Reproductive

Impairments

Among Married

Couples: United

States

Statistics based on data collected in 1965

and 1976 are presented on the fecundity

status and number of spontaneous

pregnancy losses married couples had

had as of 1976. Data are also presented

on the infertility status of couples in 1965

and 1976. The statistics are shown by

age, race, and selected socioeconomic

characteristics.

Data From the National

Survey of Famiiy Growth

Series 23, No. 11

DHHS Publication No. (PHS) 83-1987

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics,

Hyattsville, Md.

December 1982
COPYRIGHT INFORMATION

All material appearing in this report is in the pubhc domain and

may be reproduced or copied without permission; citation as to

sxxrce, however, is appreciated.

SUGGESTED CITATION

National Center for Health Statistics, W.D. Mosher and W.F. Pratt.

Reproductive Impairments among married couples United States.

!//fa/ and Hea/t/r Statistics. Pubhc Health Service. Washington. U.S.

Government Printing Office, December 1982.

Library of Congress Cataloging in Publication Data

Mosher, William D.

Reproductwe impairments among married couples, United

States.

(Vital and health statistics. Series 23, Data from the national

surwey of family growth ; no. 11) (DHHS publications ; no. (PHS)

83-1987)

Includes blbhographical references.

1. lnfertili~-United States—Statistics. 2. Fertility, Human—

United States—Statistics. 3. Health surveys-United States. 4.

United States—Statistics, Medical. 1. Pratt, Wdllam F. Il. Title. Ill.

Ser!es W. Series: DHHS Publication ; no. (PHS) 83-1987.

RC889.M76 614.5’9692’00973 82-6459

ISBN 0–8406+2520–9 AACR2
National Center for Health Statistics

ROBERT A. ISIL4EL, Acting Director

JACOB J. FELDMAN, Ph.D., Associate Director for

Analysis and Epidemiology

GAIL F. FISHER, Ph.D., Associate Director for the

Cooperative Health Statistics System

GARRIE J. LOSEE, Associate Director for Data

Processing and Services

ALVAN O. ZARATE, Ph.D., Assistant Director for

International Statistics

E. EARL BRYANT, Associate Director for Interview

and Examination Statistics

ROBERT L. QUAVE, Acting Associate Director for

Management

MONROE G. SIRKEN, Ph.D., Associate Director for

Research and Methodolo~~

PETER L. HURLEY, Associate Director for Vital and

Health Care Statistics

ALICE HAYWOOD, Information Ojicer

Vital and Health Care Statistics Program

PETER L. HURLEY, Associate Director

GLORIA KAPANTAIS, Assikant to the Director for

Data Policy, Planning, and Analysis

Division of Vital Statistics

JOHN E. PATTERSON, Director

ALICE M. HETZEL, Depu@ Director

WILLIAM F. PRATT, Ph.D., Chief Family Growth

Survey Branch

MABEL G. SMITH, Chiej Statistical Resources Branch

JOSEPH D. FARRELL, Chie$ Computer Applications

Stafl
Contents

Introduction ......................................................................................................................................................................................

Summary of principal findings .........................................................................................................................................................

Background ......................................................................................................................................................................................

Classification by fecundity status ...................................................................................................................................................

Contraceptively sterile .............................................................................................................................................................

Surgically sterile, noncontraceptive .......................................................................................................................................

Nonsurgically sterile .................................................................................................................................................................

Subfecund ................................................................................................................................................................................

Long intewal .............................................................................................................................................................................

Impaired fecundity ................................................................................................................................................................. ...

Fecund ......................................................................................................................................................................................

Comparisons with other data ..........................................................................................................................................................

Rndings ............................................................................................................................................................................................

Age, parity, and years since first marriage .............................................................................................................................

Race .............................................................................................................................................. ................................... .........

Socioeconomic characteristics and fecundity status ............................................................................................................

Education .............................................................................................................................................. ............................

Poverty level income ...................................................................................................................................................... ..

Religion .............................................................................................................................................................................

Region ...................................................................................................................................................... .........................

Occupation ........................................................................................................................................................................

Differentials in reported spontaneous pregnancy losses .....................................................................................................

Reproductive impairments and “infertility” problems ...........................................................................................................

Trends in infertility ............................................................................................................................................... .....................

References ................................................................................................................................................. .................................. ....

List of detailed tables .....................................................................................................................................................................

1

2

4

5

5

5

6

6

6

6

6

7

8

8

9

10

10

10

11

11

11

11

13

14

17

19

Appendixes

L Technical notes ...................................................................................................................................................... ................... 38

IL Concepts and definitions .......................................................................................................................................................... 45

Ill. Items on the National Survey of Family Growth questionnaire related to reproductive impairments ................................ 50

‘.ist of text figures

1. Percent distribution of all currently married couples with wife 15-44 years of age by fecundity status: United States,

1976 ............................................................................................................................................................................................. 5

...

Ill
2. Percent fecund among currently married couples with wife 15-44 years of age, by age: United States, 1976 .................

3. Percent distribution of currently married couples with wife 15-44 years of age by fecundity status and race: United

States, 1976 ...............................................................................................................................................................,.....”..........

4. Percent of currently married women 15-44 years of age with 1 or more reported spontaneous pregnancy losses, by

age: United States, 1976 ............................................................................................................................................................

5. Number of currently married couples with impaired fecundity who want a baby or another baby, by parity: lUnited

States, 1976 ...................................................................................................................................................... ...........................

6. Percent distribution of all currently married couples with wife 15-44 years of age by infertility status: United States,

1965 and 1976 ............................................................................................................................................................................

7. Percent of couples with wife 15-29 years of age classified as infertile, by race: United States 1965 and 1976 ...............

List of text tables

A. Percent distribution of currently married couples with wife 15-44 years of age by parity and fecundity status,

according to race: United States, 1976 ...................................................................................................................................

B. Percent of pregnancies (excluding induced abortions) to currently married women 15-44 years of age ending in a

spontaneous pregnancy loss and standard error of the percent, by age and outcome of previous pregnancy: [Jnited

States, 1976 ..............................................................................................................................................................................

C. Number of currently married women 15-44 years of age with 1 or more completed pregnancies, and percent with 1

or more pregnancy losses, by age, according to race United States, 1976 ........................................................................

Symbols used in tables

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but lessthan

0.05

z Quantity more than zero but lessthan

500 where numbers are rounded to

thousands

8

9

12

14

15

16

10

12

13

●

Figure does not meet standards of

reliability or precision
Reproductive

Impairments Among

Married Couples: United

States

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

VitalStatistics

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.

The National Fertility Study, a predecessor of the

National Survey of Family Growth, was conducted by

the Office of Population Research of Princeton University and was designed to provide similar kinds of data.

This report presents final data from these surveys

on reproductive impairments-that is, involuntary

conditions that make it dificult or impossible to have

children or additional children-among married couples in the United States in 1976 and 1965. These data

supersede those published in a preliminary report

using a diEerent classification scheme.1 The data in

this report are probably the most comprehensive set of

national estimates ever published on trends and

differentials in reproductive impairments in the United

States.

Two classilkation schemes are used here to measure reproductive impairments: fecundity status, which

is a demographic concept and makes the more complete use of the data available in the 1976 survey; and

infertility status, which is a medical concept, and

permits comparable measurement of trends between

1965 and 1976. Before this report and a related article

were published,2 there were no reliable national

estimates of the prevalence of infertility in the United

States.

Reproductive impairments have important effects

on birth rates as well as on the lives of the couples

affected.3 Some couples are unable to have any

children, and others are not able to have as many as

they would like. Data on reproductive impairments

may be useful in evaluating the plausibility of birth

expectations and birth rate projections; in explaining

trends and diEerences in childlessness; in assessing the

demand for adoption; and in estimating the number of

couples in need of medical treatment for reproductive

impairments, sometimes called “infertility services.”4

In this report no attempt is made to test causal

hypotheses or theories about the causes of impairments. Nor is it attempted to study the demographic

and health consequences of impairments in detail.

However, these issues have guided the selection of the

variables for analysis and presentation; and the data

presented here are considered fundamental background for such analyses.

1
Summary of principal

findings

This report presents final data on reproductive

impairments, It includes data on the fecundity status

of married couples in the United States in 1976 and on

trends in infertility among married couples between

1965 and 1976. The data are based on personal

interviews with two nationally representative samples

of currently married women 1544 years of age: the

1976 National Survey of Family Growth, or NSFG,

and the 1965 National Fertility Study, or NFS.

In this report “fecundity status” is a characteristic

of a currently married couple at the date each woman

was interviewed. Unless classified by parity (the

number of children ever born), each category of

fecundity status includes couples with any number of

children (from none to many). Fecundity status is a

demographic concept. It is used extensively here

(tables 1-14) because it makes use of all of the

questions on reproductive impairments in the 1976

NSFG. About 19 percent of married couples (or 5.1

million) were contraceptively sterile in 1976. Another

10 percent, or 2.7 million, were surgically sterile for

noncontraceptive reasons; 16 percent, or 4.3 million,

had nonsurgical fecundity impairments. About 56

percent, or 15.4 million, were fecund—that is, able to

have a baby. Most of the couples who were not fecund

had one child or more and did not want additional

children.

One definition of the population in need of medical

services to help them have children is those couples

who have impaired fecundity and who want children

or additional children. About 47 percent of the 4.3

million couples with fecundity impairments, or about

2.0 million, wanted to have a baby or another baby,

including about 840,000 who had no children, about

641,000 who had one child, and about 556,000 who

had two or more,

The percent of married couples with impaired

fecundity ranged from 9 percent among married

teenagers to 20 percent among couples with wives 40-

44 years of age in 1976. Because the proportion of

couples surgically stetile also increased sharply with

age, the percent fecund decreased from 90 percent

among married teenage women to 31 percent of

married women 40-44 years of age.

Black couples were substantially more likely to

have impaired fecundity than white couples were (23

percent compared with 15 percent) in 1976. Black

couples were less likely to be surgically sterile, however, so the proportion fecund was about 56 percent

for both white and black couples. The proportion of all

couples who had no children and who had impaired

fecundity was about 4 percent for both white and black

couples.

Fecundity status in 1976 is also shown by education, religion, geographic region, labor force status,

occupation of the wife, occupation of the husband, and

Hispanic origin of the wife. The percent fecund ranged

from 47 percent in the lowest educational group to 63

percent in the highest. White Catholic couples were

more likely to be classified as fecund than white

Protestant couples (61 percent compared with 52

percent). In the Northeast the percent with impaired

fecundity was higher, and the percent surgically sterile

was lower, than in the other three regions. ‘There are

techniques, including “synthetic estimation,” that may

be used to make estimates of the fecundity status or

infertility status of married couples for States and local

areas. The data and assumptions necessary to make

such estimates are briefly noted in this report,

Currently married women were also classified by

the number of spontaneous pregnancy losses—miscarriages or stillbirths-they reported, About 22 percent

of wives reported one or more, Among wives 35-44

years of age, 31 percent reported one or more.

Because fully comparable data on fecundity status

could not be obtained from other survey~, a final

section of this report contains statistics on couples

classified by “infertility status” in 1965 and 1976.

“Infertility status” (tables 15 and 16) contains three

categories: “surgically sterile,” “infertile,” and “fecund.”

The percent of couples who were surgically sterile

(for contraceptive or noncontraceptive reasons) increased from 16 percent in 1965 to 28 percent in 1976.

2
The increases in surgical sterility were widespread, but

they were largest among white couples, couples with

wives 30-44 years of age, and wives with 3 or more

births. In the last-named group only 22 percent were

surgically sterile in 1965, compared with 50 percent in

1976.

“Infertile” couples are those with any number of

children who have never had a sterilizing operation

and who, for at least 12 months immediately before the

interview, have been continuously married, have not

used any contraception, and have not become pregnant. Infertility is a widely used medical concept, but

there were no reliable national estimates of it before

this report and a related article.z About 1in 10 couples

were classified as infertile in both 1965 and 1976.

However, the percent infertile increased from 5 to 7

percent among the younger couples and decreased

from 16 to 13 percent among couples 3044 years of

age. Among couples 15-29 with no children or one

child, the data suggest that the percent infertile

increased from 6 to 9 percent. Among younger black

couples, the proportion infertile more than doubled,

from 5 to 12 percent.

The percent of couples classified as “fecund”

decreased between 1965 and 1976 in almost all age,

race, and parity groups, although the reductions in a

few of these groups were not statistically significant.

These reductions in the percent fecund, which were

largest at the later ages and highest parities, were

primarily a result of increases in the percent surgically

sterile.
Background

In this section, the design of the National Survey

of Family Growth (NSFG) is discussed, along with

some other important background. The design of the

1965 National Fertility Study is discussed in the

section “Trends in infertility.” The 1976 NSFG was

based on personal interviews with a multistage area

probability sample of 8,611 women 1544 years of age

in the conterminous United States. Women were

eligible for inclusion in the sample if they were

currently married, previously married, or never married but had offspring living with them in the household. Between January and September of 1976, 3,009

black women and 5,602 women of other races were

interviewed.

This report is based on data collected from

currently married women. In 1976, 6,482 of these

women were interviewed. The interview 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 maternal care

and fhmily planning services, reproductive impairments, and a wide range of social and economic

characteristics.

Characteristics such as age, race, Hispanic origin,

parity, education, geographic region, labor force status, and religion refer to the women interviewed. In

this report, fecundity status and infertility status refer

to the couple as of the date the woman was interviewed. For convenience in writing, in this report, the

term “black couples” refers 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 these 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, definitions of terms,

and sampling variability can be found both in appendixes I and II of this report and in “National Survey of

Family Growth, Cycle II: Sample Design, Estimation

Procedures, and Variance Estimation,” Series 2, Number 87.S

In this report the term “similar” means that any

observed difference between two estimates 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,0 degrees

of freedom. Statements about differences that are

qualified by using the phrases “the data suggest” or

“some evidence” indicate that the difference is significant at the 10-percent level but not at the 5-percent

level.

Following this summary and background, this

report contains sections describing how couples were

classified by fecundity status, comparisons with other

data, a detailed discussion of the findings for 1976,

differentials in pregnancy loss, reproductive impairments and “infertility problems,” and trends in infertilityy. Appendixes I-III contain technical notes on

both surveys, definitions of terms, and the 1976 survey

questions on reproductive impairments.
Classification by fecundity

status

Fecundity

questions. All

status was measured by a series of

currently married couples were classified into one of six categories of fecundity status:

contraceptively sterile, noncontraceptive surgical sterility, 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 birth have been

grouped into the overall category of “impaired fecundity.”

The data for 1976 were obtained by asking

respondents whether it was possible or impossible, and

difficult or not difficult, for them to have a baby or

another baby. If the respondent said it was diilicult or

impossible, she was asked why. With a few exceptions

(explained below), respondents who said that it was

impossible for them to have a baby or another baby

were classified as sterile, and those who said it was

difficult were classified as subfecund. The fist question

on reproductive impairments was the following:

It is g&sidly impossible for some couples to

have children. As far as you know, it is

p.msibk or impmshk for you and your husband to conceive a(nother) baby, that is, to get

pregnant (again)?

Respondents who replied that it was impossible for

them to have a baby or another baby were asked:

What is the reason that you are unable to have

a(nother) baby?

If the response was that they were sterile because of a

surgical procedure, they were then asked:

Was w reason for the operation because you

had all the children you wanted?

Contraceptively 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 1976,

nearly 19 percent of the couples in which the wife was

Fecund 56%

P

Impaired

fecundity

A

16%

Surgically aterile,

10% noncontraceptive

J

Figure 1. Percent distribution of all currently marriedcoupleswithwife

15-44 yearsof age byfecunditystatus United States, 1976

1544 years of age were contraceptively sterile (table 1

and figure 1). (This percent differs slightly from a

preliminary estimate published in Advance Data Number 36,6 because of revisions made in the data. See

reference 1.) For this report these couples are not

classified as having impaired fecundity because they

have ended their fecundity voluntarily-that is, as a

method of family limitation.

Surgically sterile, noncontraceptive

This category consists of women or their current

husbands who had a surgical sterilization (such as a

hysterectomy) for therapeutic reasons-not because

they had had all the children they wanted. About 2.7

5
million couples, about 10 percent, were classified as

surgically sterile for noncontraceptive reasons in 1976.

Nonsurgically sterile

This category is composed of women 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, 1 percent, or 368,000

couples, were classified as nonsurgically sterile in 1976.

In an earlier reportl nonsurgically sterile and noncontraceptive surgically sterile couples were shown as one

group-the “noncontraceptively sterile.” However,

because surgical sterility and nonsurgical impairments

are different types of medical conditions, these two

groups are shown separately in this report.

Subfecund

For couples in this category, it is difficult but it

may be possible to conceive and/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 diil&ky 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?

An estimated 2.9 million couples, about 10 percent,

were classitled as subfecund in 1976 (table 1).

Long interval

This category consists of currently married couples

who were not surgically sterile and who, during the 3

years of continuous marriage before the interview, did

not use contraception and did not have a pregnancy.

Many of these couples were presumably sterile, but

some might conceive in the future.T In 1976, 1.1

million, about 4 percent, of currently married couples

were classified as having a long interval (table 1),

Impaired fecundity

This category includes nonsurgically sterile couples, subfecund couples, and those with long intervals.

In 1976 about 16 percent or about 4.3 million couples

had impaired fecundity, meaning that it was physically

difficult or impossible for them to conceive or carry to

term a baby or another baby (figure 1).

Fecund

In tables 1-14 of this report “fecund” means that

there was no evidence at the time of the interview that

the couple had a problem in conceiving or delivering 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, and that they had used contraception

or been pregnant some time in the 3 years of

continuous marriage preceding the interview. About

15.4 million or 56 percent of the currently married

couples were classified as fecund in 1976 (figure 1). As

explained in appendix II, this definition differs from

the use of the term “fecund” in some other reportsG

where the subfecund and long interval couples are not

classified separately.

The passage of time, not using contraception, or an

attempt to have children increase the likelihood that

couples will discover a fecundity impairment.g For

example, couples who have ended their fecundity by

contraceptive sterilization or who have always used

contraception effectively may have undiagnosed impairments that would have significantly reduced the

chances of their having children in the fiture.

6
Comparisons with other

data

Several differences between this report and a

preliminary reportl on this subject should be noted.

The most important difference is that the category

“noncontraceptively sterile” in the earlier report has

been divided in this report to distinguish between the

“nonsurgically sterile” and “surgically sterile-noncontraceptive,” which are quite different types of

medical conditions. The category “all impaired” in the

previous report] equals the sum of the “impaired

fecundity” and the “surgically sterile-noncontraceptive” categories in the present report,

There have been a few other studies of reproductive (or fecundity) impairments in the United States,

However, the statistics in none of these can be

considered completely comparable to the statistics in

this report. (The measurement of trends is discussed

later in this report.) The 1955 and 1960 Growth of

American Families Studies both included studies of

fecundity impairments.s,g However, at least three

factors make meaningful comparisons difficult or

impossible:

● The samples in the earlier studies were more

limited in scope than in the National Survey of

Family Growth (NSFG).

. Different questions on fecundity were asked and

different classification schemes were used,

. There was a dramatic increase in the use of

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

Other factors that may tiect these comparisons

include changes in the time of first use of contraception

and changes in the age and marital status composition

of the female population 1544 years of age. In

particular, it should be noted 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.

McFalls3J0 has published two useful reviews of the

literature on reproductive impairments, which he calls

“subfecundity.” Neither review contains original data,

however.

The Hospital Discharge Survey of the National

Center for Health Statistics samples records of patients

discharged from non-Federal short-stay hospitals and

classifies the sampled records by diagnosis, including

pelvic inflammatory disease, uterine fibroma, and

other conditions. 11 These data differ from those in

NSFG because not all such conditions require hospitalization, and not all tiect fecundity. Also, the data in

NSFG are not diagnostic but self-reported. Finally, 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 01 a given year, regardless of when they first

occurred).

7
Age, parity, and years since first

marriage

Tables 1 and 2 show the distribution of currently

married couples with wives 1544 years of age in 1976,

by fecundity status and selected characteristics of the

wife.

As seen in table 1, the prevalence of impaired

fecundity—the nonsurgically sterile, subfecund, and

long interval categories combined—increased with

each 10-year age group, from 11 percent at 15-24 to 19

percent at 35-44 years of age. This difference by age

was sharpest in the “long interval” category, which

grew from 1 percent at 15–24 to 8 percent at 35-44

years of age, accounting for nearly all the net increase

in the “impaired fecundit y“ category.

The proportion contraceptively sterile increased

sharply with age from 4 percent at 15-24 to 28 percent

at 3544 years of age. Similarly, the proportion

surgically sterile for noncontraceptive reasons rose

from less than 1 percent at 15-24 years of age to 19

percent at 35-44. Thus the proportion surgically sterile

was about 4 percent at 15-24 and 47 percent at 35-44

years of age.

This 43-percentage point rise in surgical sterility

accounted for over four-fifths of the 51-percentage

point decrease in the percent fecund, from 85 percent

at 15-24 to 34 percent at 35-44 years of age. The drop

in the proportion fecund occurred in every 5-year age

group, from 90 percent among married teenagers to 31

percent of those 4044 years of age (figure 2).

Among couples with impaired fecundity, the distribution of the types of impairments changes with age.

For example, at 15–24 years of age subfecund couples

accounted for about nine-tenths of all couples with

impairments; but for those 3544, subfecundity accounted for only about half, as the long interval

subcategory increased from less than one-tenth to

about four-tenths of the total impaired fecundity

category (table 1).

The apparent drop in the percent subfecund

8

100

90

80”

70

60

50

40

30

20

10

0 D_

“

15-19 20-24 25-29 30-34 35-39 40-44

years years years years years years

Age of wife

Figure 2. Percent fecund among currently married couples with wife

1644 years of age, by age United States, 1976

between 25-34 and 35-44 years of age (from 12 to 9

percent) may reflect a shift in fecundity status over the

life cycle from subfecund to long interval or surgically

sterile; or it may reflect, among older women, a lower

prevalence of subfecundity when they were younger.

The percent surgically sterile increased in each

category of years since first marriage, from 3 percent of

those married less than 5 years to 50 percent of those

married 15 years or more before the date of interview
(table 1). The percent with impaired fecundity increased from 10 percent at less than 5 years to 16

percent at 5-9 years, but there was no significant

change in the other two categories of years since first

marriage.

Women are classified by age and parity in table 2.

At each parity the percent surgically sterile for

noncontraceptive reasons increased as age increased.

Thus being surgically sterile for noncontraceptive

reasons was associated with age. independently of

parity.

At parities zero, one, and two, the percent with

impaired fecundity increased with age. For women

with three or more children, however, this was not

true. The percent fecund was higher at 15-24 than at

3544 years of age at each parity (although this

difference was not significant at parity three or more).

Contraceptive sterility also tended to increase with age

within parity groups, but some of the differences were

not significant.

Race

Tables 3 and 4 show data for white and black

couples, respectively. The percent contraceptively sterile was lower for black couples than for white couples

in 1976 (13 percent compared with 19 percent). This

difference primarily reflects a much lower prevalence

of male contraceptive sterilization (2 percent compared with 10 percent) among black than among white

husbands. 12The prevalence of female operations for

both contraceptive and noncontraceptive reasons was

similar by race. The percents surgically sterile for

noncontraceptive reasons were not significantly

different by race overall or in any 10-year age group.

Black couples were much more likely to have

impaired fecundity than white couples were (23

percent compared with 15 percent). In the age groups

15-24 and 35-44, black couples were about 10 percentage points more likely to have impaired fecundity. The

difference at 25-34 years of age was only about 4

percentage points and was not statistically significant.

Most of the difference among wives 15-24 years of age

was in the subfecund category (9 percent of white

wives compared with 16 percent of black wives), while

most of the difference among wives 35-44 years of age

was in the long interval category (7 percent of white

agd 14 percint of black wives).

Among black couples surgical sterility was less

common and impaired fecundity more common than

among white couples. But these two differences balanced out, so that the proportion fecund was about 56

percent for both groups (figure 3).

At parities one, two, and three or more, white

couples were more likely than black couples to be

contraceptively sterile. In each parity group, black

couples were more likely than white couples to have

impaired fecundity (tables 3 and 4).

60r n White

55

f- Black

45

40

35

30

1

25

t

20

15

10

5

0 h

Contr~;:ively Surgically Impaired

sterile, fecundity

noncontraceptive

Fecund

Figure 3. Percent distribution of currently married couples with wife

15-44 years of age by fecundity status and race United States, 1976

Because parity differs by race, and because the

percent with impaired fecundity dtiers by parity, it is

important to control statistically for parity when

comparing the fecundity of white couples with that of

black couples. Black wives 15-44 years of age had a

larger average number of children than white wives

had. For example, 11 percent of black couples had no

children by the date of interview, compared with 19

percent of white couples; and 39 percent had 3 or more

children compared with 33 percent of white couples

(table A).

About 35 percent of black wives with no children

(parity zero) had impaired fecundity, compared with

21 percent of white wives with no chil@en (tables 3

and 4). But as noted above, a smaller proportion of

black wives had no children. So the proportion of all

couples who had no children and impaired fecundity

was about 4 percent for both white couples and black

couples (table A).

A similar pattern was evident for noncontraceptive

surgical sterility. About 7 percent of black couples

with no children were surgically sterile for noncontraceptive reasons, compared with only 4 percent of white

couples with no children (tables 3 and 4). However,

about 1 percent of all couples of each race were

childless and surgically sterile for noncontraceptive

9
Table A. Percent distribution of currently married couples with wife

15-44 years of age by parity and fecundity status, according to race

United States, 1976

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

conterminous United States, See appendixes I and II for discussion of the

sample design, sampling variability, and definitions of terms]

Parity and fecundity status All races ~ White Black

All parities Percent distribution

Total .............. ........................... 100.0 100.0

Surgically sterile

Contraceptive ......................

Noncontraceptive ................

Impaired fecundity ..................

Fecund.,.,..................................

Parity O

Surgically sterile

Contraceptive ......................

Noncontraceptive ................

Impaired fecundity ..................

Fecund......................................

Parity 1

Surgically sterile

Contraceptive ......................

Noncontraceptive ................

impaired fecundity ..................

Fecund......................................

Parity 2

Surgically sterile

Contraceptive ......................

Noncontraceptive ................

Impaired fecundity ..................

Fecund..................... .................

Parity 3 or more

Surgically sterile

Contraceptive ......................

Noncontraceptive ................

Impaired fecundity ..................

Fecund......................................

18,5

9.6

15.7

56.1

‘0.3

0.8

4.1

13.9

0.8

1.0

4,1

14.4

6.5

2.5

1;:;

11.0

5.4

1R

19.3

9.7

14.9

56.1

‘0.3

0.8

4.0

14.5

0.8

1.0

3.8

14.2

7.0

2.4

3.3

15.3

11.2

5.5

3.8

12.1

100.0

12.6

9.0

22.5

55.9

*0. I

‘0.6

3.9

6.4

‘0.2

*1.5

1:::

2.4

2.4

4.8

16.5

10.0

4.3

1;::

1Includes white, black, and othe?races.

reasons. Thus if being childless and having impaired

fecundity is one definition of infertility problems, these

problems were not more common among black couples

than among white couples in 1976. However, if having

a fecundity impairment at parity one, two, or three or

more is also considered an infertility problem, these

problems were more common among black than

among white couples.

In each category of years since the wife’s first

marriage, black couples were more likely than white

couples to have impaired fecundity, although the

differences at 0-4 and at 10-14 years were not

statistically significant. At 5 years or more, the data

suggest that white couples were more likely to be

contraceptively sterile.

Investigating the causes of the larger proportion of

black than of white couples with impaired fecundity is

an extremely complex matter, beyond the scope of this

report, but it is possible to list some of the factors that

should be included in such an analysis. Among the risk

factors mentioned by McFallss known or suspected to

be related to impaired fecundity in general are such

genetic factors as sickle cell anemia and certain related

conditions; what McFalls calls “psychopathology,”

including alcohol and drug abuse; nutritional

deficiencies; infectious diseases such as gonorrhea,

genital herpes, and non-gonococcal urethritis and

cervicitis; and infections after childbirth or after poorly

performed abortion, If conditions known to be associated with impaired fecundity were shown to be more

common among black than among white couples in

the relevant age groups, a plausible causal hypothesis

could be suggested.

The complexity of such a test maybe suggested by

listing, as an example, some of the factors to be

considered with respect to infections after childbirth or

poorly performed abortion. These factors probably

would include, among others, the larger average

number of children ever born to black women than to

white women, especially at younger agesls (a larger

proportion of which were unwanted at the time they

were conceivedlqJs); less adequate health care, especially prenatal care, among black women; 16a younger

average age of black women at first birth; 1’ more

closely-spaced births to black women; 18and higher

abortion rates among black women, 19

Socioeconomic characteristics and

fecundity status

Tables 5-7 contain data on the fecundity status of

currently married couples by selected socioeconomic

characteristics.

Education

There was little variation in the proportion with

impaired fecundity by education; 19 percent of women

with less than a high school diploma had impaired

fecundity compared with 15 percent of those with

more than a high school education (table 5). Both

types of surgical sterility decreased as education

increased. Primarily because of the differences in

surgical sterility by education, the percent fecund

increased with education, from 47 percent in the

lowest to 63 percent in the highest education group.

For white women (table 6) the differences in the

percent with impaired fecundity by education were

small and not statistically significant. For black wives,

however (table 7), 32 percent of those with less than a

high school education had impaired fecundity compared with 19 and 17 percent in the other ‘two

education groups of black women. The proportion for

black women with less than a high school education

(32 percent) was almost twice that for white women in

the same education group. In the upper two education

groups, the differences by race were much smaller and

not statistically significant.

Poverty level income

Special caution should be used in interpreting

small differences between poverty level income groups

10
because of the unusually large amount of missing data

on this characteristic (see appendix II). There was no

significant difference between the lowest and the

highest income group in either type of surgical sterility

(table 5), This was also true for white women (table 6)

and black women (table 7) separately. The percent

with impaired fecundity varied little from below the

poverty level to 200-299 percent of poverty level, but it

was slightly higher— 17 percent—in the highest income group (table 5).

Among couples with incomes of 300 percent or

more of poverty level, 17 percent of white and 29

percent of black couples had impaired fecundity

(tables 6 and 7). This difference is related to the finding

that 19 percent of white but only 10 percent of black

couples in the highest income group were contraceptively sterile.

Religion

Protestant couples were much more likely to be

contraceptively sterile (22 percent compared with 13

percent) and slightly more likely to be surgically sterile

for noncontraceptive reasons, than Catholic couples

were. Protestant couples were slightly less likely to

have impaired fecundity and substantially less likely to

be fecund (53 percent compared with 61 percent, table

5). The findings for white women were very similar in

all four categories of fecundity status (table 6).

Region

The percent of couples with both types of surgical

sterility was lower in the Northeast than in the other

three regions. Conversely, the percent with impaired

fecundity and the percent fecund were both higher in

the Northeast than in the other three regions (table 5).

These results were also found for white women (table

6). (The difference in surgical sterility for noncontraceptive reasons between the Northeast and the West

was significant at the 10-percent level for all women

and not significant for white women.)

Because the percent surgically sterile was lower

and the percent with impaired fecundity higher for

Catholic than for Protestant women, the results by

region might be explained by the higher percent of

couples in the Northeast who were Catholic than in

the other regions. About 51 percent of white wives in

the Northeast in 1976 were Catholic compared with 27

percent in the North Central and the West and 19

percent in the South. This interpretation is supported

by the finding that there were no significant differences

for black wives, almost 90 percent of whom were

Protestant, between the Northeast and the other

regions (table 7).

In each region except the Northeast white women

were substantially more likely than black women to be

contraceptively sterile. This difference by race ranged

from about 1 percentage point in the Northeast to

about 13 percentage points in the West (tables 6 and 7)

and is probably related to the difference in contraceptive sterility between Protestant and Catholic women

discussed earlier.

There were no statistically significant differences in

fecundity status between women in and out of the

labor force (table 5). This was also found for white

women and black women separately (tables 6 and 7).

Occupation

Table 8 shows currently married couples in 1976

by the occupation of the respondent and her husband.

The occupational classification used in this report is a

socioeconomic grouping and was not designed to

measure exposure to health hazards in the workplace.

Differences between occupational groups may reflect

age, race, and parity dtierences as well as the effects of

working in particular occupations.

Looking first at the data by occupation of the wife,

professional workers were less likely to be contraceptively sterile and less likely to be surgically sterile for

noncontraceptive reasons than all women surveyed

were. As a result they were more likely to be fecmd

(62 percent compared with 56 percent).

Managers were more likely to be surgically sterile

for noncontraceptive reasons than were women in the

total group (18 percent compared with 10 percent) and

less likely to be fecund (46 compared with 56 percent).

Operatives were also more likely to be surgically sterile

for noncontraceptive reasons than were women in the

total group, and less likely to be fecund. Household

workers were less likely to be contraceptively sterile (7

percent compared with 19 percent) and much more

likely to have impaired fecundity (37 percent compared with 16 percent). None of the other differences

between the total and particular occupational groups

was statistically significant.

The data by occupation of the husband tend to

show a similar picture—that is, the same occupational

groups tended to have significantly different fecundity

status. Couples in which the husband was a professional worker were more likely to be fecund and less likely

to be surgically sterile than were couples in the total

group. Couples in which the husband was a manager

were more likely to be surgically sterile and less likely

to be fecund than were couples in the total group.

Differentials in reported spontaneous

pregnancy losses

Respondents in the NSFG were asked if they had

had any pregnancies in addition to those ending in live

births. For each such pregnancy, they were asked:

When did that pregnancy end?

How many months were you pregnant at the

time?

11
and

How did that pregnancy end?

The answers to the last question were classified as

“miscarriage, “ “stillbirth,” or (induced) “abortion.”

Pregnancies reported as ending in “miscarriage” or

“stillbirth” are shown in the report as “reported

spontaneous pregnancy losses.”

The reporting of spontaneous pregnancy losses in

the NSFG was comparable to that in other surveys of

the same type. LeridonzO has repofied the results of a

number of surveys of women in the reproductive ages

in various parts of the world. The results from the

NSFG were similar: about 14 percent of pregnancies

(excluding induced abortions) ended in a spontaneous

pregnancy loss; there was an increase (not statistically

significant) in the pregnancy loss rate with increasing

age of motheq and the loss rate for women whose most

recent previous pregnancy had ended in a pregnancy

loss was about double that for those whose pregnancy

had ended in a live birth (table B).

Currently married women are shown in tables 9-

12 by the number of reported spontaneous pregnancy

losses they had had by the date of interview. About 15

percent of married women had had one pregnancy

loss, about 4 percent had had two, and about 3 percent

had had three or more (table 9).

The percent of wives who had had one or more

pregnancy losses increased from 12 percent of wives

15-24 years of age to 31 percent of wives 3544 years

of age (figure 4), and from 11 percent of wives with no

children ever born (parity zero) to 31 percent of wives

with three or more children (table 9).

The results by age and parity described here were

also found for white wives (table 10). For black wives

(table 11) results were similar but many of the

differences were not statistically significant. Very few

of the differences by race (tables 10 and 11) were

statistically significant.

Differences by Hispanic origin of the wife in the

percent who had had one or more pregnancy losses

were not statistically significant (table 9).

Table B. Percent of pregnancies (excluding induced abortions) to

currently married women 15-44 years of age ending in a

spontaneous pregnancy loss and standard error of the percent, by

age and outcome of previous pregnancy United States, 1976

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

conterminous United States. See appendixes I and 11for discussion of the

sample design, sampling variability, and definitions of terms]

Age and outcome

of ixevious Dre.anancv Percent Standard error

Total ......................................................... 14.1 0.6

Age

15-24 years............................................ 12.7 0.7

25-34 years............................................ 14.3 1.0

35-44 years............................................ 17.4 4.3

Outcome of previous pregnancy

Spontaneous pregnancy loss .............. 28.4 2,3

Live birth or induced abortion ............ 12.8 0.8

Tables 9-11 also contain statistics on pregnancy

losses by the fecundity status of the respondent. Only

about 15 percent of fecund couples had had one or

more pregnancy losses, compared with 25 percent of

contraceptively sterile couples, 38 percent of women

surgically sterile for noncontraceptive reasons, and 33

percent of couples with impaired fecundity. These

differences are probably related to the age composition

of the fecundity status groups since fecund women

were younger, on average, than other women.

Table C shows the proportion of women who have

had one or more pregnancy losses. This table excludes

women who have never been pregnant or who are

currently pregnant with their first pregnancy because

they cannot have had a pregnancy loss. None of the

differences by race in table C was statistically significant. The percent of women who had had one or

more pregnancy losses increased from 19 percent at

15-24 years of age to 33 percent at 35-44 years of age.

However, it is likely that part of this difference is due

to a larger average number of pregnancies among

women 35+4 years of age.

Table 12 shows currently married couples by

occupation and the number of spontaneous pregnancy

losses the woman had had. The results by occupation

35

30

25

20

15

10

5

0

15-44

years

15-24 25-34 35-44

years years years

Age

Figure 4. Percent of currently married women 1544 years of age with 1

or more reported spontaneous pregnancy losses, by age United

States, 1976

12
Table C. Number of currently married women 15-44 years of age with 1 or more completed pregnancies,tand percent with 1 or more

pregnancy losses, by age, according to race: United States, 1976

[Statisticsare basedon a sampleof the householdpopulationof the contemrinousUnited States. 8ee appendixes I and II for diecm”on of the aamp!e

design, samplingvariability,and definitionsof terms]

All recast White Black

Women wfth Woman with Woman with Women with Women with Women with

Age 1 or more 1 or more 1 or more 1 or more 1 or mom 1 or more

completed pregnancy completed pregnancy completed pregnancy

waanancies losses prwnancies 10ssss pregnancies losses

Number in Number in Number in

thousands Percent thousands Percent thousands Percent

All ages............................................... 23,101 25.9 20,677 25.9 1,991 26.3

15-24 years........................................ 3,698 18.8 3,230 18.5 407 22.8

15-19 years ................................... 548 23.0 466 21.6 ‘25.1

20-24 years ................................... 3,151 18.1 2,764 17.9 3Z 22.3

25-34 years........................................ 10,535 22.8 9,453 22.8 859 22.3

25-29 years ................................... 5,223 18.4 4,657 18.7 444 15.3

30-34 yeara ................................... 5,311 27.0 4,795 26.8 415 29.8

35-44 years........................................ 8,869 32.6 7,994 32.6 725 32.9 ,

35-39 yeare ................................... 4,609 30.7 4,145 30.1 357 37.9

40-44 yeara ................................... 4,259 34.6 3,849 35.2 368 28.1

1Excludeswomenwhohad neverbeen pregnantandthosewhowere currentlypregnantwiththeirfirstpregnancyat the date of interview.

2Includeswhite,black,andotherraces.

of the wife indicate that women in service occupations

were more likely to have had one or more pregnancy

losses than the total group (27 percent compared with

22 percent).

Couples in which the husband was a professional

worker were less likely than other couples to have had

one pregnancy loss. Couples in which the husband was

in sales or was a farmer were less likely than other

couples to have had two pregnancy losses. There were

no other statistically significant differences in table 12.

Reproductive impairments and

“infertility” problems

Fecundity impairments per se are important for

demographic and public health reasons. For other

uses, however, it may be important to define a

population that desires 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. Tables

13 and 14 illustrate one way to define the population

desiring medical treatment to help them have children.

They show the number of married couples in selected

fecundity status groups and the percent in each who

wanted to have a baby at some time in the future.

(Winting to have a baby in the future, as discussed

here, should not be confused with the “wantedness” of

past births, discussed in other NSFG reports.ldJS)

About 47 percent (an estimated 2,037,000 couples)

of all wives with impaired fecundity wanted to have a

baby; but a large majority of childless couples with

impaired fecundity (75 percent) wanted to have at least

one child; and 57 percent of couples with one child

wanted to have another. The data by parity indicate

that about 840,000 of those couples with impaired

fecundity who wanted children had no children (parity

zero), 641,000 had one child, 323,000 had two children, and 233,000 had three or more (figure 5).

The percent of wives with impaired fecundity who

wanted to have a baby at some time in the future

declined sharply with parity and age, from 75 percent

of those with no children to 21 percent of those with

three or more, and from 81 percent of wives 15-24

years of age to 21 percent of wives 35-44 years of age.

There was no significant difference in these percents

between white and black women, but the data suggest

that Hispanic wives with impaired fecundity were

more likely than other wives to want a baby. These

patterns were generally present within the categories

subfecund, nonsurgically sterile, and long interval. The

exceptions were not statistically significant. However,

considerable caution should be used in interpreting

differences in the long interval and nonsurgically

sterile categories because of the small number of

sample cases involved.

Couples who were surgically sterile for noncontraceptive reasons in 1976 are also shown in table 13.

These women were asked:

Even though it is udikely or impossible for

you to have a(nother) baby, would you like to

have a(nother) baby?

About 41 percent of the estimated 2,652,000 couplesabout l,098,000-wanted to have a baby. The

differences in this percent by ths characteristics in

table 13 were less regular than for those with impaired

fecundity, and few of the diEerences were statistically

significant.

In table 14 couples with impaired f=undity are

shown by age and race and by parity and race. For

both white and black women, the percent of couples

15-29 years of age with impairments who wanted a

baby was sharply higher than for those 3044 years of

13
1000

r

900

r

800

200

100

0

0 1 2 3 or more

Parity (number of children ever born)

Figure 5. Number of currentlv married coucdes with imDaired fecunditv

;ho want a baby or anot~er baby, by parity United States, 1976-

age. The findings were similar by parity: for both white

and black wives, those who had no children were

much more likely to want a baby than those who had

three or more.

As in table 13, the patterns in table 14 for couples

who were surgically sterile for noncontraceptive reasons were less regular than for those with impaired

fecundity.

The NSFG was not designed to estimate statistics

for areas smaller than the four major geographic

regions, and surveys of areas smaller than that rarely

collect information like the data in this report. Thus,

for estimates for smaller areas of the number of

couples with impaired fecundity, or of the number

with impaired fecundity who want a future baby,

either a special-purpose survey or some kind of

estimation technique used with national data would

have to be employed. In combination with the data in

this report, estimation techniques can produce estimates of “patient load” that may be useful for many, if

not all, purposes.

There are a variety of techniques available for

making such estimates.zl Synthetic estimation, a technique developed at NCHS,22 may be useful for making

estimates of the number of couples with impaired

fecundity for States and local areas.zsThe limitations of

the technique include the following: First, although it

has been validated for some kinds of estimates,24’25it

has not been validated for reproductive impairments

because comparable estimates at the local level do not

exist. Secondly, the estimates are subject to sampling

error; and thirdly, they are subject to bias under

certain conditions.

In short, “the advantages of the synthetic-estimation approach to local estimation are its intuitive

appeal, its simplicity, and its low cost relative to a

direct survey of the local population. A major disadvantage is its lack of sensitivity to certain local

characteristics. “22

The data required for a synthetic estimate of

fecundity impairments in a local area include a census

count or estimate of the married female population 15-

44 years of age in the area, in 5-year or 10-year age

groups; the data from the NSFG on fecundity status

by age (table 1); and the percents of couples wanting

children or additional children (tables 13 and 14).

Perhaps the most critical assumption of the technique is that the percents of women with impaired

fecundity and the percents of those with impaired

fecundity who want more children are the same within

age groups in the local area as they are in the national

population. This will normally be a reasonable assumption, but if the population of currently married

women 15+4 in the local area is predominantly black

or has other characteristics closely associated with

fecundity status, it may be worthwhile to adjust the

estimates for that fact.

It is beyond the scope of this report to discuss

specific examples of the application of synthetic

estimation or any other estimation technique, but an

example of the application of synthetic estimation to

fecundity impairments is available.zj Methodological

evaluations and improvements of synthetic estimation

techniques are also continuing.2$2@7

Trends in infertility

The 1965 National Fertility Study, or NFS, was a

predecessor of the National Survey of Family Growth

(NSFG) and was generally similar in design and

coverage. A nationally representative sample of 4,810

currently married women 15-44 years of age were

interviewed for the NFS, including 969 black wives.

Further details on the NFS maybe found in appendix

I of this report and in the monograph on the NFS.2S

Fecundity status (the classification scheme used in

tables 1–14 of this report) makes full use of the data in

the NSFG interview and provides a comprehensive

definition of reproductive impairments, which include

difficulty in conceiving, high. risk of miscarriage, and

aBecause of space limitations in this report, this discussion of trends is

relatively brief. For a more detailed analysis of trends, see reference 2.

14
danger to the life or health of the mother. However,

because of differences in the NFS and NSFG questions

on reproductive impairments, it is not possible to use

the fecundity status classification to measure trends

from 1965 through 1976. Both surveys, however,

asked each respondent for a marital history, a pregnancy history, and a contraceptive history for the 3

years before the interview. This information makes it

possible to calculate the percent of couples who were

“infertile”- who were not surgically sterile and who

for a year or more immediately before the date of

interview had been continuously married, had not used

any contraception, and had not had a pregnancym29,30,31

Infertility is a narrower definition of reproductive

impairments than the “impaired fecundity” category

of fecundity status (tables 1-14) because infertility

only includes difficulty in conceiving. The percent

classified as fecund in 1976 (62 percent) using infertility status is therefore somewhat higher than when using

fecundity status (56 percent). But using the “infertility

status” classification does permit an unbiased measurement of trends.

Tables 15 and 16 and figure 6 show currently

married women 1544 years of age by infertility status

and selected characteristics in 1965 and 1976. Infertility status consists of three principal categories: surgically sterile, infertile, and fecund. “Surgically sterile”

includes both contraceptive and noncontraceptive operations. “Infertile” consists of couples who were not

surgically sterile and were continuously married, did

not use contraception, and did not have a pregnancy

for at least 12 months before the date of interview.

“Fecund,” in tables 15 and 16, includes couples who

were neither surgically sterile nor infertile.

There was a sharp increase in the percent surgically sterile between 1965 and 1976 (table 15). The

increase among white couples was from 16 to 29

percent; among black couples the increase was smaller,

from 14 to 22 percent.

About 1 in 10 couples were classified as “infertile”

at the date of interview in both 1965 and 1976.

However, this overall stability was the result of

increases among younger wives and decreases among

older wives. There was a statistically significant increase between 1965 and 1976 in the percent infertile

among women 15–29 years of age and a significant

decrease among women 30-44 years of age (figure 7

and table 16). Among black wives 20-24 years of age,

the proportion infertile increased substantially, from 3

to 15 percent (table 15). The data suggest that the

percent infertile decreased among black wives 40-44

years of age, from 39 to 29 percent.

The percent classified as fecund in table 15

decreased between 1965 and 1976 in every age group

for wives 25 years of age and older. This was true for

white women and black women separately, although

three, of the changes among black wives were not

75 1965

70

65 .0

1976

60

55

50

%

-~ 45

0

v 40

%

E

$J 35

&

0. 30

25

20

15

10

5

0

sugcca:y Infertile Fecund

Note: Categories are not the aama asthose used in figures 1,

2,3, and 5. see text or appendix II ford efinitions.

Figure 6. Percent distribution. of ail currentty married couples with wife

1-5-44 yeara of age by infertility status United States, 1%5 and 1976

statistically significant. Most of these decreases in the

percent fecund were due to increases in the proportion

surgically sterile.

Table 16 shows that the increases in the percent

surgically sterile occurred among wives with two or

more childre~ none of the changes in the percent

surgically sterile at parity zero or one was statistically

significant. About 51 percent of white wives with three

or more births were surgically sterile in 1976, compared with only 22 percent in 1965. These increases

suggest (and other data corroborate) that couples who

had reached or surpassed their intended family size

turned to sterilization to ensure that unintended

pregnancies did not occur thereafter.

The proportion infertile (table 16) increased from 6

to 9 percent between 1965 and 1976 among women

15-29 years of age with no or one birth. This increase

was especially marked among black wives 15-29 years

of age with no or one child: 14 percent were classified

as infertile in 1976 compared with 6 percent in 1965.

The data also suggest an increase among younger

black wives with three or more children, from 3 to 11

percent.

It is beyond the scope of this report to inquire into

the causes and consequences of these changes in

15
20 r

I

15

t

5 1 n

1965

u

1976

n

White Black

Note: “Infertile” is not the same as “impaired fecundity” used in

figures 1, 2,3, and 5. See text or appendix I I for definitions.

Figure 7. Percent of couples with wife 15-29 years of age classified as

infertue, by race: United States, 1965 and 1976

reported cases of gonorrhea between 1965 and 1975.32

Reported gonorrhea case rates are highest among

women 20-24 years of age,ss and infertility is sometimes a consequence of gonorrhea. Intrauterine devices

(IUD’s) were used by less than 1 percent of married

women in 1965, but in 1976 the proportion had

increased to about 6 percent.3Q Because women who

use IUD’s have a higher risk of pelvic inflammatory

disease than women who do not,ss and because pelvic

inflammatory disease is a risk factor in infertility, this

association may also merit further investigation. Whatever its causes, the apparent increase in the percent

infertile among younger women at parity zero or one

may have significant demographic and health consequences if it persisted after 1976.

In almost every age, race, and parity group, the

percent fecund decreased between 1965 and 1976,

although the decreases in some subgroups were not

statistically significant. These reductions, primarily

reflecting an increase in surgical sterilizations, were

larger at the later ages and higher parities. The

demographic impact of the smaller percent fecund is

difficult to predict. To the extent that couples switched

to sterilization from other effective methods of contraception, the impact on birth rates probably will be

small. To the extent that couples switched’ from less

effective nonsurgical methods of contraception, however, the impact could be to reduce unwanted Ibirths at

the later ages and perhaps to make birt~ rates lower in’

future years than many observers expect.

infertility status, but it may be useful to point out some

of the possibilities that have been suggested. One

researcher who reviewed these data suggested that the

increases in the percent infertile among wives 15–29

may be related to the tripling in the number of

16
References

INational Center for Health Statistics, W.D. Moshe~ Reproductive impairments among currently married couples: United States,

1976. Advance Data From Vital and Health Statistics, No, 55.

DHEW Pub. No. (PHS) 80-1250. Public Health Service. Hyattsville, Md. Jan. 24, 1980.

ZW.D. Moshe~ Infertility trends among U.S. couples: 1965-1976.

Fare. PIann. Perspect. 14(1), Jan.–Feb. 1982.

3J. M@alls Frustrated fertility: A population paradox. popu1.

Bull. 34(2), May 1979.

Secretary of Health and Human Services: Five-Year Plan for

Family Planning Services and Population Research. Washington.

May 1980.

~National Center for Health Statistics, W.R. Grady: The National

Survey of Family Growth, Cycle II: Sample design, estimation

procedures, and variance estimation. Vital and HeaIth Statistics.

Series 2-No. 87. DHHS Pub. No. (PHS) 81–1361. Public Health

Service. Washington. U.S. Government Printing Office, Feb. 1981.

sNational Center for Health Statistics, K. Ford: Contraceptive

utilization in the United States: 1973 and 1976. Advance Data

From Vital and Health Statistics, No. 36. DHEW Pub. No. (PHS)

78-1250. Public Health Service. Hyattsville, Md. Aug. 18, 1978.

TR.Potter and M. Parken Predicting the time required to conceive.

Popui. Stud. 18(1):99-1 16, hdy 1964.

BP.Whelpton, A. Campbell, and J. Patterson: Fertility and Family

Planning in the United States. Princeton, N.J. Princeton University

Press, 1966. ch. 4.

9R, Freedman, P. Whelpton, and A. Campbell: Family Planning,

Sterihly, and Population Growth. New York. McGraw-Hill, 1959.

ch. 2.

IOJ. McFalls: Psychopathology and Subfecundity. New York.

Academic Press, 1979.

1lNational Center for Health Statistics, L. Glickman: Inpatient

utilization of short-stay hospitals by diagnosis: United States, 1975.

Vitgl and Health Statistics. Series 13-No. 35. DHEW Pub. No.

(PHS) 78-1786. Public Health Service. Washington. U.S. GovernmentPrinting Office, Apr. 1978. table F.

12National ~nter for H~th Statistics, W.D. Mo~heR contra&ptive utilization: United States, 1976. Vital and Health Statistics.

Series 23-No. 7. DHHS Pub. No. (PHS) 81-1983. Public Health

Service. Washington. U.S. Government Printing Office, Mar. 1981.

table 1, p. 17.

lgNational Center for Health Statistics, G.S. Bonham: Expected

size of completed family among currently married women 1544

years of age: United States, 1973. Advance Data From Vital and

Health Statistics, No. 10. DHEW Pub. No. (ERA) 77-1250.

Health Resources Administration. Hyattsville, Md. Aug. 12, 1977.

14Nation~ center for Health Statistics, M.L. Munson: Wanted and

unwanted bkths reported by mothers 15-44 years of age United

States, 1973. Advance Data From Vital and Health Statistics, No. 9.

DHEW Pub. No. (I-IRA) 77–1250. Health Resources Administration. Hyattsville, Md. Aug. 10, 1977.

15Nation~ center for Health Sbtistics, E. fikard: Wanted and

unwanted bkths reported by mothers 1544 years of age: United

States, 1976. Advance Data From Vital and Health Statistics, No.

56. DHEW Pub. No. (PHS) 80-1250. Public Health Service.

Hyattsville, Md. Jan. 24, 1980.

16Nation~ center for He~th Shtistics, S- T~el: prenat~ care

United States, 1969-1975. Vital and Health Statistics. Series 21–

No. 33. DHEW Pub. No. (PHS) 78-1911. Public Health Service.

Washington. U.S. Government Printing Office, Sept. 1978.

17National ~nter for He~th s~tistic~ Vital Statistics of the United

States 2976, Vol. I, Natality. DHHS Pub. No. (PHS) 81-1100.

Public Health Service. Washington. U.S. Government Printing

Office, 1980. table 1-11.

18Nation~ center for H~th Sbtistics, K. Ford: Socioeconomic

differentials and trends in the tindng of births. Vital and Health

Statistics. Series 23-No. 6. DHHS Pub. No. (PHS) 81-1982. Public

Health Service. Washington. U.S. Government Printing Office,

Feb. 1981.

19c. Tletze Induced Abortion: A world ~evie~, 1981 (4th Edition),

A Population Council Fact Book. New York. The Population

Council, 1981. table 5, p. 50.

20H. Leridon Human Fertili@: The Basic Companentz Chicago.

University of Chicago Press, 1977. ch. 4.

21N. pw=~ ad L. Kish &timation for sm~ domains. Biometr3-cs

35:365-384, June 1979.

22National Center for Health Statistics, P.S. Levy and D.K.

French: Synthetic estimation of State health characteristics based

on the Health Interview Survey. Vital and Health Statistics. Series

2-No. 75. DHEW Pub. No. (PHS) 78-1349. Public Health Service.

Washington. U.S. Government Printing Office, Oct. 1977.

23P. Placek and M. Cynamon: NCHS Data on Voluntary and

Involuntary Infertility, With Synthetic Estimation Application.

National Center for Health Statistics, Working Paper No. 1. Oct.

1980.

24National center for Health Statistics, W*L. Schaible, DOB.Br~k,

R.J. Casady, and G.A. Schnack: Small area estimation: An

empirical comparison of conventional and synthetic estimators for

17
States. Vital and Health Statistics. Series 2-No. 82, DHEW Pub.

No. (PHS) 80-1356. Public Health Service. Washington. U.S.

Government Printing Office, Dec. 1979.

ZsAmerican Statistical Association, W. Schaible, D, Brock, and G.

Schnack: An empirical comparison of the simple inflation, synthetic and composite estimators for small area statistics. Proceedings,

Social Statistics Section, 1977. pp. 1017-1021,

26American statistical Association, s. Cohen and w, K~sbwk: An

alternative strategy for estimating the parameters of local areas.

Proceedings, Social Statistics Section, 1977, pp. 781-786.

ZTNationalInstitute on Drug Abuse Synthetic estimates fOr Small

areas: statistical workshop papers and discussion, in J. Steinberg,

cd., NIDA Research Monograph Series. No. 24. Washington. U.S.

Government Printing Office, Feb. 1979.

Z8N. Ryder and C. Westoff: Reproduction in the United state%

1965. Princeton, N.J. Princeton University Press, 1971.

VB. Menning: Infertility: A Guide for the Childless Couple.

Englewood Cliffs, N.J,: Prentice-Hall, 1977.

JOR.Ansbacher, M. Shapiro, C. Witten, and H. Barber: Forum:

Management of infertility. The Female Patient 4(8):2630, Aug.

1979.

311ntemation~ P]anned Paenthood Federation, R. Kleinmm and

P. Senanayake, eds.: Handbook on Infertility. London. 1979.

SZJ.W. Curran: Economic consequences of pelvic inflammatory

disease in the United States. Am. 1 Obstet. Gynecol 138(7), Part 2:

848-851, Dec. 1, 1980, Supplement.

3SU.S.centers for Disease Control: Sexually Transmitted Disease

(STD) Statistical Letter, Calendar Year 1979. Public Health

Service. Atlanta, Ga. table 10.

~National Center for Health Statistics, W. Mosher and C. Westoff:

Trends in contraceptive practice, United States, 1965-76. Vital and

Health Statistics. Series 23-No. 10, DHHS Pub. No, (PHS) 82-

1986. Public Health Service, Washington. U.S. Government

Printing Office. In press.

35P.Senartayake and D.G, Kramen Contraception and the etiology

of pelvic inflammatory disease: New perspectives, and R. Burkmrm: Intrauterine device use and the risk of pelvic inflammatory

disease. Am. J, Obstet. Gynecol. 138(7), Part 2:852-863, Dec. 1,

1980, Supplement.

36National center for Health Statistics, D. French: me National

Survey of Family Growth, Cycle I: Sample design, estimation

procedures and variance estimation. Vital and Health Statistics.

Series 2–No. 76. DHEW Pub. No. (PHS) 78-1350. Public Health

Service. Washington. U.S. Government Printing Office, Jan. 1978.

37Nationa1 center for Health s~tisti~s: Statistics needed for

national policies related to fertility: The United States National

Committee on Vital and Health Statistics. Vital and Health

Statistics. Series 4-No. 18. DHEW Pub. No. (PHS) 78-1455.

Public Health Service. Washington. U.S. Government Printing

Office,Jan. 1978. pp. 100-149.

3$H. Shryock and J. Siegel: The Methods and Materials of

Demography. Washington. U.S. Government Printing Office, 1971.

p, 462.

39u.s. Bureau of the Census: Money income in 1975 of familieS and

persons in the United States. Current Population Reports. Series P60, No. 106. Washington. U.S. Government Printing Office, June

1977. table A-3.

18
List of detailed tables

1. Number of currently married women 15-44 years of age and

percent distribution by fecundity status, according to selected

characteristics: United States, 1976............................................

2. Number of currently married women 15-44 years of age and

percent distribution by fecundity status, according to parity

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

3. Number of currently married white women 15-44 years of age

and percent distribution by fecundity status, according to age,

parity, and years since wife’s first marriage United States,

1976 ................................................................ ..............................

4. Number of currently married black women 15-44 years of age

and percent distribution by fecundity status, according to age,

parity, and years since wife’s first marriage United States,

1976 ...............................................................................................

5. Number of currently married women 15-44 years of age and

percent distribution by fecundity status, according to selected

characteristics United States, 1976............................................

6. Number of currently married white women 15-44 years of age

and percent distribution by fecundity status, according to

selected characteristics United States, 1976 ............................

7. Number of currently married black women 1544 years of age

and percent distribution by fecundity status, according to

selected characteristics: United States, 1976 ............................

8. Number of currently married women 1544 years of age and

percent distribution by fecundity status, according to occupation of wife and occupation of husband: United States, 1976 ...

9. Number of currently married women 15-44 years of age and

percent distribution by number of reported spontaneous

pregnancy losses, according to selected characteristics

United States, 1976 ......................................................................

10. Number of currently married white women 15-44 years of age

and percent distribution by number of reported spontaneous

20 pregnancy losses, according to age, parity, and fecundity

status United States, 1976 .......................................................... 29

11. Number of currently married black women 15-44 years of age

21 and percent distribution by number of reported spontaneous

pregnancy losses, according to age, parity, and fecundity

status United States, 1976 .......................................................... 30

12. Number of currently married women 15-44 years of age and

22 percent distribution by number of reported spontaneous

pregnancy losses, according to occupation of wife and

occupation of husband United States, 1976.............................. 31

13. Number of currently married women 15-44 years of age who

23 had impaired fecundity or were surgically sterile for noncontraceptive reasons, and percent who wanted a baby or

another baby, by selected characteristics United States,

24 1976 ......... ..................................................................................... 32

14. Number of currently married women 15-44 years of age who

had impaired fecund~ or were surgically sterile for noncon25 traceptive reasons, and percent who wanted a baby or

another baby, by race, age, and parity United States, 1976 .... 33

15. Percent distnbutionl of currently married women 15-44 years

26 of age by infertility status, according to race and age United

States, 1965 and 1976 ................................................................. 34

16. Percent distribution! of currently married women 1544 years

27 of age by infertility status, according to race, parity, and age:

United States, 1965 and 1976 ..................................................... 35

28

19
Table 1. Number of currently married women 15-44 years of age and percent distribution by fecundity status, according tcl selected

characteristics United States, 1976

[Statistics are baaed on a sample of the household population of the conterminous United States. See appendixes I and II for discussion of the sample

design, sampling variability, and definitions of terms]

Surgically sterile

Number of

Impaired fecundity

Characteristic women in Total NonCixrtraceptive cont~c&ive All Sub- Long Fecund

thousands impaired surgically fecund sterile interval

All womenl ..............................

Age

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

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

20-24 years ........................

25-34 years .............................

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

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

35-44 years .............................

36-39 years ........................

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

Parity

o ................................................

1 ................................................

2 ................................................

3 or more .............................(..

Years since wife’s

first marriage

Less than 5 years ..................

5-9 years .................................

10-14 years.,, ..........................

15 years or more ...................

Hispanic origin

Hispanic ....................................

Other .........................................

27,46e

6,020

1,043

4,977

12,179

6,443

5,736

9,268

4,814

4,474

5,235

5,571

7,638

9,045

7,039

6,389

4,972

8,750

1,699

25,741

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

18.5

3.5

‘0.8

4.0

19.1

12.5

26.4

27.6

28.8

26.4

“1.5

3.8

23.3

33.5

1,8

13.7

28.2

30.2

10.7

19.1

9.6

“0.4

‘0.2

‘0.5

6.8

4.0

9.8

19.4

16.4

22.6

4.1

5.0

1:::

●1.3

3.2

10.9

20.1

8.0

9.8

15.7

10.8

*8.9

11.2

15.5

14.7

16.2

19.1

18.4

19.8

21.4

20.3

12.6

12.1

10.4

16.3

17.6

17.9 “

17.8

15.5

1.3 10.4

‘0.2 9.8

‘8.8

*0.3 10.0

1.3 11.5

“1.3 11.1

●1.3 12.0

2.1

2.3 ;::

“1.8 8.7

3.7 12.7

“0,9 15.3

‘0.7 9.2

“0.7 7.0

‘0.7 9.0

‘0.7 13.6

2.4 10.4

1.7 9.0

‘0.7 13.0

1.4 10.2

3.9

‘0.8

‘0.1

*1.O

2.6

2.3

2.9

7.7

6.2

9.3

5.0

4.1

2.6

43

‘0.6

2.1

4.8

7.2

‘4.1

3.9

56.1

85.3

90.1

64.3

56.7

68.7

47.5

33.9

36.3

31.2

73.0

70.9

55.1

38.1

86.5

66.7

43.3

31.8

63.5

55.7

I Includes women for whom yeare since wife’s first marriage and origin are unknown.

20
Table 2. Number of currently married women 15-44 years of age and percent distribution by feoundity status, according to parity and age

United States, 1976

[Statistics are based on a sample of the household population of the conterminous United States. See appendixes I and II for dieou-”on of the sample

design, sampling variability, and definitions of terms]

Parity and age

Number of Surgically sterile

women in ToW Impaired

Non- Fecund

thousands Contraceptive fecundity

contrecewtive . .

Percent distribution

All women ..................................................... 27,488 100.0 18.5 9.6 15.7 56.1

Parity O

1544 years ..................................................

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

25-34 years .............................................

35-44 years .............................................

Parity 1

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

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

25-34 years .............................................

35-44 years .............................................

Panty 2

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

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

25-34 years .............................................

35-44 years .............................................

5,235

2,738

1,931

565

5,571

2,130

2,562

879

7,638

907

4,391

2,340

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

●1.5

‘0.2

*1.8

*6.5

3.8

●0.3

4.5

*1O.3

23.3

14.4

25.4

23.0

4.1

●4.5

22.3

5.0

‘0.7

“4.0

18.2

8.9

‘0.9

6.1

17.3

21.4

10.6

27.3

53.9

20.3

11.2

21.7

37.9

12.6

7.8

11.1

17.2

73.0

89.3

66.4

17.2

70.9

87.8

69.8

33.5

55.1

77.0

57.4

42.5

Parity 3 or more

15-44 years .................................................. 9,045 100.0 33.5 16.3 12.1 36.1

15-24 years ............................................. 245 ‘ 100.0 ●26.9 ●1.2 *21 .6 50.2

25-34 years ............................................. 3,295 100.0 32.1 11.0 9.4 47.5

35-44 years ............................................. 5,504 100.0 34.6 20.2 13.3 31.9

21
Table 3. Number of currently married white women 15-44 years of age and percent distribution by fecundity status, according to age,

pari~, and years since wife’s first marriage United States, 1976

[Statistics are based on a sample of the household population of the conterminous United States. See appendixes I and II for discussion of the sample

design, sampling variability, and definitions of terms]

Surgically sterile Impaired fecundity

Age, parity, and years

Number of

women in Total Nonsince wife’s first marriage Non- All Sub- Long Fecund

thousands Contraceptive

contraceptive impaired surgically

sterile fecund interval

Percent distribution

All womenl .............................. 24,795 100.0 19.3 9.7 14.9 1.3 10.1 3.5 56.1

Age

15-24 years............................. 5,412 100.0 3.5 ‘0.4 9.7 ‘0.2 6.9 ●0.6 86.5

15-19 years ........................ 918 100.0 ‘0.8 8.5 *6.4 “0.1 90.7

20-24 years ........................ 4,493 100.0 4.0 “0.4 9.9 ‘0.3 9.0 *0.7 65.6

25-34 years............................. 10,993 100.0 20.1 6.6 15.0 1.3 11.4 2.3 56.1

25-29 years ........................ 5,606 100.0 13.1 3.9 14.7 “1.3 11.3 2.0 68.3

30-34 years ........................ 5,187 100.0 27.6 10.0 15.4 *1.3 11.4 2.6 46.8

35-44 years............................. 8,390 100.0 28.5 19.5 16.2 2.0 9.2 7.0 33.8

35-39 years ........................ 4,339 100.0 29.9 16.0 17.9 *2.2 10.0 5.7 36.2

40-44 years ........................ 4,051 100.0 26.9 23.3 16.5 *1.7 6.3 6.5 31,3

Parity

o ................................................ 4,674 100.0 *1.5 4.1 20.5 3.6 12.0 4.9 73.9

1 ................................................ 4,923 100.0 4.2 4.9 19.4 “0.9 15.0 3.5 71.5

2 ................................................ 6,939 100.0 24.9 6.7 11.6 ‘0.8 6.9 2.1 54,6

3 or more ................................ 6,059 100.0 34.4 16.9 11.6 ‘0.6 7.0 3.9 37.2

Years since wife’s

first marriage

Less than 5 years.................. 6,253 100.0 1.8 ‘1.3 9.7 ‘0.7 6.4 ‘0.7 67,2

5-9 year., ............................... 5,740 100.0 14.6 2.6 15.3 ‘0.6 13.1 *1.5 67.4

10-14 years............................. 4,512 100.0 29.4 10.8 17.1 2.5 10.2 4.4 42.7

15 years or more ................... 8,048 100.0 30.7 20.4 17.2 1,6 9.0 6,5 31,7

I Includeswomenforwhomyearssincawife’sfirstmarriageareunknown.

22
Table 4. Number of currently married black women 15-44 years of age and percent distribution by fecundity status, according to age,

parity, and yeara since wife’s first marriage United States, 1976

[Statistics are based on a sample of the household population of the conterminous United Stetes. See appandixea I and II for discussion of the sample

design, sampling variability, and definitions of terms]

Surgkal(y sterile

Number of

Impaired fecundity

Age, parity, and years women in Total Nonsince wife’s first marriage Contraceptive ~nt~c~ptive All Sub- Long Fecund

thousands impaired surgically

sterile fecund intewai

All women! ..............................

Age

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

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

20-24 years ........................

25-34 years: ............................

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

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

35-44 years .............................

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

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

2,169

509

99

410

912

484

428

749

368

381

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

12.6

‘4.0

●1.2

*4.7

9.6

*6.8

12.8

22.2

22.0

22.4

9.0

*1.1

‘2.3

‘0.8

6.9

*6.7

*7.2

16.8

15.7

17.9

22.5

20.1

●13.9

21.6

18.5

13.7

24.0

28.9

25.5

32.1

2.1 12.2 8.2 55.9

‘0.4 1.5.7 ●4.O 74.8

‘13.9 - 82,6

“0.5 16.2 ‘5.0 72.9

*1.6 11.4 5.6 64.9

●1.8 ‘7.8 ●4.2 72.8

*1.5 15.4 *7.1 56.0

*3.9 10.8 14.2 32.1

*4.1 ‘9.7 11.8 36.7

●3.6 12.0 16.5 27.6

Parity

o ................................................ 242 100.0 ‘0.8 ‘6.7 35.0 *8.1 17.2 *9.7 57.4

1 ................................................ 526 100.0 ‘0.7 ●6.2 27.1 *1.2 17.4 8.5 66.0

2 ................................................ 565 100.0 9.1 9.3 18.3 80.8 11.2 ●6.4 63.3

3 or more ................................ 837 100.0 26.0 11.1 18.8 *1.9 8.2 8.7 44.1

Years since wife’s

first marriage

Less than 5 years .................. 585 100.0 *2.6 *1.5 14.4 *1.O 11.3 *2.1 81.6

6-9 years..,, ............................. 504 100.0 “7.0 ●5.9 24.6 “0.9 15.8 ●7.9 62.5

10-14 years ............................. 368 100.0 15.4 14.7 21.4 *2.4 14.1 ●4.9 48.5

15 years or more ................... 627 100.0 25.1 14.5 27.9 ‘3.0 9.5 15.4 32.5

I Includes women for whom years since wife’s firat marriage are unknown.

23
Table 5. Number of currently married women 1544 years of age and percent distribution by fecundity status, according to selected

characteristics United States, 1976

[Statistics are based on a sample of the household population of the conterminous United States. See appendixes I and II for discussion of the sample,

design, sampling variability, and definitions of terms]

Number of Surgically sterile

Characteristic women in Total NonImpaired Fecund

thousands Contraceptive fecundity

contraceptive

Percent distribution

All womenl ...................................................................... 27,486 100.0 18.5 9.6 15.7 56.1

Education

Less than high school .................................................. 6,272 100.0 21.7

High school .....................................................................

12.6 18.9 46,8

12,970 100.0 19.0 10.0

More than high school .................................................. 8,198

14.9

100.0

56.2

15.4 6.8 14.5 63.2

Poverty level income

Below poverty level income ......................................... 1,418 100.0 17.5 *6.9

100-149 percent of poverty level income ................

14.5

2,030

61.1

100.0 20.1 8.0

150-199 percent of poverty level income ................ 3,098

14.1 57.8

100.0 18.7 7.4 13.8 60.1

200-299 percent of poverty level income ................ 6,162 100.0 21.1 10.1

300 percent or more of poverty level income .........

12.8

11,797 100.0

56.0

17.9 10.0 17.4 54.7

Religion

Protestant ......................................................................... 17,354 100.0 21.7 10.8

Catholic .............................................................................

14.7

7,792

52.7

100.0 13<1 8.6

No religion .......................................................................

17.6

1,153

60.7

100.0 14.8 *2.6 13.0 69.6

Geographic region

Notiheast .......................................................................... 5,561 100.0 13.0 6.6

North Central ...................................................................

19.9

7,893

60.5

South

100.0 19.8 10.7 13.7

9,213

55.9

................................................................................

West

100.0 18.5 10.9 15.5

4,821

55.0

.................................................................................. 100.0 23.0 9.1 14.2 53.7

Labor force status

In labor force .................................................................. 13,488 100.0 18.7 10.0

Not in labor force ..........................................................

15.1 56.1

13,957 100.0 18.4 9.3 16.3 56.1

TIncludes women with unknown education, poverly level income, religion, or labor force status, and women with religious preferences other than Protestant, Catholic, or no

religion.

24
..

Table 6. Number of currently married white women 15-44 years of age and percent distribution by fecundity status, according to selected

characteristics United States, 1976

[Statisticsare based on a sample of the household population of the conterminous United States. See appendixes I and II for discussion of the sample

design, sampling variability, and definitions of terms]

Number of Surgically sterile

Characteristic women in Total Impaired

Non- fecundity Fecund

fhousands Contraceptive contraceptive

Percent distribution

All womenl ...................................................................... 24,795 100.0 19.3 9.7 14.9 56.1

Education

Less than high school ..................................................

High ~hool .....................................................................

More than high school ..................................................

5,442

11,941

7,364

100.0

100.0

100.0

22.4

19.7

16.2

13.0

10.1

6.7

17.0

14.5

14.2

47.5

55.7

62.9

Poverty level income

63.7

56.1

60.8

55.5

54.7

Below poverty level income .........................................

100-149 percent of poverty level income ................

150-199 percent of poverty level income ................

200-299 percent of poverty level income ................

300 percent or more of poverty level income .........

1,117

1,748

2,790

5,689

11,034

100.0

100.0

100.0

100.0

100.0

17.2

21.5

18.9

21.8

16.6

●6.3

8.4

7.1

10.3

9.8

12.8

13.9

13.2

12.5

16.8

Religion

15,368

7,336

1,053

100.0

100.0

100.0

22.8

13.6

14.1

13.6

16.8

13.5

52.3

61.1

70.1

Protestant .........................................................................

Catholic.............................................................................

No religion .......................................................................

11.0

8.5

●2.4

Geographic region

Notiheast ..........................................................................

North Central...................................................................

5,100

7,479

7,838

4,378

100.0

100.0

100.0

100.0

13.3

20.2

19.6

24.1

6.8

11.0

11.0

8.5

19.4

13.1

14.5

13.7

60.5

55.7

54.9

53.7

South ................................................................................

West..................................................................................

Labor force status

In labor force ..................................................................

Not in labor force ..........................................................

11,914

12,839

100.0

100.0

19.5

19.1

10.0

9.4

14.1

15.7

56.4

55.7

1Includes women with unknown education, poverty level income, religion, or labor force status, and women with religious preferences other than Protestant, Catholic, or no

reliiion.

25
Table 7, Number of currently married black women 15-44 years of age and percent distribution by fecundity status, according to selected

characteristics United States, 1976

[Statistics are based on a sample of the household population of the contermlnous United States. See appendixes I and II fordiscuasion of the sample

design, sampling variability, and definitions of terms]

Characteristic

Number of Surgically sterile

women in Total Impaired

Contraceptive Non- fecundity Fecund

thousands contrace@ive

Percent distribution

All womenl ...................................................................... 2,169 100.0 12.6 9.0 22.5 55.9

Education

Less than high school .................................................. 691 100!0 17.9 9.3 31.5

High school .....................................................................

41.3

889 100.0 11.0 10.4 18.9 59.8

More than high school .................................................. 588 100.0 9.0 ●6.5 17.2 67.3

Poverty level income

Below poverty level income ......................................... 252 100.0 17.1 *1O.9 19.9 52.1

100-149 percent of poverty level income ................ 226 100.0 “14.5 *5.8 ●12.8 66.9

150-199 percent of poverty level income ................ 274 100.0 18.9 ●11.2 19.0 50.9

200-299 percent of poverly level income ................ 367 100.0 12.0 *9.3 12.8 65.9

300 percent or more of poverty level income ......... 578 100.0 9.8 8.6 28.5 53.3

Religion

Protestant ......................................................................... 1,908 100.0 13.6 9.1 22.0 55.2

Catholic ............................................................................. 165 100.0 *4.4 “9.6 31.2 54.8

No religion ....................................................................... 68 100.0 ‘7.0 ●6.9 ●12.1 74.0

Geographic region

Notiheast .......................................................................... 342 100.0 12.2 *5.8 25.6 56.1

North Central ................................................................... 304 100.0 13.2 ●6.4 21.0 59.4

South ................................................................................ 1,261 100.0 13.0 10.5 22.3 54.2

West .................................................................................. 242 100.0 ‘10.8 *6.6 20.5 60.0

Labor force status

In labor force .................................................................. 1,349 100.0 13.2 9.3 23.3 54.2

Not in labor force .......................................................... 819 100.0 11.7 8.5 21.0 58.8

! Includes women with unknown education, poverty level income, religion, or labor force status, and women with religious preferences other than Protestant, Ca.thofic,or no

religion.

26
Table 8. Number of currently married women 1544 years of age and percent distribution by fecundity status, according to occupation of

wife and occupation of husband United States, 1976

[Statisticsare based on a sample of the householdpopulationof the conterminousUnited States. See appendixes I and II for discussionof the sample

desire, samding variability,and definitionsof terms]

Occupation of wife and Number of Surgically sterile

women in Total Impaimd

occupation of husband Non- Fecund

thousamds Contraceptive fecundity

contraceptive

Percent distribution

All womenl ...................................................

Occupation of wife

Never worked ...............................................

Professional worker .....................................

Manager ........................................................

Sales worker ................................................

Clerical worker .............................................

Crafts wotier ................................................

Operative .......................................................

Transport equipment operator ...................

Laborer, except farm ..................................

Farm laborer.................................................

Service worker .............................................

Private household worker ..........................

Occupation of husband

Professional worker.....................................

Manager ........................................................

Sales worker ................................................

Clerical worker .............................................

Crafts worker ................................................

Operative .......................................................

Transport equipment operator ...................

Laborer, except farm ..................................

Farmr ...........................................................

Farm laborer.................................................

27,488

1,682

4,507

1,176

1,423

9,419

384

3,285

172

236

144

4,170

376

5,029

4,355

1,366

1,293

6,461

3,272

1,660

1,390

335

161

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

18.5

17.0

15.0

16.3

16.8

20.2

‘16.9

20.8

*22.5

817.1

●11.8

20.4

●7.4

15.7

23.4

16.9

15.0

19.1

19.3

21.9

14.3

“18.6

‘12.2

9.6

7.0

7.1

18.3

11.3

8.2

●1O.9

13.7

“15.0

*9.4

‘2.9

10.7

‘6.3

1E

8.1

10.9

9.4

9.3

12.8

7.4

●11.8

●10.4

Service worker ............................................. 1,866 100.0 16.7 9.5

15.7

14.8

16.3

19.1

11.4

14.8

●1O.1

15.3

●21.9

*26.6

●18.5

15.6

36.8

14.9

14,7

13.2

15.4

15.1

17,4

16.7

19.6

“22.2

●21.2

15.4

56.1

61.3

61.6

46.2

60.5

z

50.1

40.6

44.9

66.8

53.3

49.6

62.2

48.8

61.8

56.6

56.4

54.0

48.6

58.7

47.4

56,2

58.3

1Includesunknownoccupationsandotheroccupationsnotclassifiedseparately.

27
Table 9. Number of currently married women 15-44 years of age and percent distribution by number of reported spontaneous pregnancy

losses, according to selected characteristics United States, 1976

[Statisticsare based on a sample of the household population of the conterminous United States. See appendixes I and II for discussion of the sample

design, sampling variabilii, and definitions of terms]

Number of No reported 1 or more reported spontaneous

Characteristic women in Total spontaneous pregnancy losses

thousands pregnancy loss All losses 1 2 3 (or more

Percent distribution

All womenl .................................... 27,488 100.0 76.2 21.8 15.1 4.1 2.5

Age

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

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

20-24 years ..............................

25-34 years...................................

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

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

35-44 years...................................

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

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

Parity

o ......................................................

1 ......................................................

2 ......................................................

3 or more ......................................

Fecundity status

Surgically sterile

Contraceptive ............................

Noncontraceptive ......................

Impaired fecundity ........................

Fecund............................................

Hispanic origin

Hispanic.,........................................

Other...............................................

6,020

1,043

4,977

12,179

6,443

5,736

9,288

4,814

4,474

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

88.4

87.9

88.5

80.3

85.0

75.0

68.9

70.6

67.0

11.6

12.1

11.5

19.7

15.0

25.0

31.1

29.4

33.0

9.8

9.8

1??

11.7

16.8

19.9

20.0

19.9

*1.O

‘0.5

‘1.1

3.7

2.2

5.3

6.6

5.4

8.0

“0.8

*1.8

“0.6

1.9

*1.O

2.8

::

5.1

-,

_7.6.

12.4

15.5

20.9

5,235

5,571

7,638

9,045

100.0

100.0

100.0

100.0

89.3

82.3

78.9

68.7

10.7

17.7

21.1

31,3

*1.9

3.1

3.2

6.7

‘1.2

2.2

2.4

3.7

5,098

2,652

4,306

15,432

100.0

100.0

100.0

100.0

74.9

62.0

67.3

85.2

25.1

38.0

32.7

14.8

16.7

21.6

18.7

12.5

5.1

9.8

7.7

1.8

3.3

6.5

6.3

‘0.6

1,699

25,741

100.0

100.0

82.0

78.0

18.0

22.0

13.0

15,3

*3.7

4.1

*1.2

2.6

1Includes women for whom origin is unknown.
Table 10. Number of currently married whtie women 15-44 years of age and percent distribution by number of reported spontaneous

pregnancy losses, according to age, parity, and fecundity stetu~ United States, 1976

[Statisticsare based on a sample of the household population of the conterminous United States. Sss append~es I and II for discussion of the sample

design,samplingviability, and definitionsof terms]

Age, parity,and Number of No reported 1 or more reported spontaneous

fecundity status women in Total spontaneous pregnancy losses

thousands pregnancy loss All /0S.%3 1 2 3 or more

Percent distribution

All women ...................................... 24,795 100.0 78.4 21.6 15.0 4.1 2.5

Age

15-24 years................................... 5,412 100.0 89.0 11.0 9.3 ‘0.9 ‘0.8

15-19 years .............................. 918 100.0 88.9 11.1 ‘9.0 ●0.1

20-24 years .............................. 4,493 100.0

*1.9

89.0 11.0 9.4 ●1.O

25-34 years................................... 10,993 100.0

●0.6

80.4 19.6 14.1

25-29 yeare .............................. 5,806

3.8

100.0

1.7

65.0 15.0 11.9

30-34 years .............................. 5,187

2.2

100.0

‘0.9

75.2 24.8 16.6 5.5

35-44 years................................... 8,390 100.0 69.0 31.0 19.8 6.7 ::

35-39 years .............................. 4,339 100.0 71.2 28.8 19.4 5.2 4.1

40-44 years .............................. 4,051 100.0 66.5 33.5 20.2 8.2 5.0

Parity

o ...................................................... 4,874

1

100.0 89.9 10.1

4,923

75 *1.9

100.0

*1.2

......................................................

2

82.5 17.5

6,939

12;3” 3.0

100.0

*2.2

...................................................... 79.2 20.8 15.5

3 or more ...................................... 6,059

3.1

100.0

2.2

88.2 31.8 21.1 7.0 3.7

Fecundity status

Surgically sterile:

Contraceptive ............................ 4,781 100.0 75.2 24.8 16.4 5.3 3.1

Noncontraceptive ...................... 2,404 100.0 61.7 38.3 21.8

Impaired fecundity ........................ 3,701

10.1 6.4

100.0 67.6 32.4 18.4

Fecund............................................

7.6

13,909 100.0

6.5

85.2 14.8 12.4 1.8 ‘0.5

29
Table 11. Number of currently married black women 15-44 years of age and percent distribution by number of reported spontaneous

pregnancy losses, according to age, parity, and fecundity status United States, 1976

[Statisticsare basedon a sampleof the householdpopulationof the conterminousUnitedStates.See appendixesI‘ and II for discussion of the sample

design, sampling variability, and definitions of terms]

Age, parity, and

fecundity status

Number of

women in

thousands

Total

No reported

spontaneous

pregnancy loss

1 or more repotied spontaneous

pregnancy losses

All losses 1 2 3 or more

All women ......................................

Aga

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

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

20-24 years ..............................

25-34 years...................................

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

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

35-44 years...................................

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

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

2,169

509

99

410

912

484

428

749

368

381

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

75.9

81.8

81.0

82.0

79.0

85.9

71.1

68.1

63.2

72.8

Parity

o ...................................................... 242 100.0 74.8

1,,,,.,..., ..,....,,, ................................. 526 100.0 80,8

2 ...................................................... 565 100.0 76.7

3 or more ...................................... 837 100.0 72.6

Fecundity status

24.1

18.2

*19.0

18.0

21.0

14.1

28.9

31.9

36.8

27.2

16.7 3.9

15.5 “2.0

●13.6 *4.1

15.9 “1.5

14.1 ●3.6

10.1 *2.7

18.6 *4.7

20.9 ‘5.6

25.9 *6.4

16.0 *4.9

3.4

‘0.7

*1.3

‘0.6

“3.3

*1.3

●5.6

“5.4

*4.5

●6.2

25.2 18.9 *4.3 ●2.O

19.2 12.2 *4.3 *2.8

23.3 17.6 ●2.3 ‘3.4

27.4 18.4 ‘4.7 “4.2

Surgically sterila

Contraceptive ............................ 274 100.0 70.0 30.0 19.9 *3.5 ●6.6

Noncontraceptive ...................... 195 100.0 62.2 37.8 24.1 *4.9 “8.8

Impaired fecundity ........................ 488 100.0 63.8 36.2 21.5 9.4 *5.3

Fecund.,,,,....................................... 1,213 100.0 84.3 15.7 12.9 “1.7 *1.1

30
Table 12, Number of currently married women 15-44 years of age and percent distribution by number of reported spontaneous pregnancy

losses, according to occupation of wife and occupation of husband United States, 1976

[Statisticsare based on a sampleof the householdpopulationof the conterminouaUnitedStates.See appendixesI and II for discussionof the sample

design, sampllng variability, and definitionsof terms]

Occupation of wife and Number of No reported 1 or more reported spontaneous

occupation of husband women in Total spontaneous Pregnancy losses

thousands pregnancy loss All 10SSSS 1 2 3 or more

Percent distribution

All womenl .................................... 27,488 100.0 78.2 21.8 15.1 4.1 2.5

Occupation of wife

Never worked ................................ 1,682 100.0 So.o 20.0 14.0 ‘4.3

Professional worker ...................... 4,507

*1.8

100.0 80.3 19.7 12.2 5.1

Manager ......................................... 1,176

*2.3

100.0 75.6 24.4 18.2 ●4.4

Sales worker ................................. 1,423

*1.8

100.0 79.3 20.7 15.0

Clerical worker ..............................

“4.0

9,419

●1.6

100.0 79.2 20.8 14.6 3.7

Crafts worker................................. 3s4

2.5

100.0 78.8 ●2I .2 ●11.4 ●4.7

Operative ........................................ 3,285

‘5.0

100.0 78.1 21.9 15.7 4.4

Transport equipment operator .... 172

●1.7

100.0 68.7 ●31.3 ●24.8 ●1.7

Laborer, except farm ................... 236

‘4.8

100.0 80.0 ●20.O

Farm laborer..................................

“11.4 -

144

●8.5

100.0 77.1 %22.9 “14.s ●3.2

Service worker .............................. 4,170

●4.9

100.0 73.2 26.8 19.3 4.1 3.4

Private household worker ........... 376 100.0 72.6 27.4 ●19.2 *2.1 ●6.1

Occupation of husband

Professional worker ...................... 5,029 100.0 81.1 18.9 12.0 4.2

Manager .........................................

2.7

4,355 100.0 76.4 23.6 16.6 4.9

Sales worker ................................. 1,386

●2.2

100.0 76.2 23.8 18.8 ●1.8

Clerical worker 1,293

●3.2

.............................. 100.0 81.6 18.4 13.1 ●2.6

Crafts worker................................. 6,461

●2.7

100.0 78.0 22.0 15.3 4.0

Operative ........................................ 3,272

2.7

100.0 77.6 22.4 15.4 4.2

Transport equipment operator .... 1,660

‘2.s

100.0 73.5 26.5 17.5 *5.6

Laborer, except farm ................... 1,390

*3.4

100.0 78.5 21.5 16.1 ●3.7

Farmer ............................................ 335

●1.7

100.0 75.0 25.0 “20.2 “0.6

Farm laborer.................................. 161

●4.2

100.0 80.5 ●19.5

Service worker ..............................

●12.1 ●6.2

1,866

*1.2

100.0 78.9 21.1 16.2 ●3.9 ●1.O

1Includesunknownoccupationsandotheroccupationsnotclassifiedseparately.

31
Table 13. Number of currently married women 15-44 years of age who had impaired fecundity or were surgically sterile for

noncontraceptive reasons, and percent who wanted a baby or another baby, by selected characteristics United States, 1976

[Statistics are based on a sample of the housahold population of the conterminous United States. See append~ee I and II for discussion of the sample

design, sampling variability, and definitions of terms]

Women who want a baby or another baby

Impaired fecundity S::ury

Characteristic

Impaired fecundity Surgically

All Non- Sub- Long non- All Non- Sub- Long

sterile,

‘~~”~~ fecund interval impaired contraceptive surgically f nonimpaired sterile ecund intervai cl>ntraceptive

Number of women in thousands Percent

All women! .................... 4,306 368 2,856 1,082 2,652 47.3 50.8 50,7 37.2 41.4

Parity

o ...................................... 1,121 195 665 261 214 74.9 72.2 80,8 61.9 48.3

1 ...................................... 1,129 ●49 851 226 278 56.8 ●54.8 62.1 37.7 53.5

2 ...................................... 962 *56 705 200 683 33.6 ●26.5 32.9 36.2 46.1

3 or more ...................... 1,095 ’67 635 393 1,478 21,3 ●6.2 23.8 *19.9 36.0

Age

15-24 years ................... 652 ’13 588 *5 I ●25 81.2 99.9 82.0 *67.6 86.0

25-34 years ................... 1,882 161 1,405 317 823 60.4 75.2 59.0 58.9 55.0

3544 years ................... 1,772 194 864 774 1,804 21.0 ●27.2 16.0 25.4 34.8

Race

White ............................... 3,701 322 2,505 874 2,404 46.9 50.5 50.0 36.7 39.9

Black ............................... 488 45 265 177 195 49.2 62.8 53.0 42.6 52.1

Hispanic originz

Hispanic .......................... 302 ●13 220 ’69 136 60.5 ●46.9 62.5 ●56.7 54.6

Other ............................... 4,001 354 2,636 1,011 2,515 46.3 51.0 49.7 35.7 40.7

~Includes whtie, black, and other raceq also includes women for whom origin is unknown.

2Women of Hispanic origin are also included in the figures for white and black women if they were identified as white or black by the interviewer.

32
Table 14. Number of currently married women 15-44 years of age who had impaired fecundity or were surgically sterile for

noncontraceptive reasons, and percent who wanted a beby or another baby, by race, age, and parity United States, 1976

[Statisticsare based on a sample of the householdpopulationof the conterminouaUnited States. See append~es I and II for discussionof the sample

design, samplingvariability,and definitionsof terms]

Impaired fecundity Surgically sterile, noncontrsceptive

Race, age, andpatity Number of women Percent who want Number of woman

Percent who want

in thousands a baby or in thousands a baby or

another baby another baby

All racesl

To@l.......................................................... 4,306 47.3 2,652 41.4

Age

15-29 years.,.,...,,.,.................................. 1,602

30-44 years............................................. 2,704

73.3

31.9

286

2,366

60,3

39.2

Parity

1,121

1,129

962

1,095

74.9

56.8

33.6

21.3

214

278

683

1,478

48.3

53.5

46.1

36.0

1................................................................

2 ................................................................

3 or more ................................................

White

3,701 46.9 2,404 39.9

Age

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

30-44 years.i.,,........................................

1,376

2,325

73.9

30.9

248

2,155

80.7

37.5

Parity

o ................................................................

1................................................................

999

954

816

931

73.0

55.7

32.7

22.1

198

240

607

1,360

45.9

50.4

45.2

34.7

2 ................................................................

3 or more ................................................

Black

To@l.......................................................... 488 49.2 195 52.1

Age

15-29 yeaw ............................................. 169 72.6 ’38

30-44 yeare ............................................. 319

57.5

36.8 157 50.8

Parity

o ................................................................ 85 86.2

1

’16

142

77.2

................................................................ 65.8

2

●32

103

68.3

................................................................ 48.5 52

3 or more ................................................ 157

59.3

‘14.5 93 38.0

~Includeswhite,black,andotherraces.

33
Table 15. Percent distribution of currently married women 1544 years of age by infertility status, according to race and age

United States, 1965 and 1976

[Statistics are baaed on samples of the household population of the conterminous United States. Seeappendixes land llfordiscussion of the sample

deeigns, samPfing var’iabiMy,and definitions oftermsl

Infertility status

Race and age Surgically sterilez Infertile Fecund~

1976 1965 1976 1965 7976 1965

All racess Percent distribution

15-44 years................................................................ 26.2 15.6 10.3 11.2

15-19 years ................................................................ ●1.O ‘0.6 ●2.1 ‘0.6

20-24 years................................................................ 4.5 3.1 6.4 *3,5

25-29 yearn................................................................ 16.6 9.5 9.0 6.5

30-34 years................................................................ 36.2 17.0 10.3 11.6

35-39 years................................................................ 45.3 22.6 12.5 14.2

40-44 years................................................................ 49.0 26.8 15.9 20,2

White

15-44 years................................................................ 29.0 15.9 9.4 10.5

15-19 years................................................................ “0.8 ‘0.6 “2.0 *0.6

20-24 years................................................................ 4.5 3.1 5.6 3.4

25-29 years................................................................ 17.1 9.1 8.4 6.1

30-34 years................................................................ 37.8 17.2 9.5 10.8

35-39 years................................................................ 45.9 22.8 11.4 13.4

40-44 years................................................................ 50.2 26.7 14.6 18.5

Black

15-44 years................................................................ 21.6 14.2 18.1 16.3

15-19 years................................................................ *3.5 ●3.7

20-24 years................................................................ *5.5 3.4 15.4 3.4

25-29 years................................................................ 13.5 12.0 11.2 7.1

30-34 years................................................................ 20.0 13.5 18.1 15.7

35-39 years................................................................ 37.8 21.5 23.3 24.4

40-44 years.......................<....................................c... 40.3 27.3 28.8 39.0

1Seeappendx tables VI and WI for baas numbere.

8Includes both contraceptive and noncontraceptive operations.

3See text or appendix II for definition; “infertile” is not the same aa “impaired fecundity,” used in tables 1-14.

4“Fecund” is used In a different way in this table than in tables 1-14. See text or i3fIpSIFdiX 1!fOr definitions.

6Includes whfie, black, and other race.%

61.6

96.9

69.2

74.4

53.5

42.2

35.2

61.6

97.3

89.9

74.5

52.7

42.7

35.2

60.3

92.8

79.1

75.4

62.0

38.9

30.9

73.0

98.9

93.4

84.0

71.3

63.0

52.9

73,6

98,7

93.4

84.8

72.0

63.8

54.6

69.5

100.0

93.1

80.9

70.6

54.1

33.7
Table 16. Percent distributionlof currently married women 1544 years of age by infertility status, according to race, parity, and age

United Sates, 1965 and 1976

[Statiaficaare based on samples of the householdpopulationof the conterminousUnited States. See appendixes I and II for discussionof the sample

designs, samplingvariability,and definitionsof terms]

Infertility skltus

Race, parity, and age Surgically sterilea Infertile Fecundd

1976 1965 1976 1965 1976 1965

All racesc

All parities

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

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

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

Parity O-1

1544 years................................................................

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

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

Parity 2

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

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

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

Parity 3 or more

1544 years................................................................

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

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

White

All parities

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

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

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

Parity O-1

15+4 years................................................................

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

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

Parity 2

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

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

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

Parity 3 or more

1544 years................................................................

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

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

Black

All parities

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

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

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

Parity 0-1

15-44 yeara................................................................

15-29 yeara ...........................................................

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

Parity 2

15-44 yearn ................................................................

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

3044 years ...........................................................

Parity 3 or more

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

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

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

28.2

10.4

42.9

7.2

2.3

21.5

32.3

22.4

39.3

49.8

32.3

52.6

29.0

10.7

44.1

E

21.9

33.6

23.8

40.4

51.3

32.8

54.0

21.6

3H

‘::

20.9

18.4

●11.7

24.9

37.1

29.0

39.5

15.8

5.7

22.3

7.4

0.5

18.1

14.2

2;;

21.5

13.0

24.5

15.9

5.5

22.3

‘::

17.7

14.4

5.8

20.2

21.9

13.1

24.7

14.2

6.6

20.6

10.3

●1.5

19.1

6.4

●2.1

*11.4

18.9

11.9

23.6

Percent cKstribution

10.3

7.4

12.6

15.2

9.1

32.9

6.0

4.1

7.4

7.9

‘4.7

8.4

9.4

6.7

11.6

14.3

8.5

31.4

R

7.0

6.9 .

●3.5

7.4

18.1

12.1

23.2

24.6

13.7

48.4

10.9

●9.7

*12.1

17.0

●11.4

18.7

11.2

4.5

15.5

16.0

6.3

31.1

E

13.0

9.4

2.7

11.8

10.5

4.4

14.3

15.2

2::

8.5

*3,6

11.8

8.8

2.1

11.0

16.3

4.5

26.1

25.0

●5.9

44.1

17.3

3%

11.5

●3.3

16.9

61.6

82.2

44.4

77.6

88.6

45.6

61.7

73.5

53.3

42.3

63.0

39.0

61.6

82.6

44.3

78.4

89.0

46.7

60.9

72.9

52.6

41.8

63.6

38.6

80.3

78.7

44.7

88.2

85.5

30.7

70.7

78.6

63.0

45.8

59.6

41.9

73.0

69.8

62.2

76.5

93.2

50.8

76.6

90.6

67.0

89.0

84.4

63.7

73.6

90.1

63.3

77.7

93,2

52.8

77.1

90.8

68.1

69.3

84.8

84.4

89.5

88.9

53.3

84,7

92.6

36.8

76.3

92.6

57.0

69.7

84.8

59.6

~See appendixtablesVI andWI forbase numbers.

aIncludasbothcontraceptiveand noncontracaptiveoperations.

sSee textor appendixII fordefinitio~“inferlile”isnotthe same se “impairedfecundity,”usedintables 1-14.

4“Fecund”is usedina djfferentway inthistable thanintables 1-14. See text or appendix 11fOr definitions.

5Includes whte, black, and other races.

35
Appendixes

Contents

1. Technical notes ........................................................................................................................................................................

Background .......................................................................................................................................................................

Statistical design ...............................................................................................................................................................

Measurement process .....................................................................................................................................................

Data reduction ...................................................................................................................................................... .............

Reliability of estimates .....................................................................................................................................................

Estimation of standard errors ...................................................................................................................................

Testing differences ...................................................................................................................................................

Nonsampling error ............................................................................................................................................................

Interview nonresponse .............................................................................................................................................

Item nonresponse .....................................................................................................................................................

The 1965 National Fertility Study ....................................................................................................................................

Standard errors .................................................................................................................................................................

Ii. Concepts and definitions .........................................................................................................................................................

Reproductive impairments ...............................................................................................................................................

Fecundity ...................................................................................................................................................................

Fecundi~ status ........................................................................................................................................................

Surgically sterile ........................................................................................................................................................

Nonsurgically sterile ..................................................................................................................................................

Long interval ..............................................................................................................................................................

Subfecund ..................................................................................................................................................................

Fecund ..................................................................................................................................................................... ..

Infertility status .........................................................................................................................................................m

Surgically sterile ......................................................................................................................................m.................

Infertile ................................................................................................................................................m......................

Fecund .......................................................................................................................................................................

Wanted to have a (or another) baby ........................................................................................................................

Reported spontaneous pregnancy losses ...........................................~..................................................................

Demographic characteristics ..........................................................................................................................................

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

Years since wife’s first marriage ..............................................................................................................................

Marital status .............................................................................................................................................................

Hispanic origin...........................................................................................................................................................

Household population..............................................................................................................................................

Region of residence .................................................................................................................................................

Education ...................................................................................................................................................................

Religion ......................................................................................................................................................................

38

38

38

39

39

39

40

40

41

42

42

42

43

45

453

45

45

45

46

46

46

46

47

47

47

47

47

47

48

48

48

48

48

48

48

48

48

36
Labor force status ..................................................................................................................................................... 48

Poverty level income ................................................................................................................................................. 49

Occupation ................................................................................................................................................................ 49

Ill. Items on the National Survey of Family Growth questionnaire related to reproductive impairments ............................... 50

List of appendix tables

1.

IL

Ill.

Iv.

v.

V1.

V1l.

Parameters used to compute estimated standard errors and relative standard errors of numbers and percents of

women, by marital status and race: 1976 National Survey of Family Growth ..................................................................... 40

Approximate relative standard errors and standard errors for estimated numbers of currently married women of all

races combined: 1976 National Survey of Family Growth .................................................................................................... 40

Approximate standard errors expressed in percentage points for estimated percents of currently married women of

all races combined: 1976 National Survey of Family GroMh ............................................................................................... 41

Standard errors expressed in percentage points of estimated percents for currently married white women and

women of all races combined: 1965 National Fertility Study ................................................................................................ 43

Standard errors expressed in percentage points of estimated percents for currently married black women: 1965

National Fertility Study ........................................................................................................................................... .................. 44

Number of currently married women 15-44 years of age in the sample, by race, age, and parity 1965 National

Fertility Study ............................................................................................................................................................................ 44

Weighted number of currently married women 15-44 years of age, by race, age, and parity United States, 1976 ........ 44

..— ,, .*

,,,
Appendix L 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 health that

are closely related to childbearing.

The NSFG is a periodic survey based on personal

interviews with a nationwide sample of women. A

detailed description of the methods and procedures

used in Cycle I of the NSFG can be found in

“National Survey of Family Growth, Cycle I: Sample

Design, Estimation Procedures, and Variance Estimation,” Series 2, No. 76, of Vital and Health Statistics.36

The present report is based on Cycle II of the NSFG.

A detailed description of the methods and procedures

of Cycle II can be found in “National Survey of

Family Growth, Cycle II: Sample Design, Estimation

Procedures, and Variance Estimation,” Series 2, No.

87 of Vital and Health Statistics.5 This appendix

presents a summary discussion of the more important

technical aspects of Cycle IL

Fieldwork for Cycle II was carried out under a

contract with NCHS by Westat, Inc., between January

and September of 1976. The sample is representative of

women 1544 years of age in the household population

of the conterminous United States who were ever

married or had coresident offspring. Interviews were

completed with 8,611 women, 3,009 respondents were

black women, and the other 5,602 respondents were of

races other than black.

The interview focused on the respondents’ marital

and pregnancy histories, their use of contraception and

the planning status of each pregnancy, their use of

maternal care and family planning services, fecundity

impairments and their expectations about future

births, and a wide range of social and economic

characteristics. Although the time required to comNOTE A list of references follows the text.

38

plete the interviews varied considerably, the average

Cycle II interview lasted about 58 minutes.

Statistical design

The NSFG is based on a multistage area probability sample. Black households were sampled at higher

rates than other households so that reliable estimates

of statistics could be presented separately for white and

black 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 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. If a

woman 15-44 years of age, ever-married or nevermarried with offspring in household was listed as being

in the household, an extended interview was conducted. If more than one woman in the household met the

eligibility criteria, one of the women was randomly

selected for an extended interview.

The statistics in this report are estimates for the

national population and were computed by mrdtiplying each sample case by the number of women she

represented in the population. The multipliers, or final

weights, ranged from 647 to 43,024 and averaged

3,822. They were’ derived by using three basic steps:

● Inj?ation by the rec@rocal of the probability of

selection.—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 tist 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 category

and PSU. Response to the screener was 93.8

percen~ the response to the interview was 88.2

percent, yielding a combined response rate of

approximately 82.7 percent.

. Poststratljication by marital status, age, and race.—

The estimates were ratio adjusted within each of

the 12 age-race categories to an independent

estimate of the population of ever-married women.

The independent estimates were derived from the

U.S. Bureau of the Census Current Population

Surveys of March 1971-March 1976. The numbers

of never-married women with coresident offspring

were inflated by the first and second steps only.

The effect of the ratio-estimating process was to

make the sample more closely representative of the

population of women 15-44 years of age living in

households in the conterminous United States, who

were ever married or with coresident offspring. The

Iinal 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 numbers and percents may not sum to

the total because of the rounding.

Measurement process

Field operations for Cycle II 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 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 accuracy was found. A 10:percent 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 interivew schedule applicable to

this report is reproduced in appendix III. The complete schedule for currently married women was

reprinted elsewhere.sT Two different forms of the

NOTE: A list of references follows the text.

questionnaire were used, one for interviewing currently married women and the other for interviewing

widowed, divorced, separated, or never-married women with coresident offspring. The two forms differed

mainly in wording when reference was made to the

husband some questions in one schedule did not

appear in the other.

Data reduction

The responses of each woman to the interview

questions were translated into predetermined numerical codes, and these code numbers were recorded on

computer tapes. The first few questionnaires coded by

each coder were checked completel~ 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

schemq these errors were corrected.

Missing data on age and race were imputed

because they were used in the nonresponse adjustments and for poststratification purposes. Unlike Cycle

I, however, other missing data were not imputed to

expedite release of the data. Therefore, percents and

other statistics in Cycle II were based on cases with

known data. For most variables, the level of missing

data was less than 1 percent. The level of missing data

is noted in the “Concepts and definitions” for each item

that was missing 2 percent or more of the responses.

For those few variables for which missing data may

pose a problem for analysis (e.g.,

come), this fact is noted in the text.

Reliability of estimates

Because the statistics presented

poverty level inin 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

out of 100 that an estimate from the sample will

differ from a complete count by less than the standard

error. The chances are about 95 out of 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 25 percent are

considered unreliable. These figures are marked with

an asterisk to caution the user, but may be combined

39
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, es’tlmated empirically by using a technique

known as balanced half-sample replication. This technique produces highly reliable, unbiased estimates of

sampling errors. Its application to the NSFG has been

described elsewhere.sJ6

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(iV) = (A + B/N’)’/’

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 sampling

rates were used for black and other women. The

estimates of~ and B 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:

RSE~ = (A + B/N)Yz

SEN= (A + B/N)x )( N’

RSEPI= (VP X (100 – P’)/X’)fi

SE,’= (B X P’ X (100 – P)/X’)~

where

iv= number of women

P’ = percent

Table 1.Parameters used to compute estimated standard errors and

relative standard errors of numbers and percents of women, by

marital status and race: 1976 National Survey of Family Growth

Part?meter

Marital status and race

A B

Currently married

AH races............................................. -0.0001858989 6751.0619

Black ................................................... -0.0006310400 2798.6440

White and other ............................... -0.0002056235 7021.1665

Ever married

All races............................................. 0.0001700390 6486.5185

Black ................................................... -0.0004520643 2848.2362

White and other ............................... 0.0000422037 7111.5185

J? = number of women in the denominator of

the percent

SE = standard error

RSE = relative standard error

Tables II and III show some illustrative standard

errors of aggregates and percents of currently married

women of all races from Cycle 11of the NSFG.

Testing differences

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’I– PZ

then

(P’l )2 . (RSEP ,1)2 + (P’2)2 o (RSEP /2)2

where P’Iis the estimated percent for one group and

P’z is the estimated percent for the other group, and

RSEPI1and RSEP2are the relative standard errors of

P’I and P’z, respectively. 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 statistically significant difference among comparable proportions or other statistics from two or more

subgroups is sufficiently large when a diiTerence 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

NOTE: A list of references follows the text.

Table Il. Approximate relative standard errors and standard errors for

estimated numbers of currently married women of all races

combined: 1976 National Survey of Family Growth

Size of estimate Relative

standard error

Standard error

50,000 ..........................................

100,000........................................

500,000 ...!....................................

1,000,000 ....................................

3,000,000 ....................................

5,000,000 ....................................

7,000,000 ....................................

10,000,000 ..................................

20,000,000 ..................................

36.7

25.9

11.5

8.1

4.5

3.4

2.8

2.2

1.2

18,000

26,000

58,000

al ,000

136,000

171,000

195,000

221,000

246,000

40
Table Ill. Approximate standard errors expressed in percentage points for estimated percents of currently married women of all races

combined: 1976 National Survey of Family Growth

.&Xirnded oercent

Base of percent

2 or 98 5 or 95 7 or 93 10 or 90 15 or 85 20 or 80 30 or 70 40 or 60 50

Standard error expressed in percentage points

100.OOO.................................................... 3.6 5.7 6.6 7.8 9.3 10.4 11.9 12.7 13.0

500.000 .................................................... 1.6 2.5 3.0 3.5 4.2 4.7 5.3 5.7 5.8

1,000,000 ................................................ 1.2 1.8 2.1 2.5 2.9 3.3 3.8 4.0 4.1

3,000,000 ................................................ 0.7 1.0 1.2 1.4 1.7 1.9 2.2 2.3 2.4

5,000,000 ................................................ 0.5 0.8 0.9 1.1 1.3 1.5 1.7 1.8 1.8

7,000,000 ................................................ 0.4 0.7 0.8 0.9 1.1 1.2 1.4 1.5 1.6

10,000,000 .............................................. 0.4 0.6 0.7 0.8 0.9 1.0 1.3

20,000,000 .............................................. 0.3 0.4 0.5 0.6 0.7 0.7 E 0.9 :::

&/e of use of tab/e ///: If 30 percent of currently married women in a specific category used the oral contraceptive pill and the base of that percent was 10,000,000,

then the 30-percent column and the 10,000,000 row would indicate that 1 standard error is 1.2 percentage pointa and 2 standard errors are twice that, or 2.4 percentage

points, Therefore, the chances are about 95 out of 100 that the true percent in the population was between 27.6 and 32.4 percent (30.0 percent k 2.4 percent). This is

called a 95-percent confidence interval. In addition, the relatiie standard error of that 30-percent estimate is 1.2 percent dwided by 30 percent or 4.0 percent.

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 out of

100 samples.

Although the 5-percent criterion is conventionally

applied, it is in a sense arbitrary; depending 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

(l-percent) level, but if one can accept a 10-percent

chance of concluding a difference exists when there

actually is none in the population, a test of significance

at the 0,10 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 40 degrees

of freedom. Statements about differences that are

qualified in some way (e.g., 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. 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 halfsample replication design (40 for Cycle II) 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 40 degrees of

freedom.

Example: In 1976, 29.0 percent of 24,795,000

currently married white women or their husbands had

been surgically sterilized, compared with 21.6 percent

of 2,169,000 currently married black women or their

husbands. To test this racial diiTerence at the 0.05 level

of significance, compute

29.0 -21.6

t = ~(29.o)z . RS 2

‘(29.0) + (21.6) 2 . RsE~2 ,.6)

By using the parameters from table I in the formula for

the RSE of a percent,

and

Thus

‘021JT5“ wF?

= 0.026

RSE{z,,,~=

(100-21.6)

99

= 0.068

29.0–21.6

t =

= 4.48

The two-tailed 0.95 critical value (1 - a) for a t statistic

with 40 degrees of freedom is 2.02. Therefore, the

difference is significant at the 0.05 level.

Nonsampling error

Although sampling error affects the precision of

reliability of survey estimates, nonsampling error

introduces bias. To minimize nonsampling error,

41
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

editin~ an 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.

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 question$ and errors of recording,

coding, and keying by survey personnel.

A discussion of interview nonresponse and item

nonresponse follows. The third and fourth types of

errors cannot be accurately measured, but the quality

control procedures (some of which are discussed under

“Measurement process” and “Data reduction”) of the

survey were designed to reduce such nonsarnpling

errors to a minimum.

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 indirectly in two ways. First, an independent relisting of about 20 percent of the segments

was performed, and any differences between the two

lists were pointed out to listers by supervisory stti and

reconciled. Second, listing accuracy was 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 segment was

checked to see if any structures had been missed in the

listing process; if the first structure was a multiple-DU

structure, the entire structure was checked for missed

DU’S, About 700 dwelling units, or about 2 percent of

the sample of DU’S designated for screening, were

. included in the sample as a result of the missed DU

procedure.

Of the original sample of 32,653 DU’S screened,

5,490 were found vacant, not DU’S, or group quarters.

Of the remaining DU’S, 6.2 percent were not screened

successfully. This figure included 2.5 percent refusals

to have household members listed, 0.4 percent with

language problems, 1.7 percent where no one could be

found at home, and 1.7 percent for other reasons such

as being refused access to the unit or because of illness.

Of the 25,480 households for which screening was

completed, 10,202 were found to contain an eligible

respondent. However, interviews were not completed

in 11.8 percent of these cases because of refusals by the

eligible respondents (5.8 percent), language problems

(0.6 percent), no contact after repeated calls (1.8

percent), or other problems (3.6 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 where the answer was not

codable. Nonresponse to individual questions was very

low in Cycle II, as in Cycle I. Some examplw of item

nonresponse among a total of 8,611 respondents are

number of pregnancies, 3 cases; religion of respondent,

17 cases; religion of husband, 232 cases; education, 14

cases; occupation, 185 cases; and poverty level income,

1,348 cases. Most of the items with relatively high

levels of missing data were characteristics of the

respondent’s current or last husband, and the sources

and amount of income,

Unlike Cycle I of the NSFG, missing data items

were not imputed in Cycle II, except for a few

respondents with missing information on age and race,

which were required for the nonresponse and

poststratiiication adjustments. A small amount of

missing data was tolerated in Cycle II to facilitate

faster release of data and data tapes from the NSFG,

Assignment of missing data codes and editing of

selected variables was performed by the NSFG staff

when necessary or desirable for analysis, as explained

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 it can be detected indirectly by the

extensive computer “cleaning” and editing procedures

used in the NSFG.

The 1965 National Fertility Study

The 1965 National Fertility Study (NFS) collected

information on fertility and family planning from a

nationally representative area probability sample of

currently married women born since July 1, 1910 (15-

42
55 years of age) and living with their husbands in the

conterminous United States. The survey was conducted by Norman B. Ryder and Charles F. Westoff of the

Office of Population Research, Princeton University,

under contract with the National Institute of Child

Health and Human Development of the U.S. Public

Health Service.

National Analysts, Inc. of Philadelphia drew the

sample, conducted the interviews, edited and coded the

questionnaires, and prepared the basic data file. A total

of 5,617 women were intemiewed, including 4,810

women 15-44 years of age. The interview completion

rate in the NFS (the number of successfully completed

interviews divided by the number of women eligible to

be interviewed) was 88 percent. Of the 12 percent not

interviewed, approximately two-thirds, or 8 percent,

refused to be interviewed, the remaining 4 percent

were cases in which no one was at home and other

miscellaneous reasons. Further discussion of the design and conduct of the 1965 NFS maybe found in the

full report of the study.zs

Standard errors

Standard errors for the 1965 NFS are measures of

sampling variability-the variation that occurs because a sample of women (rather than all women) was

interviewed. The chances are approximately 68 out of

100 that an estimate (a percent from the NFS) would

differ from the actual population value by less than 1

standard error and approximately 95 out of 100 that

the difference would be less than twice the standard

error.

The contractor for the 1965 NFS produced tables

of estimated standard errors, from which tables IV and

V were derived. The number of sampled women on

which the percents for 1965 are based are shown in

appendix table VI. The weighted numbers of women

on which the percents for 1976 (used in tables 15 and

16) are based are shown in appendix table VII.

NOTE A list of references follows the text.

Table IV. Standard errors expressed in percentage points of estimated percents for currently married white women and women of all races

combined 1965 National Fertility Study

Size of sample

Estimated percent

5 or 95 10 or 90 15 or 85 200r80 25 or 75 30 or 70 4oor60 50

Standard error in percentage points

50 ......................................................... 3.1 4.3 5.1 5.7 6.2 6.6 7.0 7.2

75 ......................................................... 2.6 3.5 4.2 4.7 5.1 5,8 5.9

loo ..........................................o............ 2.2 3.1 3.7 4.1 4.4 E

150 ....................................................... 1.8 2.5 3.0 3.4 3.9 u! ::

200 ....................................................... 1.6 2.2 2.6 3.0 u 3.4 3.6 3.7

250 ....................................................... 1.5 2.0 2.4 2.7 2.0 3.1 3.3 3.3

....................................................... 1.3 1.9 2.2 2.5 2.7 2.8 3.0 3.1

400 ....................................................... 1.2 1.6 1.9 2.2 2.4 2.5 2.7 2.7

....................................................... 1.1 1.5 1.8 2.0 2.2 2.3 2.4 2.5

mo ....................................................... 1.0 1.4 1.7 1.9 2.0 2.1 2.3

600 ....................................................... 0.9 1.3 1.5 1.6 1.6 1.9 2.0 ::;

l.wo .................................................... 0.8 1.1 1.4 1.5 1.7 1.8 1.9 1.9

l.wo .................................................... 0.7 1.2 1.3 1.4 1.5 1.6 1.7

2.000.................................................... 0.7 u 1.1 1.2 1.3 1.4 1.5

2.500.................................................... 0.6 1.0 1.2 1.2 1.3 ;:: 1.4

3.0m ...................!................................ 0.6 :; 1.0 1.1 1.2 1.3 1.3 1.4

3.5w .................................................... 0.6 0.8 0.9 1.1 1.1 1.2 1.3 1.3

3,841.................................................... 0.6 0.8 0.9 1.0 1.1 1.2 1,3 1.3

43
Table V. Standard errors expressed in percentage points of estimated percents for currently married black women

1965 National Fertility Study

Size of sample

Estimated percent

5 or 95 10 or 90 15 or 85 20 or 80 25 or 75 30 or 70 40 or 60 50

50 .........................................................

75 .........................................................

loo .......................................................

150 .......................................................

250 .......................................................

3oo .......................................................

4oo .......................................................

5oo .......................................................

600 .......................................................

600 .......................................................

3.2

2.6

2.3

1.9

1.7

1.5

1.4

1.3

1.2

1.1

1.0

4.3

3.6

3.1

2.6

2.3

2.1

2.0

1.8

1.6

1.6

1.4

Standard error in percentage points

5.2 5.8 6.3

4.3 4.8 5.2

3.7 4.2 4.5

3.1 3.5 3.6

2.6 3.1 3.4

2.5 2.8 3.1

2.3 2.6 2.8

2.1 2.4 2.6

2.0 2.2 2.4

1.9 2.0 2.3

1.7 1.9 2.0

6.6

5.5

4.6

4.0

3.6

3.2

3.0

2.7

2.5

2.4

2.2

7.1 7.2

5.9 6.0

5.1 5.2

4.3 4.4

3.8 3.9

3.5 3.5

3.2 3.3

2.9 3.0

2.7 2.7

2.5 2.6

2.3 2.3

l.ooo .................................................... 1.0 1.3 1.6 1.6 1.9 2.1 2.2 2.2

Table W. Number of currently married women 15-44 years of age in the

sample, by race, age, and Darit!c 1965 National Fertilitv Study

Age! and parityz All racess White Black

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

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

20-24 years., ...........................

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

30-S4 years, ............................

35-S9 years .............................

40-44 yeara .............................

All parities

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

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

30+4 years ........................

Parity O-1

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

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

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

Parity 2

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

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

3044 years ........................

Parity 3 or more

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

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

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

Number of women in sample

4,810 3,771 969

212 155 54

855 641 203

651 651 183

964 762 185

923 741 172

1,005 821 172

4,610 3,771 969

1,918 1,447 440

2,692 2,324 529

1,318 1,032 272

782 636 136

536 396 136

1,177 986 173

493 391 94

684 595 79

2,315 1,753 524

643 420 210

1,672 1,333 314

Table V1l. Weighted number of currently married women 15-44

years of age, by race, age, and parity United States, 1976

Agel and parityz All racesa White Black

15-44 yeara ............................

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

20-24 years ............................

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

30-84 years ............................

35-89 years ............................

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

All parities

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

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

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

Parity O-1

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

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

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

Parity 2

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

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

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

Parity 3 or more

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

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

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

Number of women in thousands

27,466 24,795 2,169

1,043 916 99

4,977 4,493 410

6,443 5,806 484

5,736 5,187 428

4,814 4,339 368

4,474 4,051 381

27,486 24,795 2,169

12,463 11,217 993

15,024 13,577 1,177

10,805 9,796 768

6,037 7,341 526

2,766 2,455 242

7,638 6,939 565

3,186 4,098 279

4,452 2,641 286

9,045 6,058 837

1,238 1,034 188 .

7,606 7,024 649

1Sample numbers for table 15.

eSample numbers for table 16.

sIncludes white, black, and other races.

1Weighted numbers for table 15.

ZWeighted numbers for table 16.

~Includes white, black, and other races.
Appendix Il. Concepts and

definitions

Reproductive impairments

Reproductive impairments were measured in this

report using two slightly different classification

schemes. Fecundity status, which is a demographic

concept and makes full use of the data in the 1976

NSFG, was used in tables l-l% and infertility status,

which is a medical concept and allows unbiased

measurement of the trend in the prevalence of

difficulty in conceiving in 1965 and 1976, was used in

tables 15-16. After a definition of fecundity, this

appendix contains definitions of fecundity status and

its categories, and then of infertility status and its

categories.

Fecundity

Following standard demographic usage, fecundity

refers to the ability (at the date of interview) of a

currently married couple to reproduce, that is, to have

live-born children; while “fertility” refers to “actual

birth performance” or number of live births.s 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 reproductive

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 probably 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 thus classified as fecund

in the absence of any data to indicate sterility or any

other reproductive impairment.

NOTE: A list of referencesfollows the text.

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 diflicult 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 on reproductive impairments in the NSFG

interview: whether or not they or their spouses had

had sterilizing operations, accidents, or illnesses of

diagnosed congenital problem% whether or not they

had been trying to become pregnant and had not used

contraception for a substantial period of timq and

whether or not their physician had told them that they

had medical conditions that would make having a

child, or another child, difficult or dangerous. In this

report, data are presented for currently married

couples in which women have also provided information on their husbands’ fecundity.

Fecundity status (tables 1–14) 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 many of the tables.

Surgically sterile

A 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

45
sterile couple was further classified by the woman’s

answer to the question: “Was m reason for the

operation because you had all the children you

wanted?” An affirmative answer was classified as

surgically sterile<ontraceptive (in the text, “contraceptively sterile”) and a negative answer as surgically

sterile—noncontraceptive (in the text, “surgically sterile for noncontraceptive reasons”).

Surgically sterile 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 most cases, the surgery 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 (“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 subsequently

regrets the operation and seeks a reversal. However,

even these contraceptively sterile couples are not

fecund, which is important from a demographic point

of view.

Sterilizing operations in which therapeutic considerations 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-noncontraceptive” with

those in the general category of “impaired fecundity,”

as was done in a preliminary report on this subject. I

Nonsurgically sterile

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 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 interval

Couples were classified “long interval” because,

while they reported no specific diagnostic cause, they

NOTE A list of references follows the text.

46

had experienced at least 3 years of unprotected

intercourse without becoming pregnant. About 11

percent of these women reported that it was impossible

for them to become pregnant in the future. 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

reproductive impairment. 30~31

Subfecund

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

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 couple was classified as “fecund” in tables 1–14

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. This is a more restricted

use of the term “fecund” than in previous NSFG

reports,b”z which used the two-category classification

“sterile” and “fecund.” In previous reports “fecund”

included most of those with long intervals as well as all

nonsterile women who are classified in this report as

fecund or subfecund.

In this report “fecund” is a residual category in the

sense that, if there was no information that indicated

any kind of reproductive impairment, couples were

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. Through these procedures it was possible to classify all but 3 respondents (out of 8,611) by

fecundity status. These three cases were in(cluded with

fecund couples.
Infertility status

Following current medical usage, a couple is

considered to have a problem of infertility subject to

medical attention after 1 year of unsuccessful efforts to

become pregnant.zg!lorslInfertility status is used in

tables 15 and 16 of this report because it was not

possible to measure fecundity status in a comparable

way with data from the 1965 National Fertility Survey

(NFS) and from the 1976 NSFG. However, it was

possible to measure infertility, as defined above, from

the two surveys and to classify couples into one of

three principal categories: surgically sterile, infertile,

and fecund.

Surgically 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 NFS and the 1976

NSFG, these operations are not classified by contraceptive intent in these comparisons over time. For a

discussion of this issue, see reference 34.

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 immediately

preceding the interview. In addition, a few wives (0.3

percent in 1976 and 1.8 percent in 1965) who reported

that it was physically impossible for them or their

husband to have a baby, although they did not meet all

three of the criteria for the infertile category, were

included here.

Fecund

The category “fecund” is composed of those not

classified as sterile or infertile and is therefore a

residual group, as is the same category in the fecundity

status classification. The proportions fecund in the

infertility status classification in 1976 are slightly

higher than the corresponding proportions classified

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 live issue. 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, even

though the pregnancy may not have ended in a live

birth.

NOTE A list of references follows the text.

In 1976,92 cases out of 6,482 (about 1.4 percent of

married couples) could not be classified by infertility

status because of missing data. Such couples were

presumed to be fecund because no other information

on their questionnaires indicated any evidence of

surgical sterility or infertility.

Wanted to have a (or another) baby

Many couples who are sterile or who have impaired fecundity have already borne as many children

as they want. Thus, to assess the potential need for

medical research and services for reproductive impairments, it is useful to know the numbers of couples with

impairments who would like to have a future child.

Couples who were surgically sterilized for noncontraceptive reasons, who were nonsurgically sterile (including a few with long intervals who believed they

were sterile), and the few who were subfecund and

expected to have an operation or abortion to prevent

or terminate another pregnancy 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 subfecund 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 it appeared on further analysis that they

wanted a baby. They did not have an intent because

they did not know whether it was possible to have a

baby or another baby. In a preliminary reportl these

women were not counted as wanting a baby or another

baby because the necessary analysis had not yet been

undertaken.

Reported spontaneous pregnancy losses

These losses refer to the reported number of

pregnancies that ended in a “miscarriage” or “stillbirth.” There were 3,214 pregnancies not ending in live

births reported by the 8,611 NSFG respondents. Of

these, the outcomes of 14 pregnancies (less than 0.5

percent) were not ascertained and were excluded, as

were the 357 reported induced abortions. Most of the

remaining 2,843 pregnancies 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,

47
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; in two previous

reports, the term “fetal losses” included reported

induced abortions. 14J5

Demographic characteristics

Parity

Parity refers to the number of live births the

respondent has had.

Years since wife’s first marriage

This refers to the number of years between the

wife’sfirst marriage and the interview date.

Marital status

This report is based only on currently married

women. Couples who are temporarily separated for

reasons other than marital discord, such as vacation,

illness, or Armed Forces, are classified as married.

Hispanic origin

A respondent was classified as being of Hispanic

origin’if she reported her origin or descent as Mexicano,

Chicano, Mexican American, Puerto Rican, Cuban, or

other Spanish regardless of whether she also mentioned any other origin.

In tables where data are presented for women

according to race and Hispanic origin, those of

Hispanic origin are included in the statistics for white

and black women if they were identified as such by the

interviewer.

Household population

The household population consists of persons

living in households. A household is a person or a

group of persons, where no more than five persons are

unrelated to the head of the household, who occupy a

room or group of rooms intended as separate living

quarters; that is, the occupants do not live and eat with

any other persons in the structure. Either direct access

from the outside of the building or through a common

hall, or complete kitchen facilities for the exclusive use

of the occupants of the household must be present.

Region of residence

Data are classified by region of residence into the

four major Census regions: Northeast, North Central,

South, and West. Sample size greatly restricts the

possibility of meaningful analyses by social characterNOTE A list of references follows the text.

48

istics among smaller geographic divisions. The areas

comprising these four major geographic regions are as

follows:

Geographic region

and division States included

Northeast

New England ............. Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut

Middle Atlantic ........... New York, New Jersey, Pennsylvania

North Central

East North Central .... Ohio, Indiana, Illinois, Michigan, Wisconsin

West North Central... Minnesota, Iowa, Missouri, North Dakota,

South Dakota, Nebraska, Kansas

South

South Atlantic ............ Delaware, Maryland, District of Columbia,

Virginia, West Virginia, North Carolina, South

Carolina, Georgia, Florida

East South Central ... Kentucky, Tennessee, Alabama, Mississippi

West South Central.. Arkansas, Louisiana, Oklahoma, Texas

West

Mountsin ..................... Montana, Idaho, Wyoming, Cc)lorado, New

Mexico, Arizona, Utah, Nevada

Pacific,......................... Washington, Oregon, California, Alaska,

Hawaii

Alaska and Hawaii were not included in the

sample for the NSFG.

Education

Education was classified according to the highest

grade or year of regular 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 the last grade or year of school attended,

whether that grade was completed, whether any other

vocational or nonacademic schooling was obtained,

and whether such other schooling was included in the

years of regular school or college reported.

The term “high school” indicates that the woman

completed high schoo~ the term “less than high

school” indicates that the woman did not complete

high school; the term “more than high school”

indicates that the woman completed at least 1 year of

college.

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 groups, two other categories-other

and none—were used,

Labor force status

A woman was categorized as being “in the labor

force” if she was working full time or part time; if she

had a job but was not at work because of temporary

illness, vacation, or a strike; or if she was unemployed,

laid off, or looking for work.
Poverty level income

The poverty index ratio was calculated by dividing

the total family income by the weighted average

threshold income of nonfarm families with the head of

household under 65 years of age, based on the poverty

levels shown in U.S. Bureau of the Census Current

Population Reports, Series P-60, No. 106, “Money

Income in 1975 of Families and Persons in the United

States,” table A-3.sgThis definition aocounts for the sex

of the family head and the numtkr of persons in the

family. Total family income includes inoome from all

sources for all members of the respondent’s family.

Poverty level income was not ascertained for 1,348

of 8,611 sampled women (16 percent), including 23

percent of sampled black women and 12 percent of

sampled white women. Therefore, special care should

be taken in interpreting small differences by poverty

level income,

Occupation was determined by asking women,

“What (is/was) your (main) occupation? That is, what

(is/was) your job called? What (are/were) your most

important activities or duties? What kind of place

(do/did) you work for? What do they make or do?”

The answers to those questions were recorded verbatim and used by coders to fmd the most appropriate

standard job title in the 1970 U.S. Census occupation

classification. If the responses indicated more than one

occupation, the primary occupation was coded. If none

was primary, the first-mentioned occupation was

coded. Although the classification used was very

detailed, occupations have been grouped into major

categories for this report, according to the practice of

the U.S. Bureau of the Census.

NOTE A Iist of references follows the text.

49
Appendix Ill. Items on the

National Survey of Family

Growth questionnaire

related to reproductive

impairments

SECTIOND

BEGIN DECK 15-

We are talking with women about children they may have i~ the future, as well as about those

they already have. (IF “R” HAS ALREADY NENTIONBO STERILITY, MENOPAUSE, ETC.: I think we

have already covered 8ome of these next questions, but I *d better go through them with you

to be sure that 1 record the answers correctly. )

D-1, It is physically 4mpo@sible for some Possible . . . . . . . . . ..l (D-6)

couples to have children. As far aS

you know, is it possible or impossible

for you and your husbanf to conceive

Impossible. . . . . . . . . . 2 (D-2) 1S

a (nother ) baby, that is, to get Donmt mow, Not Sure. . . . . 8 (D-6)

pregnant (again) ?

D-2, What is the reason that YOU are unable to have a (nether) baby? (F.ECOFD VEREAT2M ON –

LINES AT LEFT, CODE ALL THAT APPLY, THEN FOLLOW SKIP INSTRUCTION FOR SMALLEST CODE

NuMBER . IF RESPONSE INDICATES A PROBLEM OTHER THAN STERILITY, CHANGE D-1 TO

“POSSISLE” AND GO TO D-6 . )

‘,RI1has had sterilizing

Speration. . . . . . . . .

2mpossible for “R” due

to accident or Illness . .

‘~” sterile for other

reasons . . . . . . . . . .

‘JR!,ha~ reached menopauae .

Eiisband has had -

~izinu ODeratiOn. . .

Impossible ~or- husband

due to acciden~lness

Husband sterile for

other reasons. . . . . . .

Cou le unable to conceive,

+ know reason. . . . .

.01m(D-3)

.02 (D-3)

.03 (D-3)

.04 (D-14)

.05 (D-3)

.06 (D-3)

.07 (D-3)

.08 (Probe)

PROBE: How many years altogether have you gone without using any birth

control method and still not become pregnant? (BXCORO VERSAT2M

ON LINES AT LEFT AND ENTER NUNBER OF YEARS. )

18 11

(Box 27A)

NO. OF YRS . I

]OX27A. ~, SAY: I know that YOU ‘.. talked about the reasons that You

haven qt become pregnant but could you tell me a little

bit more your difficulty in getting pregnant?

THEN CODE “YES” [N D-6 AND RECORD RESPONSE IN D-7,

~, CODE 6 IN D-3 AND CONTINUE,

.

(ASK QUESTION ONLY IF CHOOSE APPROPRIATE QUESTION : Was ~ reaeon for

D-2 IS FEMALE OPERATION;

OTHERWISE , CODE

(A) When was the operation done? the operation

because you had

WITHOUT ASKING . ) (B) When did (you/your husband) become all the children

What kind of operation sterile? (If D.K. , PROBE: . . . you wanted?

was it? learn of the sterility)

One ovary

of”‘

CHECK TSE APPROPRIATE CIRCLE IN D-3 AND PROBE TO FIND OUT IF SSE

=oved (“R” IS ~ THAT SHE IS STERILE.

~ sterile) . . .

One tube tied

If she is sure, circle Code “6 - other reasons” in o-3 and follow

o~ the appropriate skip instruction for that category.

=removed (“R” If she is not sure, record her answer verbatim and skip to D-S.

~ sterile) . . .

~ ovaries YeS . . . 1 (D-76)

removed. . . . . . 1 (D-4A) /

MONTH / YEAR (D-S) No. . , . 2 (D-14)

~ tubes tied Yes . . . 1 (D-78)

or removed . . . . 2 (D-4A) /

MONTH / YEAR (D-S) No. . . . 2 (D-14)

Hysterectomy

(Removal of

Yes . . . 1 (D-76)

/

uterus). . . . . . 3 (D-4A) MONTH / WsAR (D-5) No. . . . 2 (D-14)

Vasectomy Yes . . . 1 (D-76)

(cutting male /

sperm ducts) . . . .2 (D-4A) MONTH / (D-5) No. . . . 2 (D-14)

Other operation or Yes . . . 1 (D-76)

type unknown . . . 5 (D-4A) /

MONTH / YEAR (D-5) No . . . . 2 [D-14)

Accident, illness or

other reasons. . . 6 (D-4BJ /

MONTH / YEAA (D-14)

20

20❑ “-’”l=un”il

50
CONTINUE DECK

II-6, Some people are able”to have a(nother) baby, but they have difficulty getting

pregnant or holding onto the baby. Ae far as you know, ia there any problem

or dif ficulky for you and your husband to conceive or deliver a (nether) baby?

Yes. $ . . . . . . . . . . .l(D-7)

NO. . . . . . . . . . . . . .2(D-8)

D-7, What is the reason itwculdbe difficult for you to have a(nother) baby?

(RECORD VERSATIM ON LINES AT LEFT AND CIRCLE APPROPRIATE CODE BELOW. )

Physical difficulty getting

pregnant. . . . . . . . . . 1

Difficult for husband to

father child . . . . . . . .2

Dangerous for “R*’to

become pregnant (again) . . . 3

Dangerous to the baby . . . . 4

Difficult to carry

pregnancy full 9 months. . . 5

Other. . . . . . . . . . . .6

D-8, At any time has a medical doctor advised you to become pregnant (again)?

Yes. . . . . . . . . . . . .l(D-8)

15

26

27

,8

No. . . . . . . . . . . . . .2(Boz28) ‘-

II-9, Did he or she say it would be dangerous for you, and/or for the baby, or

was it for some other reason?

Dangerous for R . . . . . . . 1

Dangerous for baby. . . . . . 2

Dangerous for both. . . . . . 3

Other reason (SPECIFY)

4

D-10, When did You talk with the doctor about this?

m

/

MONTH / YEAR

D-n, will YOU have an operation to be sure you don’tbeccme pregnant (again)?

Yes. . . . . . . . . . . . .l (D-14)

No, . . . . . . . . . . . . .2 (D-12) 34

Maybe. . . . . . . . . . . . 3 (D-12)

D-12, will Your husbandhave mkow=tion to be sure You don’t become

pregnant (again)?

Yes. . . . . . . . . . . . .l (D-14)

NO. . . . . . . . . . . . . .2(D-lS) S5

Maybe. . . . . . . . . . . . 3 (D-13)

D-13, If (after this b~y iS born) YOU find that YOU are pregnant (again), will you

have the pregnancy ended by a doctor for health or medical reasons?

Yes. . . . . . . . . . . . .l (D-14)

No. . . . . . . .“. . . . . .2 (Boz28) $6

Maybe . . . . . . . . . . . .3 (Box28)

D-14, Even though it is unlikely or impossible for you to have a(nother)

baby, would you like to have a (nether) baby (after this one)?

Yee. . . . . . . . . . . . .1

No.. ;. . . . . . . . . . .2

S7

D-15, would your humband ~a(nother) baby?

Yes. . . . . . . . . . . . .1

No. . . . . . . . . . . . . .2 se

Don’tKnow. . . . . . . . . . 8

D-16, (Since/If) you and your husband are unable to have e(nother)

baby, do you intend to adopt any children?

Yes. . . . . . . . . . . . .1

No. . . . . . . . . . . . . .2

}

(D-7L7) :S

Maybe. . . . . . . . . . . .3

Box 28, lF R IS CURRENTLY PREGNANT, SKIP TO D-41; OTHERWISE. CONTINUE,

I

* U.S. GOVERNMENT PRINTING OFFICE: 19S3-381-161:524 51
Vital and Health Statistics series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 10.

SERIES 11.

Programs and Collection Procedures. -Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data ~ol.

Iection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Research. -Studies of new

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to statistical theory.

Analytical and Epidemiological Studiea. -Reports presenting analytical or interpretive studies based on vital

and health statistics, carrying the analysis further than the

expository types of reports in the other series.

Documents and Committee Reports. -Final reports of

major committees concerned with vital and health statistics and documents such es recommended model vital

registration laws and revised birth and death certificates.

Data from the National Health Interview Survey .-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected in the

continuing national household interview survey.

Date From the National Health Examination Suway and

the National Haalth and Nutrition Examination Suwey.–

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutional ized

population provide the basis for ( 1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population with

respect to physical, physiological, and psychological

characteristics and (2) analysis of relationships among the

various measuremen~ without reference to an explicit

finite universe of persons.

SERIES 12. Data From the Institutionalized Population Suweys-Discontinued in 1975. Reports from these suweys are included in Series 13.

SERIES 13. Data on Health Resources Utilization. –Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulatory care, hospital care, and family

planning services.

SERIES 14. Data on Health Resources: Manpower and Facilities.–

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15. Data From Special Surveys .–Statistics on health and

health-related topics collected in special surveys that are

not a part of the continuing data systems of the National

Center for Health Statistics.

SERIES 20. Data on Mortality .–Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; and

statistics on characteristics of deaths not available from

tha vital records based on sample suweys of those records.

SERIES 21. Date on Natality, Marriage, and Divorce. -Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

SERIES 22. Data From the National Mortality and Natelity Surveys.–

Discontinued in 1975, Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respectively.

SERIES 23. Data From the National Suwey of Family Growth. -

Statistics on fertility, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of ever-married women 1544 years of

age.

For a list of titles of reports published in these series, write to:

Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

National Center for Health Statistics

3700 East.West Highway

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

DHHS Publication No. (PHS)83-1987, Series 23. No. 11

POSTAGE AND FEES PAID

U.S, DEPARTMENT OF HHS

HHS 396

r

A

THIRD CLASS k

For listings of publications in the VITAL AND HEALTH STATISTICS series, call 301-436-NCHS