764

4,955

1,194

26,016

4,561

2,868

28,731

7,139

13,428

11,032

8,358

23,241

13,06s

2,806

23,721

5,072

7,170

10,237

7,085

7,108

100.0 40.2 59.8 14.9 29.0 15.9

15.3

16.6

16.5

14.9

●14.9

16.3

15.3

“5.3

17.0

18.4

16.8

13.2

15.7

16.0

16.1

16,7

14.0

23,6

14.5

14.7

16.8

18.3

100.0

100.0

100.0

100.0

100.0

47.5

42.5

37.1

30.4

38.8

52.5

57.5

62.9

61.6

81.2

23.2

16.8

11.1

12.4

‘1 3.4

13.9

24.1

35.3

34.3

32.8

100.0

100.0

37.2

53.3

62.8

46.7

15.1

14.3

31.3

17.2

100.0

100.0

56.8

38.5

43.2

81.5

13.8

15.0

24.0

29.5

100.0

100.0

42.1

40.2

38.8

57.9

59.8

61.2

26.3

15.4

7.0

13.2

27.5

100.0 40.9

100.0

100.0

100.0

45.2

38.3

35.7

54.8

61.7

64.3

21.4

12.6

12.0

17.6

33.1

36.3

100.0

100.0

100.0

42.9

40.9

35.3

57.1

59.1

64.7

22.9

13.7

16.1

15.6

31.4

25.1

100.0

100.0

100.0

100.0

43.5

3a.5

41.0

38.3

56.5

61.5

59.0

61.7

17.3

13.3

13.4

16.4

24.7

33.5

28.7

27.1

‘Excludes women who have never been pregnant

‘Includes white, black, and other races,

alncludes pregnancies with mother’s age at outcome not ascertained, and those currently pregnant, not shown separately by age at pregnancy outcane,

37
Appendixes

Contents

I. Technical notes . . . . . .

Background . . . . . .

Statistical design . . . . . .

Measurement process . . . .

Data reduction . . . . . . .

Reliability of estimates . . .

Estimation of standard errors

Testing differences . . . . .

Nonsampling error . . . . .

Interview nonresponse . . . .

Item nonresponse . . . . . .

H. Concepts and definitions . . . . . .

Fecundity impairments . , . . . . , .

Fecundity . . . . . . . . . . . . . . .

Fecundity status . . . . . . . . . . . .

Surgically sterile . . . . . . . . . .

Nonsurgically sterile . . . . . . . .

Long interval . . . . . . . . . . .

Sub fecund . . . . . . . . . . . . .

Fecund . . . . . . . . . . . . . . .

Infertility status . . . . . . . . . . .

Surgically sterile . . . . . . . . .

Infertile . . . . . . . . . . . . . .

Fecund . . . . . . . . . . . . . . .

Wanted tohave ababy . . . . . . . .

Reported spontaneous pregnancy losses

Surgical sterilization . . . . . . .

Pelvic inflammatory disease . . . . . .

Cesarean section delivery . . . . . . .

Smoking and alcohol during pregnancy

Demographic terms . . . . . . . . . .

111. Accuracy and completenessof reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Items on the 1982 National Survey of Family Growth questionnaire related to fecundity, infertility, and reproductive

health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of appendix tables

39

39

39

40

40

40

40

41

42

42

43

44

44

44

44

44

45

45

45

45

45

45

45

45

46

46

46

46

46

46

47

48

49

1. Estimates of parameters A and B for relative standard error curves, by age, marital status, and race . . . . . . . . . 4 I

11. Approximate relative standard errors and standard errors for estimated number of women of all races combined: 1982

Nationa lSurveyo fFamilyGrowt h.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...41

111. Approximate standard errors for estimated percents expressed in percentage points, for women of all races: 1982

Nationa lSurveyo fFamilyGrowt h.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...41

IV. Percent of women with an induced abortion in 1981, by race and marital status, as estimated, as reported, and the

difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...48

38
Appendix 1

Technical notes

Background

This report is one of a series based on the National Survey

of Family Growth (NSFG), conducted by the National Center

for Health Statistics (NCHS). The NSFG was designed to

provide data on fertility, family planning, and aspects of maternal and child he~th that are closely related to childbearing.

The NSFG is a periodic survey based on personal interviews with a nationwide sample of women. The NSFG has

been conducted three times, in 1973, 1976, and 1982. The

present report is based on Cycle III of the NSFG. A detailed

report on Cycle HI is contained in reference 14. A detailed

description of the methods and procedures of Cycle II can

be found in another report?z This appendix presents a summary

of the more important technical aspects of the 1982 NSFG.

Fieldwork for Cycle 111was carried out under a contract

with NCHS by Westat, Inc., between August of 1982 and

February of 1983. The sample represents women 1544 years

of age regardless of marital status, in the noninstitutionalized

population of the conterminous United States. Women living

in group quarters, such as college dormitories, were included

in Cycle III. Interviews were conducted with 7,969 women;

3.201 were black, 4,577 were white, and 191 were of other

races.

Interviews were conducted by trained female interviewers

in respondents’ homes and lasted an average of 1 hour. The

interview focused on a woman’s pregnancy history, her use

of contraceptives in each pregnancy interval, her physical

ability to bear children, her expectations of bearing children

in the future, her use of family planning and infertility services,

her marital history, labor force participation, and a wide range

of social, economic, and demographic characteristics.

Statistical design

The NSFG is based on a multistage area probability sample. Black households and households with resident teenage

women were sampled at higher rates than other households

so that reliable estimates of statistics could be presented separately for black and teenage women. In addition, the sample

was designed to provide tabulations for each of the four major

geographic regions of the United States.

The first stage of the sample design consisted of drawing

a sample of primary sampling units (PSU’S). A PSU consisted

NOTE: A list ofreferencesfollowsthe text.

of a county, a small group of contiguous counties, or ~ standard

metropolitan statistical area as defined by the U.S. Bureau

of the Census in 1970. The second and third stages of sampling

were used to select several segments (clusters of 15 to about

60 dwelling units) within each PSU. A systematic sample

of dwelling units was then selected from each segment. Each

sample dwelling unit was visited by an interviewer who listed

all household members. The interviewer then consulted a computer-generated sampling table to determine which woman,

if any, should be interviewed.

The statistics in this report are estimates for the national

population and were computed by multiplying each sample

case by the number of women she represented in the population. The multipliers, or final weights, ranged from under

500 to over 50,000 and averaged about 7,000. They were

derived by using three basic steps:

● Irzjlution by the reciprocal of the probability of se[ection—

The probability of selection is the product of the probabilities of selection of the PSU. segment, household,

and sample person within the household.

● Nonresponse adjustment—The weighted estimates were

ratio adjusted for nonresponse by a multiplication of two

factors. The first factor adjusted for nonresponse to the

screener by imputing the characteristics of women in responding households to women in nonresponding households in the same PSU and stratum. The second factor

adjusted for nonresponse to the interview by imputing

the characteristics of responding women to nonresponding

women in the same age-race-marital status category and

PSU. Response to the screener was 95.1 percent: the

response to the interview wzs 83.5 percent, yielding a

combined response rate of approximately 79.4 percent.

● PoststratiJcation by marital status, age, and race—The

estimates were ratio adjusted within each of 24 age-racemarital status categories to independent estimates of the

population of women 15-44 years of age. The independent

estimates were derived from the U.S. Bureau of the Census

Current Population Surveys.

The effect of the ratio-estimating process was to make

the sample more closely representative of the noninstitutionalized population of women 15-44 years of age in

the conterminous United States. The final poststratification

reduced the sample variance of the estimates for most statistics.

All figures were individually rounded; aggregate figures

(numbers) were rounded to the nearest thousand. Aggregate

39
numbers and percents may not sum to the total because of

the rounding.

Measurement process

Field operations for Cycle III were carried out by Westat,

Inc., under contract with NCHS; these operations included

pretesting the interview schedule, selecting the sample, interviewing respondents, and performing specified quality control

checks. Interviewers, all of whom were female, were trained

for 1 week prior to field work. The first five interview schedules

done by each interviewer were reviewed; after a high level

of quality was achieved by an interviewer, this review was

reduced to a sample of questionnaires, unless an unacceptable

level of error was found. A 107percent sample of respondents

was recontacted by telephone to verify that the interview

had taken place and that certain key items were accurately

recorded.

A portion of the interview schedule applicable to this

report is reproduced in appendix IV. Two forms of the questionnaire were used, one for women 15–24 years of age and

one for women 25-44 years of age. The questionnaire for

women 15–24 included a few additional items that referred

to early experiences that women over 25 could not be expected

to remember accurately.

Data reduction

The responses of each woman to the interview questions

were translated into predetermined numerical codes, and these

co~e numbers were recorded on computer tapes. The first

few questionnaires coded by each coder were checked completely; after an acceptable level of quality was reached, verification of coding was performed on a systematic sample of

each coder’s questionnaires. The data were edited by computer

to identify inconsistencies between responses, as well as code

numbers that were not allowed in the coding scheme; these

errors were corrected.

Missing data on all variables used in this report were

imputed in order to provide consistent national estimates.

(To speed release of the public use computer tape, however,

not all variables on the computer tape were imputed. ) If the

level of missing data is relatively high (more than 5 percent),

this fact is noted in the “Concepts and definitions.” Only

two items are so affected: poverty level income and age (or

date) of first intercourse.

Reliability of estimates

Because the statistics presented in this report are based

on a sample, they may differ somewhat from the figures

that would have been obtained if a complete census had been

taken using the same questionnaires, instructions, interviewing

personnel, and field procedures. This chance difference between sample results and a complete count is referred to

as sampling error.

Sampling error is measured by a statistic called the

standard error of estimate. The chances are about 68 in 100

that an estimate from the sample will differ from a complete

count by less than the standard error. The chances are about

95 in 100 that the difference between the sample estimate

and a complete count will be less than twice the standard

error. The relative standard error of an estimate is obtained

by dividing the standard error of the estimate by the estimate

itself, and is expressed as a percent of the estimate. Numbers

and percents that have a relative standard error that is more

than 30 percent are considered unreliable. These figures are

marked with an asterisk to caution the user, but may be

combined to make other types of comparisons of greater

reliability.

Estimation of standard errors

Because of the complex multistage design of the NSFG

sample, conventional formulas for calculating sampling errors

are inapplicable. Standard errors were, therefore, estimated

empirically by using a technique known as balanced halfsample replication. This technique produces highly reliable,

unbiased estimates of sampling errors. Its application to the

NSFG has been described elsewhere .14’52

Because it would be prohibitively expensive to estimate,

and cumbersome to publish a standard error for each percent

or other statistic by this technique, standard errors were

computed for selected statistics and population subgroups

that were chosen to represent a wide variety of demographic

characteristics and a wide variation in the size of the estimates themselves. Curves were then fitted to the relative

standard error estimates (ratio of the standard error to the estimate itself) for numbers of women according to the model

RSE(N’) = (A + B/N’)1’2

where N’ is the number of women and A and B are the parameters

whose estimates determine the shape of the curve. Separate

curves were fitted for women of all races combined, for black

women, and for women of races other than black, because

different sarrtpling rates were used for black and other women.

Separate curves were fitted for teenagers, for the same reason.

The estimates of A andB are shown in table I.

To calculate the estimated standard error or relative standard error of an aggregate or percent, the appropriate estimates

of A and B are used in the equations:

RSEW = (A + B/N’ )1’2

SE~, = (A + B/N’ )1’2(N’ )

RSEP, = (B/P’ c (100 – P’)/X’)1’2

SEP, = (B*P’ “(100 – P’)/X’)1’2

where N’ = number of women

P’ = percent

X’ = number of women in the denominator of the

percent

NOTE: A list of references follows the text.

40
SE = standard error

RSE = relative standard error

Tables II and 111show some illustrative standard errors

of aggregates and percents of women of all races from Cycle III of the NSFG.

TaMe 1. Estimates of parameters A and B for relative standard error

curves, by age, marital statuaj and race

Age, Parameter Parameter

marital status, and race A B

Women 15-44 years of age

by marital status and race

All races and white:

All marital statuses . . . . . . . . . -0.0003935957 21,306.413351

Evermarried . . . . . . . . . . . . . . – 0.001097329 39,609.167663

Never marrie d . . . . . . . . . . . . -0.0009351043 17,608.883330

Black:

All marital statuses, ever married,

and never married . . . . . . . . . -0.0009086323 6,346.048380

Women 15-19 years of age

Allraces and white . . . . . . . . . . . . -0.001456493 13,862.104404

Black . . . . . . . . . . . . . . . . . . . -0.003322363 4,727.056926

Tab& Il. Approximate relative standard errors and standard errors for

estimated number of women of all races combined: 1982 Nstiinal Suwey

of Family Growth

Relative

Size of estimate standard error Standard error

50,000 . . . . . . . . . . . . . . . . . .

100,000. . . . . . . . . . . . . . . . .

500,000. . . . . . . . . . . . . . . . . .

1,000,000. . . . . . . . . . . . . . . . .

3,000,000. . . . . . . . . . . . . . . . .

5,000,0W. . . . . . . . . . . . . . . . .

7,000,000 . . . . . . . . . . . . . . . .

10,000,000. . . . . . . . . . . . . . . .

30,000,000. . . . . . . . . . . . . . . .

65.2

46.1

20.5

14.5

8.2

6.2

5,1

4.2

1.8

33,000

46,000

102,000

144,000

245,000

310,000

359,000

416,000

532,000

Testingdtierences

The standard error of a difference between two comparative statistics, such as the proportion surgically sterile among

white couples compared with black couples, is approximately

the square root of the sum of the squares of the standard

errors of the statistics considered separately, or calculated

by the formula

if

d=p’ –P’2

1

then

Sd = ti(P’1)2* (RSEP,,)2+ (P’2)2 ● (RSEP,:)2

where P’, is the estimated percent for one group and P’,

is the estimated percent for the other group, and RSE , and

RSEP,2are the relative standard errors of P’, and P’2, r&~ectively. This formula will represent the actual standard error

quite accurately for the difference between separate and uncorrelated characteristics although it is only a rough approximation

in most other cases.

A difference among comparable proportions or other statistics from two or more subgroups is statistically significant

when a difference of that size or larger would be expected

by chance in less than 5 percent of repeated samples of the

same size and type, if no true difference existed in the populations sampled. Such a difference would be statistically significant at the 0.05 level. By this criterion, if the observed difference or a larger one could be expected by chance in more

than 5 percent of repeated samples, then one cannot be sufficiently confident to conclude that a real difference exists between the populations. When an observed difference is large

enough to be statistically significant, the true difference in

the population is estimated to lie between the observed difference plus or minus 2 standard errors of that difference in

95 of 100 samples.

Although the 5-percent criterion is conventionally applied,

it is in a sense arbitrary; depefiding on the purpose of the

particular comparison, a different level of significance may

be more useful. For greater confidence one would test for

significance at the 0.01 ( 1-percent) level, but if one can accept

Table Ill. Approximate standard errora for estimated percents expressed in percentage points for women of Z4 races 19S2 National Survey of Family

Growth

Estimatadpercent

Base of percent 2 or 98 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4 10.1 13.6 18.5 21.2 22.6 23,1

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . ...’..... 2.9 4.5 6.2 8.2 9.4 10.1 10.3

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 3.2 4.4 5.8 6.7 7.1 7.3

5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 1.4 2.0 2.6 3.0 3.2 3.3

10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.0 1.4 1.8 2.1 2.3 2.3

30,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.6 0.8 1.1 1.2 1.3 1.3

50,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.4 0.6 0.8 0.9 1.0 1.0

Example of use of fable Ill: If 30 percent of women in a specific category were using the pill, and the base of thst percent was 10, OOQ,OOO,then the 20-percant column and the 10,000,000 row

mdcate that 1 standard error is 2,1 percentage pGints ard 2 standard errors are twice that, or 4.Z percentage points. Therefore, the chances are 95 in 1W hat the true percent m the population

was between 25,8 and 34.2 (30,0 p+wsent plus or minus 4,2 percent), This is called a 95.percent confkkmce interval. In addtilen, the relabve stsndard error of that W-percent estimate is

21 percent divided by 30 percent, or 7.o parcent,
a 10-percent chance of concluding a difference exists when

there actually is none in the population, a test of significance

at the 10-percent level would be appropriate.

The term “similar” means that any observed difference

between two estimates being compared is not statistically significant, but terms such as “greater,” “less, ” “larger,” and

“smaller” indicate that the observed differences are statistically

significant at the 0.05 level, by using a two-tailed t-test with

39 degrees of freedom. Statements about differences that are

qualified in some way (for example, by the phrases “the

data suggest” or “some evidence”) indicate that the difference

is significant at the 0.10 level but not the 0.05 level.

When a substantial difference observed is found not to

be statistically significant, one should not conclude that no

difference exists, but simply that such a difference cannot

be established with 95-percent confidence from this sample.

This is especially important in Cycle III because the number

of ever-married women in the sample is 4,651 in Cycle III,

compared with 7,970 in Cycle H-a reduction of 42 percent.

This means that the standard errors in Cycle III are larger

than in Cycle H, so it is harder to establish significant differences in Cycle HI than in Cycle 11. Lack of comment in

the text about any two statistics does not mean that the difference was tested and found not to be significant.

The number of replicates in the balanced half-sample

replication design minus one (39 in Cycle III) can reasonably

be used as an estimate of the number of degrees of freedom,

although the exact value of the degrees of freedom is unknown.

Therefore, in this report, differences between sample statistics

are compared by using a two-tailed t-test with 39 degrees

of freedom.

Example: In 1982, 68.8 percent of 25,195,000 currently

married white women were using some method of contraception, compared with 61.0 percent of the 2,130,000 currently

married black women. To test this racial difference at the

.05 level of significance, compute

[= 68.8 – 61.O

r

ti(68.8)’* RSE’,,8 ,, + (6 I .0)2” RSE2(,,,0,

Relative standard errors are computed using the appropriate

values for B from table I:

r

RSE[bX,8)=

J

(39809, 1677)*(100 – 68.8)

(68.8 )”(25,195,000)

and

RSE,br ~),=

J

(6346.0484)= (100 – 61 .0)

(61.0 )”(2,130,000)

= 0.044.

Thus

68.8 – 61.O t=

The two-tailed .95 critical value ( 1–w) for a t statistic with

39 degrees of freedom is 2.02. Therefore, the difference is

significant at the 5 percent level.

Nonsampling error

Although sampling error affects the reliability of survey

estimates, nonsampling error may introduce bias. The results

of any survey are subject to at least four types of potential

nonsampling error, including interview nonresponse; nonresponse to individual questions or items within the interview;

inconsistency of responses to questions; and errors of recording, coding, and keying by survey personnel.

To minimize nonsampling error, stringent quality control

procedures were introduced at every stage of the survey, including a check on completeness of the household listing;

extensive training and practice of interviewers; field editing

of questionnaires; short verification interviews with a subsample of respondents; verification of coding and editing; independent recode of a sample of questionnaires by NCHS;

keypunch verification; and an extensive computer “cleaning”

to check for inconsistent responses, missing data, and invalid

codes. A detailed description of some of these procedures

follows; others were previously discussed.

Interview nonresponse

Interview nonresponse occurs when no part of an interview

is obtained. It can result from failures at any of three principal

steps: ( 1) failing to list all households in sample segments,

(2) failing to screen all listed households, and (3) failing

to interview an eligible woman in each screened household.

A discussion of these steps follows.

The completeness of listing cannot be tested directly because it requires an independent, accurate enumeration of

the households that should have been listed. In the NSFG,

listing completeness and accuracy were tested by the missed

dwelling unit (DU) procedure at the time of screening: If

the first structure in a segment was included in the sample,

the whole skgment was checked to see if any structures had

been missed in the listing process; if the first structure was

a multiple-DU structure, and if the first-listed unit in the

building was included in the sample, the entire structure was

checked for missed DU’s.

Of the original sample of 34,641 DU’S screened, 3,614

were found to be vacant or not DU’S. 14C)fthe 31,027 occupied

DU’S, 4.9 percent were not screened successfully. Screening

was completed in 29,511 households; 9,964 of these contained

eligible respondents who were selected for interview. Interviews were not completed with 16.5 percent of these cases

because of refusals by respondents (8.3 percent) and by the

parents of respondents under 18 years of age (1.5 percent),

ti(68.8)2* (0.027)2 + (61.0)2-(0.044)2

= 2.39 NOTE Alistofreferencesfollowsthetext.

42
no contact after repeated calls (2.8 percent), or other problems

(4.0 percent).

The nonresponse adjustment for interview nonresponse

described earlier imputes the characteristics of responding

women of the same age group, race, marital status, and geographic area to nonresponding women.

Item nonresponse

Item nonresponse may have occurred when a respondent

refused to answer a question or did not know the answer

to a question, when the question was erroneously not asked

or the answer was not recorded by the interviewer, or when

the answer could not be coded. Nonresponse to individual

questions was very low in Cycle III, as it was in Cycle II. Some examples of item nonresponse among a total

of 7,969 respondents are the religion of the respondent, 11

cases, and the respondent’s occupation, 37 cases. The item

with the most item nonresponse was family income, with

1,767 cases. Missing data were imputed for all data items

in this report. For those few items where the proportion of

cases imputed was high, this fact is noted in the appropriate

section of the definitions.

As with all survey data, responses to the NSFG are subject

to possible deliberate misreporting by the respondent. Such

misreporting cannot be detected directly, but can be detected

indirectly by the extensive computer “cleaning” and editing

procedures used in the NSFG.

43
Appendix II

Concepts and definitions

Fecundity impairments

Fecundity impairments were measured in this report using

two different classification schemes. Fecundity status, which

is a demographic concept and makes full use of the data

in the NSFG, was used in tables 1-6 and figures 1–3. Infertility

status is a medical concept and allows comparable measurements of the trend in the prevalence of difficulty in conceiving

in 1965, 1976, and 1982, and was used in tables 7, 8, G,

and H, and in figures 3 and 4. This appendix contains definitions of fecundity, fecundity status, infertility status, and other

variables used in this report.

Fecundity

Following standard demographic usage, fecundity refers

to the ability (at the date of interview) of a woman or currently

married couple to reproduce, that is, to have live-born children;

while “fertility” refers to “actual birth performance” or number

of live births. In this report any medical, physical, or behavioral

condition that damages or diminishes a couple’s fecundity—

their ability to have children—is termed a fecundity

impairment.

It is difficult to measure the fecundity of a population,

and this is particularly true in household surveys that must

rely on the reports of respondents. The principal difficulty

in measuring fecundity is that some conditions have not been

diagnosed or may be completely obscured by the use of contraception (including contraceptive sterilization) by couples

who might otherwise have discovered an involuntary impairment. A woman or a couple is therefore classified as fecund

in the absence of any data to indicate sterility or any other

impairment.

Fecundity status

In reports from the National Survey of Family Growth,

the classification of fecundity status is based on the answers

women gave to a series of questions on whether, as far as

they knew, it was possible or impossible, or difficult or not,

to conceive a child or carry a pregnancy to live birth. In

some cases, success in measuring fecundity depends on the

amount of medical information respondents have about themselves, on their interest in having children in the future, and

on the opportunities they have had to detect that a problem

exists. However, most respondents were able to answer the

relatively straightforward questions in the NSFG interview

whether or not they or their spouses had had sterilizing operations, accidents, illnesses or diagnosed congenital problems;

whether or not they had been trying to become pregnant

and had not used contraception for a substantial period of

time; and whether or not their physician had told them that

thay had medical conditions that would make having a child,

or another child, difficult or dangerous. In this report, currently

married women have also provided information on their husbands’ fecundity. For unmarried (never married or formerly

married) women, fecundity status refers to the woman; for

currently married women, fecundhy status refers to the couple.

Fecundhy status (tables 1-6) is classified in six categories:

contraceptively sterile, surgically sterile for noncontraceptive

reasons, nonsurgically sterile, long interval, subfecund, and

fecund. For convenience and statistical reliability, the three

categories of nonsurgically sterile, long interval, and subfecund

have been combined under the heading of “impaired fecundity”

in several tables.

SurgicaHy sterile

A woman (or couple) was classified as surgically sterile

if the woman reported that it was impossible for them to

have a baby or another baby because she or her husband

had had a sterilizing operation. A surgically sterile woman

or couple was further classified by the woman’s answer to

the question “Was one reason for the operation because you

had all the children you wanted?” An affirmative answer

was classified as “contraceptively sterile,” and a negative

answer as “surgically sterile for noncontraceptive reasons.”

Surgically sterile women or couples, who form the majority of those who are no longer fecund, are different from

those who have “impaired fecundity” because their fecundity

status is caused by surgery and because not all surgically

sterile couples can be considered to have “impairments” in

the usual sense of the term. In most cases the surge~ is

undertaken for family planning rather than for therapeutic

reasons; and in other cases there is probably a mixture of

these motives. Surgical sterilization in which family limitation

is the controlling motive (C’contraceptively sterile”) cannot

properly be considered an impairment in fecundity or reproduction from the point of view of the sterile person or couple,

except possibly in the instances in which a person or a couple

later regrets the operation and seeks a reversal. However,

these contraceptively sterile couples still are not fecund, which

is important from a demographic point of view.

Sterilizing operations in which therapeutic considerations

44
were the controlling cause may properly be considered reproductive impairments because of their underlying causes. Although the question on the intent of sterilization operations

may not permit identification of all sterilizations that were

in part therapeutic, it is possible to identify the broadest level

of reproductive impairments in which the involuntary limitation

of childbearing may be involved by combining the surgically

sterile for noncontraceptive reasons with those who have “impaired fecundity.”

Nonsurgieally sterile

Women or couples were classified as “nonsurgically

sterile” if the woman reported that it was impossible for her

or her husband to have a baby or another baby for some

reason other than surgery-such as accident, illness,

menopause, or a congenital problem. A few women who

had experienced at least 3 years of trying to become pregnant

and not using contraception reported their conclusion that

it was impossible for them to become pregnant, but these

women are included in the “long interval” category.

Long intervsl

Couples were classified “long interval” because, while

they reported no specific cause, they had experienced at least

3 years of unprotected intercourse without becoming pregnant.

The remainder were classified in this category simply because

they reported no contraceptive use and no pregnancy in the

3 years of marriage preceding the survey. While some of

these couples might conceive in the future, the general medical

judgment is to consider 1 year of unprotected intercourse

as evidence of a fecundity impairment.32-35Note that a 3-year

period of nonuse without pregnancy is used for the “long

interval” category, suggesting probable (though not certain)

sterility ! 5 However, a l-year period of nonuse without

pregnancy is used for the “infertile” category, suggesting the

need for medical evaluation to see if a treatable condition

exists?2-35

Subfecund

Women or couples were classified as “subfecund” if the

woman reported that the couple had difficulty in conceiving

or delivering a baby or another baby, or that a pregnancy

in the future would be so dangerous to the woman, the baby,

or both that she would have a sterilizing operation or abortion.

Subfecund couples probably are not sterile, but their ability

to reproduce is diminished or impaired. For some couples

subfecundity may be the basis for subsequent sterilizing

operations.

Fecund

A woman or couple was classified as “fecund” in tables 1-6 if the woman reported that (a) it was possible to

have a baby or another baby; (b) there was no difficulty

having a future baby; and (c) the couple had used contraception

or the wife had been pregnant within the 3 years prior to

the interview.

In this report “fecund” is a residual category in the sense

that, if there was no information that indicated any kind of

fecundity impairment, the woman or couple was classified

as fecund. Respondents were classified as surgically sterile,

nonsurgically sterile, subfecund, long interval, and fecund,

in that order. For example, if the data necessary for the

nonsurgically sterile category were missing, the case was next

tested for the subfecund and then for the long interval

categories. The chances of misclassification because of this

procedure were virtually eliminated, however, since the classifications for all respondents were then checked for consistency

with other information (for example, current contraceptive

status); and all inconsistent cases were reconciled by using

other information on the questionnaire.

Infertility status

Following current medical usage, a couple is considered

to have a problem of infertility needing medical attention

after 1 year of unsuccessful efforts to become pregnant .32-35

Infertility status is used in tables 7 and 8 of this report because

it was not possible to measure trends in fecundity status comparably since 1965. However, it was possible to measure

infertility, as defined above, from the 1965, 1976, and 1982

surveys and to classify couples into one of three principal

categories: surgically sterile, infertile, and fecund.*1‘16’17

SurgiesHy sterile

A couple was classified as surgically sterile in the same

manner as is defined under fecundity status. However, because

the contraceptive intent of sterilizing operations was not determined in completely comparable ways in the 1965 and 1976

surveys,16’17these operations are not classified by contraceptive intent in these comparisons overtime.

Infertile

Couples who were not surgically sterile were classified

as infertile if they (a) had been continuously married,

(b) had not used contraception, and (c) had not become pregnant, for a year or more immediate~y preceding the interview.

In addition, a few wives who reported that it was physically

impossible for them or their husband to have a baby were

included here.

The “infertile” category provides medical practitioners

with a specific measure of difficulty conceiving that is used

for diagnosis and screening. The percent of currently married

couples who are infertile is lower than the percent of married

couples with impaired fecundity, because infertility includes

only difficulty conceiving, while impaired fecundity includes

difficulty conceiving and difficulty or danger carrying a

pregnancy to term.

Fecund

The category “fecund” is composed of those not classified

as sterile or infertile and is therefore a residual group, as

is the same categoty in the fecundity status classification.

The proportions fecund in the infertility status classification

are slightly higher than the corresponding proportions classified

NOTE: A list of references follows the text.

45
by fecundity status. This difference between the two classifications appears to be due primarily to wives for whom it was

difficult or dangerous to carry a pregnancy to term. Most

such wives were classified as having impaired fecundity but

would not be classified as “infertile” because they used contraception or had a pregnancy within the year before interview.

Wanted to have a baby

Some women or couples who are sterile or who have

impaired fecundity have already borne as many children as

they want. To assess the potential need for medical research

and services for fecundity impairments, it is useful to know

the numbers with impairments who would like to have a

child in the future. Those who were surgically sterilized for

noncontraceptive reasons, who were nonsurgically sterile, or

who were sub fecund and expected to have an operation or

abortion for health reasons were asked, “Even though it is

unlikely or impossible for you to have a(nother) baby, would

you like to have a(nother) baby?’ Most sub fecund couples

and most of those with long intervals were asked, “Do you

and your husband intend to have a(nother) baby?’ Women

answering “yes” to either question were classified as wanting

a baby or another baby. Such couples may be viewed as

needing medical services for their fecundity impairments.

A few women who indicated that having a baby or another

baby was beyond their control—that they did not know if

they intended to have a baby, that it was “up to God,” and

so forth-were also classified as “wanting another baby. ”

They were so classified because analysis suggested that they

would like a baby. They did not have an intent because

they did not know whether it was possible to have a baby

or another baby.

Reported spontaneous pregnancy losses

These losses refer to the reported number of pregnancies

that ended in a “miscarriage” or “stillbirth.” Most were reported

as miscarriages. Cases of multiple losses or live births plus

a loss were treated as one loss. Therefore, this is a count

of the number of pregnancies ending in one or more spontaneous pregnancy losses rather than the total number of spontaneous fetal losses. In almost all cases, however, the number

of spontaneous fetal losses and the number of pregnancy losses

is identical. In this report, “reported spontaneous pregnancy

losses” excluded reported induced abortions.

Surgical sterilization

In tables 9–11, data on surgical sterilization are presented.

Women who reported that it was impossible for them to have

a baby because of a sterilization operation were asked:

‘What kind of operation did you or your husband have that

makes it impossible to have a(nother) baby?’

The categories included “both tubes tied or removed” (“tubal

ligation” in tables 9–11 ), hysterectomy, and vasectomy. Other

types of sterilizing operations were obtained, recorded, and

included in the total, but there were not enough of these

other operations for separate analysis. About 100 respondents

reported more than 1 operation. If one was to the female

and the other to the male, the female operation was used

in tables 9–1 1. If both were female or both male, the earlier

operation was used.

The age of the respondent at sterilization (table 10) was

determined by subtracting the date of the operation (“When

did youlyour husband) have (OPERATION)?”) from her date

of birth. The woman’s age was used even if the operation

was done on her husband.

Pelvic inflammatory disease

All women in the NSFG were asked:

“Have you ever been treated in a doctor’s office, clinic, or

emergency room for an infection in your fallopian tubes, womb,

or ovaries, also called a pelvic infection, pelvic inflammatory

disease, or PID?’

Women who responded affirmatively were also asked:

“How many different times have you been hospitalized for

one day or longer for a pelvic infection?”

Women who answered “never” to the second question were

classified as having received “ambulatory” treatment for PID;

those who answered “once or more” were classified as having

been “hospitalized” for PID. These data are discussed in tables

12 and 14, and in a more detailed article?7

Cesarean section delivery

For each pregnancy, women were asked,

“Thinking about your (1st12ncVetc.) pregnancy, in which of

the ways shown on this card did the pregnancy end?’

The card contained the following alternatives:

A.

B.

c.

D.

E.

Stillbirth

Miscarriage

Abortion

Birth by cesarean section

Birth by normal (vaginal) delivery

Respondents who chose response “D’ were classified as having

a cesarean section delivery. The data were used in table 15,

which is based only on live births.

Smoking and alcohol during pregnancy

Women in the NSFG who had ever been pregnant were

asked:

“On the average during your (last) pregnancy, how many cigarettes per day did you smoke, if any?”

and:

“During your last pregnancy, how often did you usually drink

alcoholic beverages, that is, beer, wine, or liquor?’

One of the categories in the smoking question was “didn’t

smoke,” and one of the categories in the drinking question

was “never.” The responses to these questions were used

in tables 16 and 17.

NOTE: A list of referencesfollowsthe text.

46
Demographic terms

Age (at interview)-Age is classified by the age of the

responding woman at her last birthday before the interview.

Age at pregnancy termination-This is calculated as the

difference in completed years between the date the respondent’s

pregnancy ended and the date of her birth. The sum of the

categories for this variable does not add to the total number

of pregnancies because women who were currently pregnant,

or whose age at pregnancy outcome was not determined,

were excluded from the figures by age at pregnancy termination

in tables 14-17.

Race—Race refers to the race of the woman interviewed

and is reported as black, white, or other. In Cycle 111,race

was classified according to the woman’s report of which race

best described her. In Cycles I and H, race was classified

by the observation of the interviewer. Comparisons of Cycle III data indicate that results using either method of classification are very similar.

Marital status—Persons were classified by marital status

as married, widowed, divorced, separated, or never married.

In Cycles I and II, informally married women—women who

volunteered that they were sharing living quarters with their

sexual pa-trier-were classified as currently married. These

women constituted about 2 percent of currently married respondents in Cycle I and 3 percent in Cycle H. In Cycle III, such women were classified according to their legal

marital status. Thus, statistics on currently married women

for 1982 shown in this report are not strictly comparable

to those for 1973 and 1976. However, reclassifying women

in the 1973 and 1976 surveys according to the 1982 definition

of marital status makes little difference in the distributions

of currently married women by fecundity status for these years.

In all cycles, women who were married but separated

from their spouse were classified as separated if the reason

for the separation was marital discord, and as currently married

otherwise. “Formerly married” includes widowed, divorced,

and separated women.

Hispanic origin—A respondent was classified as being

of Hispanic origin if she reported that her only or principal

national origin was Puerto Rican, Cuban, Mexican American,

Central or South American, or other Spanish. In tables where

data are presented for women by race, women of Hispanic

origin are included in the statistics for white and black women

if they were classified as such by race.

Education—Education was classified according to the

highest grade or year of regulm school or college that was

completed. Determination of the highest year of regular school

or college completed by the respondent was based on responses

to a series of questions concerning (a) the last grade or year

of school attended and (b) whether that grade was completed.

Poverty level income—The poverty index ratio was calculated by dividing the total family income by the weighted

average threshold income of families with the head of household under 65 years of age. The ratio is based on the poverty

levels shown in U.S. Bureau of the Census Current Population

Reports, Series P-60, No. 140, “Money Income and Poverty

Status of Families and Persons in the United States, 1982,”

table A–3. This definition accounts for the sex of the family

head and the number of persons in the family. Total family

income includes income from all sources for all members

of the respondent’s family. For a substantial number of respondents (22 percent), total family income was not ascertained. These missing values were imputed using a known

value of another similar, randomly selected respondent. Because of these high levels of missing data, small differences

by poverty level income should be interpreted with caution.

Living arrangements at age 14-Women were classified

as living with both parents if they answered “yes” to the

question, “When you were 14, were you living with both

your own mother and your own father?” If they answered

“no,” they were classified as living with one or neither parent.

Region of residence—Data are classified by region of

residence into the four major Census regions: Northeast, Midwest, South, and West. Sample size greatly restricts the possibility of meaningful analyses by social characteristics among

smaller geographic divisions. The States included in these

four major geographic regions are as follows:

Gaographicregionand

division

Northeast

New England . . . . . . . . . . . .

Middle Atlantic . . . . . . . . . . .

Midwest

East North Central . . . . . . . .

West North Central . . . . . . .

South

South Atlantic . . . . . . . . . . . .

East South Central . . . . . . .

West South Central . . . . . . .

West

Mountain . . . . . . . . . . . . . . . .

Pacific . . . . . . . . . . . . . . . . . .

States includad

Maine, New Hampshire, Vermont,

Massachusetts, Rhode Island,

Connecticut.

New York, New Jersey, Pennsylvania.

Ohio, Indiana, Illinois, Michigan,

Wisconsin.

Minnesota, Iowa, Missouri, North

Dakota, South Dakota, Nebraska,

Kansas.

Delaware, Maryland, District of Columbia, Virginia, West Virginia, North

Carolina, South Carohna, Georgia,

Florida.

Kentucky, Tennessee, Alabama,

Mississippi.

Arkansas, Louisiana, Oklahoma,

Texas.

Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah,

Nevada.

Washington, Oregon, California.

Religion—Women were classified by religion in response

to the question, “Are you Protestant, Roman Catholic, Jewish,

or something else?’ In addition to the three major religious

groupings, two other categories-other and none—were used.

Because the category of Protestant includes numerous individual denominations, these respondents were further asked

to identify the denomination to which they belonged. Those

who answered “other” to the original question and named

a Protestant denomination were included as Protestant. Although specific denominational names were obtained and recorded, the numbers of cases for most denominations were

too few to produce reliable estimates; therefore, they were

combined in larger categories.

47

.- _—
Appendix Ill

Accuracy and completeness of

reporting

Ryder and Westoff 53 and, later, Ryder54’55 suggested

that deliberate underreporting of induced abortion may produce

biased measures of fecundity and contraceptive efficacy. Here

our concern is to answer the question “Are estimates of infertility and long intervals biased because of unreported induced

abortions?’

The Centers for Disease Control and Henshaw and others56

have compiled statistics on abortions in the United States

in 1980 by marital status and race. In table IV these are

compared with data from the National Survey of Family

Growth. The table is not shown by age because the NSFG

estimates in age groups have large sampling errors. The estimates from Henshaw and others are shown in the first and

fourth lines of table IV (“estimated”). The percents of women

who reported an abortion in 1981 in the survey are shown

in the second and fifth lines of table IV (“reported”). The

difference between the estimated and reported figures is the

percent who concealed, or did not report, an abortion that

They had in 1981, which is the same year in which they

were being classified as infertile or with a long interval.

The data in table IV show that about 2.8 percent of

Table IV. Peroent of women with an induced abortion in 1981, by race

and martil atatuq as estimated, as reported, and the dfierence

Black

Marital status All races White and other

Married

Estimated’ . . . . . . . . . . 1.1 0.9 3.1

Reported* . . . . . . . . . . . 0.9 0.9 1.2

Oifterence . . . . . . . . . . . 0.2 0.0 1.9

Unmarried

Estimated’ . . . . . . . . . . 5.0 4.4 7.1

Reported* . . . . . . . . . . . 2.2 2.3 1.7

Difference, . . . . . . . . . . 2.8 2.1 5.4

‘Source, reference 56. Abortion ratea per 1,000 women converted to percents by dividing by

10 See alao reference 11, table 7.

‘Reported in the National Survey of Family Growth, Cycle Ill.

NOTE A list of references follows the text.

all unmarried women—2. 1 percent of unmarried white

women, and 5.4 percent of unmarried black and other

women—apparently concealed an abortion in 1981. However,

measures of infertility and of long intervals are computed

only for currently married women, and the data in table IV

show that unreported abortions are much less a problem among

married women. For white married women, abortion reporting

was complete. About 1.9 percent of wives who were classified

as “black” or “other” apparently did not report an abortion

in 1981.

Thus, unreported abortions have virtually no effect on

the classification of all married women or of white married

women as infertile or with long intervals. For black women

and others, however, the maximum possible effect would

be 2 percentage points. Is it likely that the effect would

be this large? If a respondent conceals an induced abortion

she may do so in one of three ways:

(1)

(2)

(3)

Reporting an induced abortion as a spontaneous fetal

10ss.

Not reporting the pregnancy, whereby the abortion

is classified as an interval of successful use of

contraception.

Not reporting the pregnancy, whereby the abortion

is classified as an interval of nonuse of contraception

without pregnancy.

Respondents using (1) and (2) would be classified as

fecund, as they should be. Only (3) would misclassify respondents as infertile when they were in fact fecund. How many

would be concealed in each of these three ways is unknown.

Comparing the results in Cycle III with those in Cycle II, overall, about 67 percent of abortions to married women

in 1975 were reported by women in the 1976 survey. About

82 percent of abortions to married women in 1981 were reported by women in the 1982 survey (table IV). Thus, abortion

reporting among married women has, apparently, improved.

(Unmarried women apparently reported only about 44 percent

of their 1981 abortions in the 1982 survey, as shown in

table IV).

48
Appendix IV

Items on the 1982 National

Survey of Family Growth

questionnaire related to

fecundity, infertility, and

reproductive health

B-19. Thinking about your ( lst/2nd/etc. ) pregnant y,

zn which of the ways shown on this card did

the pregnancy end? (CIRCLE CODE HERE AM3

—

ON B&P RECORD. )

L

HAND

CARD

7

P..

B.

c.

D.

E.

Stlllb~rth . . . . . . . . . . . .

Miscarriage. . . . . . . . . . . .

Abort ion . . . . . . . . . . . . .

Birth by Cesarean sectmn. . . . .

Birth by normal (vaginal) delivery

IF MULTIPLE OUTCOME, CIRCLE FIRST OUTCOME

WOVE AND ENTER LEr TER FOR OTHER OUTCOME(S)

ON LINE . . . . . . . . . . . . . . . . . . . .

FIRSf

PREGNANCY

. . . . . . . 1 (B-22)

. . . . . . . 2 (B-22)

. . . . . . . 3 (B-22)

. . . . . . . 4 (B-20)

. . . . . . . 5 (B-20)

SECONO

PREGNANCY

. . . . . . . 1 (B-22)

. . . . . . . 2 (B-22)

. . . . . . . 3 (B-22)

. . . . . . . 4 (B-20)

. . . . . . . 5 (B-20)

SECTION D

We are also talking with women about children they would like to have or expect to have in the future. (IF “R” HAS

ALREADY MENf IONED SfERILITY OR MENOPAUSE, EfC. , SAY: I think we have slready talked about some of these questions,

but I‘ d better go through them with you to be sure I record the anawers correctly. )

BOX 35. IF R IS CURRENTLY PREGNANT, SKIP ro D-15, PAGE 49.

BEGIN CARD 16

D-1 . Some (couples/women) find it physically impossible to have (more) children. As far as YOU know, is it

~ or impossible for you (and your husband) to conceive a(nother) baby, that is, to get pregnant

(again)?

Possible . . . . . . . . . . . . . . . . . . 7 (0-15)

Impossible . . . . . . . . . . . . . . . .. 2(0-2)

Don$t know, not sure . . . . . . . . . . . . 8 (D-15)

IB

D-2. Have you (or your husband) had an operation, or more than one operstion, thst makes it impossible for you to

conceive a(nother) baby (together)?

Yes . . . . . . . . . . . . . . . . . . . . . 1 (D-3)

No . . . . . . . . . . . . . . . . . . . . . 2 (D-12)

D-3. Mat kind of operation, or operations, did you (or your husband) have that makes it impxsible to have

a(nother) baby? (CIRCLE CODE(S) ON TOP OF TABLE ON NEXT PAGE. IF CUDf 5 CIRCLED, GO TO BOX 36 BELOW.)

19

❑

20

49
D-3

ASK D-4 THROUGH D-8 IN SEQUENCE FOR BOTH TUBIS HYSTERECTOMY VASECTOMY OTHER

EACH OPERATION. BOTH OVARIES ~ OR (REJWL)OF (CUTTING MALE OPERATION OR

_REt40vED REMOVED SPERM DUCTS) TYPE UNKNOWN

1 2 3 4 5 (BOX 36)

D-4 . Men did ( ou/your husband) have

(OPERATION;? lTl---’-YTf-- —---T-’--YR-- —-T——’—YtT— —-—f#7R———— ---F&-T’R---

D-7 . Was one reason for having (OPERATION)

because you (had all the children

you wanted/did not want to have any

children)?

Yes . . . . . . . . . . .

No . . . . . . . . . . .

. . .

. . . ;

. . .

. . . ;

. . .

. . . ;

. . . 1

. . . 2

. . . 1

..!, 2

0-12. ‘that ia the reaaon that it ia physically impossible for you (and your husband) to have a(nother) baby?

(RECORD VER8ATIM, THEN CODE ALL THAT APPLY. )

,, RI, haa re~hed menopause. . . . . . . . . . 01

Impossible for “R1l due to ~cident

orillneas . . . . . . . . . . . . . . . .02

!(R~l sterile for other reasons. . . . . . . . 03

VRU not yet fertile, perioda have

notatarted . . . . . . . . . . . . . . . . 04

Impossible for husband due to accident

or illness . . . . . . . . . . . . . . . . 05

Husband sterile for other reasona. . . . . . 06

Couple (or respondent) unable to

conceive, do not know reaaon . . . . . . . 07

m62-63

m64-65

0-13. hhen did it become impossible for you ( and your husband) to have a(nother ) baby? (IF OON’ T KNOW, PROBE:

Ken did you first know it was physically impossible . . . ?)

I 1111

MONTH ( SEASON) YEAR 66-69

—

D-14. If it were possible for you to have a(nother) baby, would you yourself like to have one?

Yea . . . . . . . . . . . . . . . . . . ...1

M

~} (D-37)

. . . . . . . . . . . . . . . . . . . . .

D-15. Some people are able to have a(nother) baby, but have difficulty getting pregnant or holding onto the bsby.

As far as you know, ia there any problem or difficulty for you ( and your husband) to conceive or deliver

a(nother) bsby (after this pregnancy)?

Yes . . . . . . . . . . . . . . . . . . . . . 1 (D-16)

k . . . . . . . . . . . . . . . . . . . . . 2 (D-17)

~n’t know . . . . . . . . . . . . . . . . . 8 (D-17)

70

71

—

50
D-16. What is the resson it would be difficult for you to have a(nother) baby? (RECORD VERBATIM ON LINES AT LEFT

AND THEN CIRCLE APPROPRIATE CODE. )

R has physical difficulty getting

pregnant . . . . . . . . . . . . . . ...1

Difficult for husband to father child. . . . 2

Dangerous for *IR,* to become pregnant

eqain . . . . . . . . . . . . . . . . ...3

Dangerous forthebsby. . . . . . . . ...4

Difficult to carry pregnsncy full

9manths . . . . . . . . . . . . . . ...5

Other. . . . . . . . . . . . . . . . . . . .6

72

D-17. At my time haa a medical doctor advised you never to beccine pregnant (again)?

Yes. . . . . . . . . . . . . . . . . . . . . 1 (D-18)

k

73

. . . . . . . . . . . . . . . . . . . . . 2 (BOX 42)

E-24. To get a complete picture of childbearing and wcinen’a health in this country, we also need to know about the

treatment women have received for health problems that could affect their childbearirq. Have you ever been

treated in a doctor’s office, clinic, or emergency roan for an infection in your fallopian tubes, womb, or

ovaries, also called a pelvic infection, pelvic inflammatory diaeaae or PID? (IF DDN’T KNOW, PROBE: a female

infection causing abdominal pain or lower stomach cranps. )

Yes. . . . . . . . . . . . . . . . . . . . . 1 (E-25)

NO . . . . . . . . . . . . . . . . . . . . . 2 (E-26)

E-25. How many different times have you been hospitalized one day or longer for a pelvlc infection? Would you

say . . .

Never, . . . . . . . . . . . . . . . . . . .1

I%ce,. . . . . . . . . . . . . . . . . . . .2

2-3times, . . . . . . . . . . . . . . . . .3

Or, more than 3 times? . . . . . . . . . . . 4

51
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SERIES 1.

SERIES 2.

SERIES 3

SE RI ES4.

SERIES 5

SERIES 10

SERIES 11,

SE Ftl ES 12.

SERIES 13.

Programs and Ccdlccticsn Proccdurctg-f%epor-ts d,:~crib[ng

the gmeral programs of the National Center for tiealrh

Stat[?it [cc and its of ftcm and divic.lcms and the datn col -

kctron methcxk uxd They al~o [nclude d?fin, t!on:. and

other m,aterial nc!ce$wr$j for uncferztand!ncj the data

Dato Evaluation and Mcthcidci Flczcmrch –Studle: of nef:

Jtatiztlcal m~thodolo~+ rncludlng e:..fmrimental twts af

IW,...I surve,; methods, ztudlm of wtal ztatls.tics collection

methodz, nev~ anah$tical techniques, oiqectlw ewluat[on~

of reliability of collect!?d data, and ccmtr!but!cms to

ztattstlcal theor.} Studtes algo include comparison of

Lf,S. methodology v~ith those of other countmx

Analytical and Epidcmiolugmal Studicw-R(+ports pr@-

!enting anal,; tic,al or int~,rpretive gtudux bawd on vital

znd health ztatlnt(cr, carrying th,! wml,;srs further thm

the expository typm of reports in the other v?ri,?~

Dcmumc.nts and Corn mittes Reports– F [nal r.parts ctf

major committees cancwned t.:(th ,vttal and htialrh statl$ticc and documents such m recommended model vrt.al

rq]st ration la\.J; and revtmd lmrth and d!?ath certtflcm!?s

C9mparativo International Vital and I-fcalth Statlsticrj

Reports- Andytmai and ds!xnptrw? rtports compartng

U S. vital and health ?tatijr[csv.vth thow? of other countrmz

Data From the National Health Intowmw Surt”cy-Statls.

t!cc on illnezs, accdwwd !nJuricc, dlsablllty, use of hciGpltal, medtcal, dsntal, and other s’?rvlce!., and othc.r

Iwalth-n?lated topim, all bawd on data collected [n rhe

continuutg national houmh old intwvic!i.~ survey

Data From the National Health Exizmmcmon Survey and

the Natiorml I-foa!th and Nutrition Examination Survey–

Data from direct examination, tmoncj, and measurement

of national campl,x of the civ!l [an nonlnzt]t ut(onallzed

population provide the bwc for 11I estimates of the

medically cfcfmed prevalence of qmcific diwav?s (n the

United Statez snd the di~tr!butiom of the population

~;:ith respect to phys!ca!, phyriologtcal, and psycho.

logical chwacterl$ticz cmd (2) anal;, z~s of relation~hlps

amang the vartous mmwrements \-.vthOUt reference to

an explicit finite unfverw of persons.

Data Front the Institutionalized Population SurvcW-DIscontinued m 1975. RcgrcwtS from tfww wrveyz we In.

clucf~d in Series 13.

Data an H8akh Resources Utilization -Stat (st[c!j an the

utilization of health mcmpcn..w and facilitiix providing

longwwm care, ambulatory care, hospital care, and fam!ly

planning mrviwz.

SERIES 14

SERIES 15

SE RI ES20

SERIES 21

SERIES 22

SERIES 23.

Data on Health 13esotmx~: Manpower and Faci!itiesStat! zticri on ths? numb?rz, gsacyaph[c distrlbut[cm, and

ch mactermtrcs af htalth resnurce; includlng ~hysrci,an$,

dmt(m~, nur:es, other h,ealth accupatian~, hozprta!g,

nurnnsj homm. arid outpatient facilities

Data From SPSCKJ1 Surveys-StatlLticL an haa[th ?nd

he,alth-r,?[ated taplc~ callccti:d in special wrve!;$ rhat

are not a part of the ccmttnuing data ;,; ~temz of the

~Jatlonal Center for I+ealth Stat! st!cs

Data on P.?ortality-b’oricms ztat[mict cm mortality other

than as Includsa’ m regular annual or monthly rkports

SP~cml =dvw b case of d?ath, w:, and other d?mo.

graphic varmbles; g?agraphic ,and timp $erle~ analt,,~e~,

and statistics on characteristics of d?athc not w.’aIlaMe

fram the vital records bas?d on zample sur,~el~z of tha~e

records

Data on Namlity, Marriage, and Divorce -Varmus sta.

tlstlc$ on natal it,;, marr,acj?, and d!,.rcirce other than as

]ncluded In regular annual or manthiy repnrtz Sfmc[a[

:in~l;r~: by d?mogr~.ohic ,:arfablcs, tyogrsphrc and t,me

~f:r,,?; znal.; v?t. studies of fert,li!~; ; and jtat]ztlct on

character j~trc~ of b!rthz not ava,lable fram the !:ital

recordz b,azed on zampl@ 5uPJ,?*,*$of th~:,+; rccafdj

Data From the Nmmrm! P.lortality and Natalny SurveysD,zccmtlnued In 1975, Repart~ frctm these sample surveys

bawd on wtal recordz ar~ mc[udzcl ,n Serwz 20 and 2?,

recp):ctwl:l~,

Data From tlm Natmncd Survey of Family GrowthStat, zt[ix on fert(lit$; . famrly farmatton and d,xolurton,

famrl$, planntng, and related maternal and )nfznt health

tOp]Cs d?r!+ved from a p:erladlc ~urvey of a n,~t(on~..:[de

probablltt,; sample of m,er-married $:.omen 1544 *;ears

of a$J9.

For an$i..ar~ to cy-tettionc about this report or for a fist af titles of

reportc published in thew zeries, cant,?ct,

Scwntific and Technical Information Branch

Natianal Center for Health Stati$tic~

Public HeaIth Ser.’!ce

kfyattwllle, P:Id. 20782

301436-8500
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

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National Center for Health Statistics

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