Sustainable Development Goals

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60072-5.pdf

Adolescence: a foundation for future health

BACKGROUND: Global regional and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries we estimate infertility prevalence and trends 1990 to 2010 by country and region. METHODS AND FINDINGS: We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status contraceptive use and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010 among women 20-44 y of age who were exposed to the risk of pregnancy 1.9% (95% uncertainty interval 1.7% 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy 10.5% (9.5% 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia Sub-Saharan Africa North Africa/Middle East and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] >/=0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp=0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth however the absolute number of couples affected by infertility increased from 42.0 million (39.6 million 44.8 million) in 1990 to 48.5 million (45.0 million 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy. CONCLUSIONS: We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children we found little evidence of changes in infertility over two decades apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends.

/pdf/national-regional-and-global-trends-in-infertility-3p18vigqmq.pdf

National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys

BackgroundThe rate of unintended pregnancy in the United States increased slightly between 2001 and 2008 and is higher than that in many other industrialized countries. National trends have not been reported since 2008. MethodsWe calculated rates of pregnancy for the years 2008 and 2011 according to women’s and girls’ pregnancy intentions and the outcomes of those pregnancies. We obtained data on pregnancy intentions from the National Survey of Family Growth and a national survey of patients who had abortions, data on births from the National Center for Health Statistics, and data on induced abortions from a national census of abortion providers; the number of miscarriages was estimated using data from the National Survey of Family Growth. ResultsLess than half (45%) of pregnancies were unintended in 2011, as compared with 51% in 2008. The rate of unintended pregnancy among women and girls 15 to 44 years of age declined by 18%, from 54 per 1000 in 2008 to 45 per 1000 in 2011. Rates of unintended pregnancy...

https://www.nejm.org/doi/suppl/10.1056/NEJMsa1506575/suppl_file/nejmsa1506575_appendix.pdf

Declines in Unintended Pregnancy in the United States, 2008–2011

Problem: Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide. Reporting Period Covered: September 2012-December 2013. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results for 104 health-risk behaviors plus obesity, overweight, and asthma from the 2013 national survey, 42 state surveys, and 21 large urban school district surveys conducted among students in grades 9-12. RESULTS: Results from the 2013 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 41.4% of high school students nationwide among the 64.7% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 34.9% had drunk alcohol, and 23.4% had used marijuana. During the 12 months before the survey, 14.8% had been electronically bullied, 19.6% had been bullied on school property, and 8.0% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors that contribute to unintended pregnancies and STIs, including HIV infection. Nearly half (46.8%) of students had ever had sexual intercourse, 34.0% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.0% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 59.1% had used a condom during their last sexual intercourse. RESULTS from the 2013 national YRBS also indicate many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 15.7% of high school students had smoked cigarettes and 8.8% had used smokeless tobacco. During the 7 days before the survey, 5.0% of high school students had not eaten fruit or drunk 100% fruit juices and 6.6% had not eaten vegetables. More than one-third (41.3%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day. INTERPRETATION: Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health-risk behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., physical fighting, current cigarette use, and current sexual activity), but the prevalence of other health-risk behaviors has not changed (e.g., suicide attempts treated by a doctor or nurse, having ever used marijuana, and having drunk alcohol or used drugs before last sexual intercourse) or has increased (e.g., having not gone to school because of safety concern and obesity and overweight). Public Health Action: YRBSS data are used widely to compare the prevalence of health-risk behaviors among subpopulations of students; assess trends in health-risk behaviors over time; monitor progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth. Language: en

/pdf/youth-risk-behavior-surveillance-united-states-2013-36byboxh0c.pdf

Youth risk behavior surveillance - United States, 2013

Periodic estimation of the incidence of global unintended pregnancy can help demonstrate the need for and impact of family planning programs. We draw upon multiple sources of data to estimate pregnancy incidence by intention status and outcome at worldwide, regional, and subregional levels in 2012 and to assess recent trends using previously published estimates for 2008 and 1995. We find that 213 million pregnancies occurred in 2012, up slightly from 211 million in 2008. The global pregnancy rate decreased only slightly from 2008 to 2012, after declining substantially between 1995 and 2008. Eighty-five million pregnancies, representing 40 percent of all pregnancies, were unintended in 2012. Of these, 50 percent ended in abortion, 13 percent ended in miscarriage, and 38 percent resulted in an unplanned birth. The unintended pregnancy rate continued to decline in Africa and in the Latin America and Caribbean region. If the aims of the London Summit on Family Planning are carried out, the incidence of unwanted and mistimed pregnancies should decline in the coming years.

/pdf/intended-and-unintended-pregnancies-worldwide-in-2012-and-4iiskd9hvb.pdf

Intended and unintended pregnancies worldwide in 2012 and recent trends.

Unintended pregnancy can carry serious consequences for women and their families. We estimate the incidence of pregnancy by intention status and outcome at worldwide, regional, and subregional levels for 2008, and we assess recent trends since 1995. Numbers of births are based on United Nations estimates. Induced abortions are estimated by projecting from recent trends. A model-based approach is used to estimate miscarriages. The planning status of births is estimated using nationally representative and small-scale surveys of 80 countries. Of the 208 million pregnancies that occurred in 2008, we estimate that 41 percent were unintended. The unintended pregnancy rate fell by 29 percent in developed regions and by 20 percent in developing regions. The highest unintended pregnancy rates were found for Eastern and Middle Africa and the lowest for Southern and Western Europe and Eastern Asia. North America is the only region in which overall and unintended pregnancy rates have not declined. We conclude with a brief discussion of global and regional program and policy implications.

/pdf/unintended-pregnancy-worldwide-levels-trends-and-outcomes-43xwasuz4e.pdf

Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes

Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends.

https://www.guttmacher.org/pubs/journals/Sedgh-Lancet-2012-01.pdf

Induced abortion: incidence and trends worldwide from 1995 to 2008

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30380-4.pdf

Gilda Sedgh

Papers

Intended and unintended pregnancies worldwide in 2012 and recent trends.

Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes

Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends.

Induced abortion: incidence and trends worldwide from 1995 to 2008

Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends.