Decision making concerning fertility control is, for many people, a deeply personal and sensitive issue, often involving religious or philosophical convictions. Thus it is important for the clinician to approach the subject with particular sensitivity, empathy, maturity, and nonjudgmental behavior.
Despite the introduction of modern contraceptives, unintended or unplanned pregnancies continue to be a major problem in the United States and worldwide. According to the 2009 National Survey of Family Growth, there were a total of 6,408,000 pregnancies in the United States, of which 49.2% were unintended. Among the unintended pregnancies, nearly half result in a pregnancy termination and more than 10% in spontaneous abortion, a substantial degree of pregnancy wastage. Unintended and unplanned pregnancies have social and economic ramifications; they also have a significant impact on public health. Approximately 40% of unintended pregnancies occur among women who do not desire pregnancy yet do not use a method of contraception. Approximately 60% of unintended pregnancies occur among women using some form of birth control. Such data suggest that many women and couples are inadequately motivated to use contraception, that side effects may be problematic for some, that access may be an issue for others, or that some methods may be difficult for women to use correctly. However, encouraging is the latest report of the National Survey of Family Growth (2009) that the teenage pregnancy rate dropped 40% from 1990 to 2005, reaching an historic low of 70.6 per 1000 women aged 15–19 years. Rates fell much more for younger than for older teenagers.
Individual Indications for Birth Control
Contraception is practiced by most couples for personal reasons. Many couples use contraception to space their children or to limit their family size. Others desire to avoid childbearing because of the effects of preexisting illness on the pregnancy, such as severe diabetes or heart disease. For all of these types of decisions, clinicians must provide accurate information about the benefits and risks of both pregnancy and contraception. However, medical conditions that may substantially increase the risk of using some form of contraception usually increase the risks associated with pregnancy to an even greater extent. As a matter of public policy, some countries, especially those that are less developed, promote contraception in an effort to curb undesired population growth.
Legal Aspects of Contraception
Contraceptives are prescribed, demonstrated, and sold throughout most of the United States without restriction.
Despite high rates of unprotected intercourse and unintended pregnancy, the pros and cons of providing contraceptive information and materials to teenagers have been vigorously debated. Most states either have legislation that permits access to contraception for persons under 18 years or have not addressed the issue legislatively. There is a general consensus among physicians that teenagers should be given contraceptive advice and prescriptions within the limits of the law. Physicians must be careful to avoid imposing their own religious or moral views on ...