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[Oral contraception in France in 2001: results of an opinion poll survey conducted on 3609 women between 15 and 45] La contraception orale en France en 2001: resultats d’une enquete par sondage portant sur 3609 femmes agees de 15 a 45 ans.
Gynecologie, Obstetrique and Fertilite. 2003 Mar; 31(3):220-229.The aim of this study concerning the taking of the pill in France in 2001 was threefold, i.e. to assess its rate as well as its characteristics of use, and to appraise the most frequent side effects as reported by women. Three thousand six hundred and nine women representative of the French female population between 15 and 45 years of age were recruited thanks to a survey, which took place in 2001. The data were collected from self-questionnaires. Women on the whole have quite a good opinion of oral contraception and most of them are convinced of its efficiency. As far as pill tolerance is concerned, opinions do vary, more than half of the women judging that being on the pill is not without side-effects. Though, the rate of use of oral contraceptives has increased by 12% since 1994. Most women (48%) use first and second generation pills and this in all age brackets. Thirty per cent of women aged 30 to 45 keep loyal to the same patent medicine, which they keep using for more than 10 years. Among the side-effects that can be found, two of them - putting on weight (31%) and hydrosodium retention (26%) - are the most frequently quoted, in all age brackets. This accounts for the relatively low ratio of women who find their pill quite satisfactory (58% of the cases). Despite the diversity of all the different patented pills that are available, efforts are still to be made in order to reduce what side-effects are encountered when using them. (author's)
Canadian Journal of Human Sexuality. 1999 Fall; 8(3):167-173.This part of the 1998 Canadian Contraception Study describes findings related to Canadian women's familiarity with, opinions about, and use of various contraceptive methods. Familiarity was almost universal for oral contraceptives and condoms, but less than 60% of women aged 15 to 44 were familiar with the other methods. Respondents had the most positive opinions about oral contraceptives (64% of women had a "very favourable opinion"), were less positive about male sterilization (40%), condoms (37%), and female sterilization (31%) and even less so for each of the other methods cited (less than 15% in all cases). Condoms and oral contraceptives were the most widely used methods among sexually active women using contraception (44% and 43% respectively). These findings confirm the central place of oral contraceptives and condoms in the contraceptive awareness and practices of Canadian women. (author's)
Washington, D.C., NARAL Pro-Choice America Foundation, 2004 May 10. 12 p.Although emergency contraception has been available and proven safe for more than 25 years, too few Americans are aware that contraceptive methods are available that can prevent pregnancy after sex. In fact, nearly three-quarters of women surveyed have not heard of emergency contraceptive pills (ECPs), and only six percent of women aged 18 to 44 have used ECPs. Emergency contraception may be used when contraceptive methods fail, when they are misused or not used at all, and when women are sexually assaulted. Although emergency contraceptive methods are not a substitute for ongoing contraceptive use and do not protect against the transmission of sexually transmitted diseases, these important and underutilized contraceptive options can reduce unintended pregnancy and the need for abortion. In fact, a 2002 study revealed that ECP use was likely responsible for up to 43 percent of the decline in the number of abortions in the U.S. between 1994 and 2000—with ECP use preventing over 50,000 abortions in 2000 alone. Emergency contraceptive pills are the most commonly used method of emergency contraception. ECPs are ordinary birth control pills that reduce a woman’s chance of becoming pregnant by up to 89 percent when taken within days of unprotected sex. ECPs do not cause abortion; rather they prevent pregnancy by inhibiting ovulation, fertilization, or implantation before a pregnancy occurs. In fact, ECPs do not work if a woman is already pregnant. The U.S. Food and Drug Administration (FDA) has approved two dedicated ECPs – PREVEN and Plan B. The copper-T intrauterine device (IUD) can also be used as an emergency contraceptive. (excerpt)
Perceptions and realities: How safe is the pill? The role of the media, healthcare providers, and the pharmaceutical industry in shaping American women's perceptions about birth control. Q and A.
New York, New York, AGI, 1996 Jan 31. 4 p. (Emerging Issues in Reproductive Health: A Briefing Series for Journalists)Contraceptive choice and usage is affected by various factors at different stages of reproductive life including childbearing hopes, sexual behavior, health history, exposure to sexually transmitted diseases (STDs), ability to use a method consistently and correctly, the side effects and/or health benefits of various methods, and the degree of risk associated with unplanned pregnancy. Survey data indicate that most adults in the US gain family planning information from health professionals as well as from friends and family and the mass media. Perceptions about various methods can influence contraceptive usage in general and method choice in particular. While a majority of US adults find oral contraceptives (OCs) "very" or "somewhat" safe, 21% think OCs are somewhat unsafe, and 11% find them very unsafe. Most safety concerns center on the inability of the OC to protect from STDs and ignore specific health effects that vary for individual women. The fact is that failure to use a contraceptive poses greater risk than any method and that OCs are effective contraceptives that do not hinder future fertility. While the relationship of OC use and breast cancer remains uncertain, OCs are known to protect against ovarian and endometrial cancers. OC use is associated with a relatively small increased risk of cardiovascular disease, and the risk increases in older women and women who smoke. Pregnancy also increases the risk of cardiovascular disease. Recent studies reporting 1) an increased risk of venous thrombosis and 2) a decreased risk of myocardial infarction with new formulations of the OC underscore the importance of taking individual circumstances into account when prescribing OCs. The new studies also indicate a need for additional research on the effects of OC use.
BRITISH JOURNAL OF NURSING. 1995 Nov 9-22; 4(20):1174-5.The Committee on Safety in Medicines issued warnings against using oral contraceptives containing desogestrel and gestodene. These warnings were based upon findings from three unpublished studies pointing to the existence of an increased risk of thrombolytic disease in 30/100,000 pill users. The warning was published in the mass media before general practitioners and family planning staff were made aware. In so doing, users of oral contraceptive pills have become concerned, confused, distressed, and anxious. This warning has injured confidence in medical services. It would have been better for general practitioners and family planning staff to have been made privy to the data before it went public. The author notes that the risk of thrombosis in pregnancy is twice as high as the reported risk of using oral contraceptives containing desogestrel and gestodene, and that even non-pill users have a 5/100,000 risk of thrombosis. Other evidence points to the many health benefits of oral contraceptive use.
HEALTH AND SEXUALITY. 1996 Fall; 5(1):6-7.Women need accurate information about the various forms of contraception from which they may choose. Findings from four recent national telephone surveys conducted among reproductive-age women in the US since 1993, however, indicate that women in the US are not well informed or are misinformed about oral and other forms of contraception. Brief summaries are presented of the following surveys: the 1993 Gallup Organization follow-up survey conducted for the American College of Obstetricians and Gynecologists of 995 women's views on contraception, the 1995 Lou Harris and Associates telephone poll conducted for the American Medical Association of US women's attitudes and perceptions about reproductive health matters, the January 1996 Kaiser Family Foundation survey of 279 women's perceptions about contraception, and the Health Benefits of Contraception, ARHP survey of 280 women. The second part of this latter survey will be completed later in 1996. The common theme in the four surveys is that women do not have enough accurate information about contraception. Reproductive health professionals need to take advantage of every opportunity to provide such information, correct misperceptions, improve their counseling skills, and spread the word about the health benefits of contraception.
HEALTH AND SEXUALITY. 1996 Fall; 5(1):1, 3-5, 16.Oral contraceptives (OC) were first introduced in the US in the early 1960s as an efficient, convenient, and reversible method of contraception. The pill has since undergone many changes. Most OCs prescribed today contain 35 mcg of estrogen and 0.5-1 mg of progestin, approximately one-third the estrogen and one-tenth the progestin in the original OCs. Considerable scientific research, economic analysis, and social marketing have yielded invaluable data on how OCs, the most popular form of birth control in the US, have affected the lives of women, men, and society overall. Researchers have also investigated the health risks and benefits of OC use. Both truths and myths exist about the effects of OC use. A 1993 Gallup poll conducted for the American College of Obstetricians and Gynecologists found that 65% of patients believe oral pill use to be at least as dangerous as pregnancy. 58%, however, were unable to name one non-contraceptive benefit of the pill. A 1995 Harris poll conducted for the American Medical Association found that although 96% of reproductive-age women considered themselves to be knowledgeable or very knowledgeable about contraception, 56% incorrectly believed a woman periodically needs to give her body a rest from OC use. The authors discuss the benefits and risks of using OC.
INTERNATIONAL JOURNAL OF FERTILITY. 1989; 34 Suppl:14-7.Between 1945-1948, the population of Japan increased by 5 million people. Further, between 1947-1950, 2.7 million recorded births occurred each year resulting in the population growing from 72-83.2 million. The crude birth rate fell from a high of 34.3 in 1947 to a low of 11.1 in 1986. The population is expected to increase from 117-130 million (1090-2010) and then fall to and stabilize at 118 over 70 years. 80% of married women in Japan want to have 2-3 children. In 1984, 59% of married women used a family planning method and 83.1% ever used such a method. In 1979, the condom was the leading contraceptive among married couples (82%) followed by the rhythm method (23%). Since 1948 japanese women have been able to obtain a legal abortion. 600,000 induced abortions occur annually in Japan today. Even though the number of abortion have fallen steadily from 1955, the percentage of abortions among teenagers has increased from 1.6-4.7% between 1975-1985. Japanese would like to reverse this trend and the expected approval of oral contraceptives (OCs) could help do so. In 1979, only 3% of married couples depended on OCs. A concern of OCs many people worldwide held for many years was the cardiovascular risk of the high dose OCs. In Japan, however, the rate of thrombosis is lower than it is among Europeans and Americans. Thus Japanese women appear to be suitable candidates for Ocs, but, in 1986, 52% of married women had not formed an opinion on the pending approval of OCs. Further 43% said they would not use an OC. These results indicated a great need for OC education as well as for education on all contraception. Since 99% of all births occur under the guidance of skilled health workers, the health workers could inform women about contraceptives, but often are too busy to do so.
Accra, Ghana, Marketing and Social Research Institute, 1990 Jul. , 58 p.Consumers of Ghana Social Marketing Program (GSMP) products were questioned to determine their socioeconomic, demographic, attitudinal, and behavioral characteristics, measure GSMP product advertising awareness levels among them, and determine the impact of GSMP promotional efforts on their adoption of these products. Products include the Panther condom, Kamal vaginal foam, Norminest oral pill, and oral rehydration solution (ORS). Study findings are summarized per product for user profile, product knowledge, attitudes, usage, distribution, availability, quality, image, and price, purchasing pattern, brand loyalty, and advertising awareness. The Panther condom has met with great success as the major condom product on the market. It does, however, suffer the reputation of tearing among some users. Kamal's market share is growing at the expense of a government-sponsored competitor and the pill, while Norminest users demonstrated inadequate product knowledge of compliance issues and contraindications. ORS is also successful, but with much potential to expand its market share. Recommendations targeted to each product are provided.
[Unpublished] 1989. Presented at the IIDSS Conference, August 18-20, 1989.  p.The author explains the operations of and rationale behind the Social Marketing for Change (SOMARC) project of the Futures Group. Using indigenous private sector company commercial channels in developing countries, SOMARC helps develop advertising campaigns and other marketing approaches to sell branded condoms, oral contraceptives, vaginal foaming tablets, and sometimes IUDs. Commercial marketing research techniques are employed in these exercises, and include developing and evaluating advertising and marketing strategies, designing and testing advertising messages, and selecting and improving product names and packaging for their contraceptive products. Although technical assistance is generally required in most countries, local companies are nonetheless depended upon to develop and manage the projects overall. The importance of brand image research in reaching target markets is discussed, followed by examples of testing and evaluating marketing strategies, product names, package testing, and advertising messages.
In: Hormones and sexual factors in human cancer aetiology, edited by J.P. Wolff, J.S. Scott. Amsterdam, Netherlands, Elsevier Science Publishers, 1984. 175-81. (International Congress Series 650; ECP Symposium No. 1)Confidence in the pill as a safe method of contraception has dropped in the past decade. In part, this trend has been caused by case-control studies (e.g., those by Pike and Vessey) that have found an association between oral contraceptives (OC) use and certain forms of cancer. Although these studies have been criticized on methodological grounds and other studies have failed to find such an association, public opinion has been profoundly affected by the mass media's alarmist exposure of these findings. Such studies serve to reinforce the fears of women with a neurotic character structure who already have a deep-seated phobia about cancer and other potential dangers of daily life. A study conducted in France in 1983 by the French Institute of Public Opinion found that 29% of the 688 respondents aged 18-50 years were convinced that the pill can cause cancer. It is speculated that many women with this opinion come from religious backgrounds that discourage sexual pleasure and oppose contraception. To such women, cancer may be viewed as a form of punishment for their pill use. Physicians can play an important role in eradicating some fear of the pill's effects of conducting yearly breast and cervical examinations and giving patients the opportunity to express their concerns.
MARHIA. 1990 Jan-Jun; 3(1-2):27-8.The Institute for Social Studies and Action of the Philippines is endeavoring to encourage the public and the Catholic Church to Recognize the differences between contraception (which prevents the union of the sperm and ovum) and abortion (which terminates pregnancy long before the fetus is viable). Nonetheless, widespread opposition to contraceptives, especially the IUD, persists because they are considered abortifacients. In terms of the IUD, there is accumulating research evidence that the device works primarily by preventing fertilization and, less frequently, by interfering with implantation. The injectable contraceptive, Depo-Provera, which is banned in the Philippines, suppresses ovulation, as does the pill. Despite the evidence that the most widely available contraceptives are not abortifacients, debate over this issue obscures a far more central issue--the right of each woman to plan her family size and the interval between births. Screening and counseling provided by well-trained health personnel can enable women to choose the contraceptive method that best suits their needs and protects their health. A lack of access to contraception is in part responsible for the 2000 maternal deaths that occur in the Philippines each year during pregnancy or delivery.
A study of contraceptive drop-outs in Lesotho: using focus groups to determine causes of discontinuation.
[Unpublished] . , 36,  p.Focus groups of married women aged 25-40 from Lesotho who has used contraception for at least 3 months, but discontinued within the last 12 months, were conducted in 1989 to learn reasons for discontinuation. Groups had 3, 5, 6, and 9 participants, and other groups of staff were also held. In warm-up discussion topics it was learned that Basotho families desired families of 2-6 children; that men wanted the maximum number of children and believed that family planning promoted promiscuity in wives; that most people believed in spacing births and practiced traditional methods to do so, primarily breastfeeding and abstinence. Women liked injection because they can be used without husband's knowledge, and do not require daily medication or constant resupply. Misinformation was common on all methods, and lists of examples are included for each method. Some of the many reasons for discontinuing were real or impugned side effects. Many women complained of vaginal wetness (which was also a reason for accepting contraception). Many also accepted and others stopped to keep husbands at home. High cost of pills and exams was a reason cited. Program-related reasons were long lines at clinics and unavailability and brand-switching by the clinics. Staff focus groups identified several characteristics among drop-outs: husbands disapproved of contraception; negative rumors used to pressure women; inadequate counseling on side effects; pressures from in-laws and husbands to have more children. Screening out of potential drop-outs was not considered a viable policy. Staff groups suggested that the government emphasize IEC campaigns for men, the public and private doctors, and maintain supplies of the same brands of contraceptives at its clinics.
JOURNAL OF THE FLORIDA MEDICAL ASSOCIATION. 1986 Oct; 73(10):763-8.The increase in safety and public confidence in oral contraceptives (OCs) stems essentially from 3 factors: the availability of lower dose OCs, a better identification of risk factors, and more public awareness of noncontraceptive health benefits associated with OC use. The combination OC, used by 99% of women using OCs, continues to contain estrogen and progesterone in synthetic form, but the dosages and formulations have changed, giving the new pill a wider margin of safety. The OCs of today contain 1/5 the estrogen and 1/10 the progesterone as in the original OCs. During the decade of the 1980s, with estrogen dosage as low as therapeutically possible, medical research has shifted toward a more thorough evaluation of the progesterone component. In 1974 the Royal College of General Practitioners Study found a correlation between progesterone dosage and the frequency of high blood pressure developing in OC users. Subsequent studies reported that high blood pressure, which was likely to develop in about 5% of OC users on higher dose pill, will revert to normal when OC use is stopped. Additional research has linked pills containing progesterone in high dosages to elevations in blood sugar and blood cholesterol. Since progesterone dosage has declined from 10 milligrams in the original pill to 1 milligram or less in current formulations, there appears to be a wide margin of safety for most healthy young women using OCs. In the mid-1980s, further research on OCs has become more fine tuned with greater emphasis on how different types and combinations of hormones influence side effects and safety. The most recent development has been the introduction of "multiphasics" or sometimes called "triphasics." Multiphasic pills are basically low dose pills which vary hormone dosage in each of 3 separate phases in an effort to roughly simulate changes that would occur in a normal menstrual cycle. A better understanding of risk factors has increased markedly the margin of safety for women considering OC use. The report of the Alan Guttmacher Institute, "Making Choices," revealed that if women over 35 or who smoked did not use OCs, 86% of the approximately 500 pill-related deaths that occurred each year could be prevented. The Guttmacher report also attempted to quantify health benefits and risks to provide a more accurate overall picture of OC effects. Table 1 shows that many more hospitalizations are prevented than are caused by OC use. Among hospitalizations prevented, most were for benign breast disease, pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, ovarian cancer, and endometrial cancer. No evidence has linked defects or miscarriages to pregnancies conceived immediately after stopping OC use. The overall fertility of OC users and non-OC users is identical regardless of how long a woman uses OCs. A lack of consistent health education programs in the public schools has contributed in some instances to misinformation about OC and other contraceptive methods.
Ottawa, Canada, International Development Research Centre, 1973. 30 p. (IDRC-009e)This paper evaluates the progress of a Latin American population through stages in family planning adoption. The focus is on changes in knowledge of contraception, attitudes, and practices which occurred over 5 years (1964-69) of widespread public discussion concerning family planning and of program activity in Bogota, Colombia. Data from 2 surveys, 1 in 1964 and the other in 1969, permit the 1st temporal analysis of family planning adoption for a major metropolitan city in Latin America. Additional data on rural and small urban areas of Colombia from the 2nd survey permit a limited assessment of diffusion of family planning from the city to the nation as a whole. The 1st survey in Bogota revealed moderate to high levels of knowledge of contraceptive methods and generally favorable attitudes to birth limitation. However, at this time many women had never spoken to their husbands about the number of children they wanted, nor tried a contraceptive method at any time. The 2nd survey showed substantial changes in this picture. The proportion of currently mated women who had spoken to their husbands about family size preference changed from 43 to 62% for an increase of 71%. Fertility fell appreciably over this period, especially among younger women. Family planning program services had a significant direct contribution to the adoption process, since 36% of mated women had been to a clinic by 1969. The most modern methods of birth control -- the anovulatory pill and the intrauterine device -- which were scarcely known in 1964 were widely known in 1969, and contributed most to the observed increase in current contraceptive practice. However, among the previously known methods, the simplest method of all, withdrawal (coitus interruptus), showed the greatest increase in current practice and remained the most commonly used method. These findings suggest that favorable attitudes and knowledge tend to become rather widespread before levels of husband-wife discussion of family size preferences and levels of contraceptive trial increase appreciably. The results also indicate that contraceptive knowledge and favorable family planning attitudes are spreading rapidly outward from the cities into the rural areas, but that contraceptive practice is still predominantly restricted to urban populations. (author's)
Journal of Social History. 1985 Spring; 18(3):399-411.The transition from resistance to acceptance of birth control in the US can be characterized as a 3 stage process, with each period facing its own issues and choices. The 1st stage -- the fight over birth control in the early 20th century -- has been documented by historians like James Reed, Linda Gordon, and David Kennedy. A 2nd stage, approximately the years from 1936-60, has not been fully explored although the period was crucial in shaping the current system of contraceptive health care. This discussion focuses on this transitional period, particularly its 1st decade, 1936-47. Physicians' attitudes, as revealed through American Medical Association (AMA) policy and a national survey conducted in 1947, are considered in relation to reported data on clinic and private practice. This evidence reveals that despite the liberalization of laws and public opinion in the mid-1930s, contraception did not become widely available until after 1960 -- the beginning of the 3rd stage in the history of American contraception -- and that the restriction of birth control information during the period was traceble in large part to the medical profession. Analysis of the 1936-47 decade, particularly with regard to the concerns of doctors, provides a framework for understanding the forces that affected contraceptive health care in the mid 20th century and suggests conditions that continue to shape the politics of birth control. In 1936, when the AMA's committee on contraception submitted its 1st report, it was clear that legal and public opinion had moved decisively toward more liberal attitudes concerning birth control. In 1937 the AMA passed a qualified endorsement of birth control, indicating that the organized medical profession as represented by the AMA held views on birth control at the beginning of the 2nd stage that were more conservative than those of most middle-class Americans. Its conservatism was challenged by lay groups who threatened to circumvent standard office practice if physicians failed to modify their views. Public opinion and behavior thus had a demonstrable effect on medical attitudes. 10 years after the AMA resolution a suvey found that more than 2/3 of physicians approved of contraception for any married women who requested it. The 1937-47 period witnessed 2 important changes in medical attitudes toward contraception: the profession's public, though cautious, endorsement of birth control; and the apparent adoption of liberalized standards for the prescription of contraceptive materials. The period also was a time of tremendous growth for the new birth control clinics that offered services to women who could not afford private care. Available evidence suggests that physicians' attitudes toward contraception, and particularly toward birth control clinics, were more important than either laws or public opinion in limiting the availability of those contraceptives considered most efficient (and most compatible with sexual pleasure) between 1936-60.
Journal of the Royal College of General Practitioners. 1984 Nov; 34(268):600-2.The immediate responses of physicians and patients to adverse publicity about the possibility of cancer among women using combined oral contraceptives (OCs) were studied in 2 separate locations: the main family planning clinic in the city of Aberdeen, and a provincial general practice of 10 doctors based in the Peterhead Health Centre. A press release was issued 1 day prior to publication of 2 articles in the Lancet of 22 October 1983, reporting possible risks of breast and cervical cancer in some patients on combined OCs. For the 20 workdays immediately after publication, the 16 participating doctors at both locations collected survey data on the ages of patients and outcomes of consultations for all patients who expressed concern about the OCs. In the family planning clinic, 207 consultations with clinic doctors were prompted by anxiety over the pill and accounted for 24.8% of the workload over the 20 days. In the practice, 73 women (7.8% of all the pill users) who attended over the 20 days expressed concern about OCs. The general practitioners reported lower than expected levels of patient response, whereas the family planning clinic required extra sessions to accomodate the temporary upsurge in demand. At each consultation, the doctor either changed the type of pill, changed the method of contraception, or offered reassurance only. At the family planning clinic and practice respectively, the 1st outcome choices were a change of pills for 58.5% and 39.7% of patients, a change of method for 14.0% and 2.7%, and reassurance only for 27.5% and 57.5%. The mean age of patients was 25.1 years at the family planning clinic and 25.6 years at the health center. This limited study suggests that the predicted "pill scare" did not occur at the Peterhead Health Centre, while in contrast the family planning clinic reported a marked increase in workload including inquiries from the press and local radio stations. Factors accounting for the general practitioners' more conservative responses to patients with pill-related anxiety may have included differences in the type of patient seen; the greater time constraints on the general practitioners, whose patients were booked at 6-minute intervals compared to 12-minute intervals in the clinic; or the continuity of care provided by the general practitioners.
[Unpublished] 1981. Presented at the Fifty-Eighth Annual Meeting of the American Orthopsychiatric Association, New York, March 28-April 1, 1981. 14 p.Approximately 1.3 million teenage pregnancies result from the pervasive sexual activity which majority of teenagers aged 15-19 indulge in today. Adolescent pregnancy and childbirth has adverse health, psychosocial and economic effects for both adolescent parents and their children. Analysis of the trend in American public opinion toward sex education and contraception using data from the American Institute of Public Opinion (the Gallup Organization) shows that majority of the public have always favored sex education for teenagers and are almost as approving of specifically providing birth control information as part of the sex education. (Compared to Census data, Gallup samples of approximately 1500 cases have generally been found to be representative of age, sex, race and geographic area groupings; the 95% sampling tolerance for the samples is within 3% in either direction). There is also a generally upward trend in approval of providing contraception for teenagers. Since 1972, most Americans have approved of contraceptive services for teenagers. The favorable public opinion toward sex education and contraception is brought about by: 1) mass media exposure of the subject of teenage sexuality, 2) establishment of teenager programs by opinion leaders, and 3) recent recognition by courts of the rights of minors, including access to fertility control services on their own consent. Inspite of favorable public opinion however, current poliby concerning sex education and adolescent contraceptive services does not reflect public support. Only 30 states have policies expressly addressing sex education in schools, and even these policies do not reflect strong commitment to such instruction. Thus, most students do not receive sex education and over half of the teenage population at risk of unplanned pregnancy is not receiving contraceptive services. Half of initial premarital pregnancies by teenagers occur in the first 6 months of sexual activity. Thus, adolescent sex education programs must reach young people of both sexes before they begin sexual activity. Accessibility is the most important determinant of contraceptive use by teenagers. Provision of more and better teenage contraceptive services and sex education should be an important policy goal of the American people.