This argument spawned impassioned debates about whether abstinence was an outmoded concept in the late twentieth century that ignored the realities of adolescent sexual activity, and about whether discussing contraception with teenagers gave tacit approval to their sexual activity, or perhaps even encouraged it. Disagreements were especially intense over whether school-based sex education for adolescents should stress abstinence only, or should combine messages about abstinence with material on contraception as well. Although some federal health officials took the former position, other people, especially those in the family planning field, took the latter view, thereby often finding themselves at odds with federal policy leaders. The intensity of the debate had the unfortunate effect of polarizing many groups who share a common interest in reducing adolescent pregnancy. Thus, the time seemed right for a review of the knowledge base regarding the causes, consequences, and prevention of unintended pregnancy, including the effectiveness of abstinence-based education.
Abortion is perhaps the most divisive issue related to unintended pregnancy.
As any observer of the American scene over the last 20 years would note, the abortion controversy has dominated discussions of reproductive health and has led to painful divisions across many ideological, political, and religious lines. In particular, the heated debate over the acceptability of abortion itself has diverted attention from many other important and closely related issues, such as finding ways to encourage couples to prevent both unintended pregnancy and STDs simultaneously or learning how best to offer contraceptive services in communities whose health care systems are changing rapidly. Put another way, in arguing about how to resolve problem pregnancies, less attention has been given to preventing such pregnancies in the first place. Within this broad context, the Institute of Medicine's Committee on Unintended Pregnancy was established to explore the relationship of unintended pregnancy in the United States to the health and well-being of children and families and to make recommendations for policy, practice, and research. In meeting its charge, the committee and staff used several methods to gather needed information.