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  • Title: The potential impact of improvements in contraception on fertility and abortion in Western countries.
    Author: Westoff CF, Hammerslough CR, Paul L.
    Journal: Eur J Popul; 1987 Nov; 3(1):7-32. PubMed ID: 12280731.
    Abstract:
    Survey information on fertility intentions, patterns of contraceptive use, contraceptive failures, and abortions is used to develop estimates of unwanted births and of unplanned pregnancies for 7 countries -- Finland, France, Netherlands, Norway, Sweden, UK, and the US, by contraceptive method. European fertility is the primary focus, and the data were derived from 6 European fertility surveys selected primarily because of the inclusion of data such as fertility intentions and contraceptive-exposure status and the availability of abortion data from other sources. The US was included both for comparative purposes and to provide some of the needed information not available from the European surveys. The 1st objective was to estimate the unwanted birthrates to women who want no more births; the 2nd objective involved estimating the unplanned pregnancy rates for all women. In regard to the 1st objective, the ultimate reduction in general fertility that can be achieved by reduction of contraceptive failure is minimal, i.e., under 10%. The reductions in unwanted pregnancy rates can be realized primarily by substantial increases in the proportion of couples contraceptively sterilized and by a reduction in the nonuse of contraception. The main effect of improvements in contraceptive practice will be to reduce high abortion rates, rather than to reduce fertility. Most abortions are to women who ultimately want to have (more) children, suggesting a considerable potential for the reduction of abortions through the improvements of contraceptive practice. Reductions of 1/3 to 1/5 of abortions in the countries studied seem possible, even without new technology. The main source of such reductions lies in the adoption of any contraceptive method on the part of nonusers. For example, if all nonusers in the UK simply shifted to the least effective category -- other methods, which includes withdrawal, rhythm, and the diaphragm, with all else remaining constant, the implied reductions in abortions would be nearly 30%. The hypothetical reductions in abortions significantly underestimate the true potential impact of improvements in contraceptive practice because they do not consider teenage pregnancy. To achieve comparability across national surveys, the age group forming the highest common denominator -- ages 20-44 -- had to be selected. The proportion of abortions that are obtained by teenagers is about 1/6 in Sweden, 1/4 in Norway, and over 1/4 in the US.
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