Design and results of the Women's Health Study.

The Women's Health Study was a methodological experiment carried out in Chicago. More than 1,000 women took part; a comparison sample of 100 men was also included. The sample was selected from two sources. Most of the women and all of the men were selected from an area probability sample that had been screened to identify women in the eligible age range; the rest of the women were selected from rosters at cooperating abortion clinics and were known to have had an abortion. Questionnaires based on the one used in the National Survey of Family Growth were administered to the sample; the questionnaire included items on abortion, sexual behavior, and illicit drug use. The experiment examined five variables: whether the questionnaire began with a series of medical questions or with questions on pregnancy; whether the interview was conducted by a nurse or field interviewer; whether the interview was done at the respondent's home or outside the home; whether the interviewer or respondent administered the questions; and whether the data were collected on paper or via computer. Of the five experimental factors, the one with the most consistent effect was the method of administering the questions. Self-administration significantly increased the reported number of sexual partners, sexually transmitted diseases, and the level of condom use compared to administration by an interviewer. Computer assistance occasionally interacted with the site of the interview to effect reporting. The other two experimental variables-the version of the questionnaire and the data collection staff-had few discernible effects. None of the variables affected reported drug use over the lifetime.

The demography of infertility in the United States.

"Some popular descriptions of infertility have suggested that there are nine or ten million infertile couples, that one in six couples is infertile, that infertility is increasing rapidly, or that there is an 'epidemic' of infertility in the USA.... The purpose of this chapter is to determine whether these perceptions are accurate and if not, to suggest why there is a perception that infertility is epidemic.... We report two measures of infertility here. The first is called 'impaired fecundity' and is derived from a series of direct survey questions...on the ability to have children. The second is 'infertility status' among married couples." Data are from the National Survey of Family Growth for 1976, 1982, and 1988. Data for 1965 are from the National Fertility Study.

A comparison of breast-feeding data from the National Surveys of Family Growth and the Ross Laboratories Mothers Surveys.

This study compares rates of breast feeding reported in the National Surveys of Family Growth with those from the Ross Laboratories Mothers Surveys. Both surveys have documented rates of breast feeding over the last 30 or more years. Despite differences in survey methodology, both surveys document similar long-term trends in breast feeding. The similarities of rates in breast feeding also are evident across several maternal sociodemographic characteristics. We conclude that both surveys produce reliable and useful estimates of breast feeding.

What do women use when they stop using the pill?

Current use of oral contraceptives among currently married women aged 15-44 declined from 25 percent to 13 percent between 1973 and 1982, while ever-use increased from 60 percent to 80 percent. By 1982, the pill appeared to be used mainly to delay first pregnancies, secondarily to space subsequent conceptions, and only rarely as a means of ending childbearing. Most women who had stopped using the pill by 1982 had done so on their own initiative: Only about one-third had been advised by a doctor to discontinue use. Virtually all former users gave some physical problem connected with pill use as a reason for quitting the method. At the time they quit, former users had been taking the pill for an average of 3.2 years. The decline in current use of the pill during the 1970s coincided with a marked increase in contraceptive sterilization, but was not the result of a direct switching from the pill to sterilization by individual women. Only 21 percent of women who quit the pill chose sterilization as their next method. The majority--60 percent--switched to nonpermanent methods, the condom being the most popular in all age-groups; the proportions selecting the condom as their next method ranged from 20 percent of 15-19-year-olds to 12 percent of 30-44-year-olds. Nineteen percent of former pill users did not adopt any method after discontinuing the pill.

PIP: Current use of oral contraceptives (OC) among currently married US women aged 15-44 declined from 25% to 13% between 1973 and 1982, while ever-use increased from 60 to 80%. By 1980, the pill appeared to be used mainly to delay 1st pregnancies, 2nd to space subsequent conceptions and only rarely as a means of ending childbearing. Most women stopped at their own initiative, 1/3 were advised by their physicians. Almost all former users (who as a group had been taking OCs for an average of 3.2 years) gave a physical problem connected with quitting. 21% of the women who quit OCs chose sterilization as their next method. 60% switched to nonpermanent methods, with the condom being most popular in all age groups. 19% of former users did not adopt any method after discontinuing OCs. Over 1/2 adopted a new method without any break in contraceptive use. 20% had some break in use but were not exposed to the risk of unintended pregnancy. 27% were exposed and went unprotected for some time after quitting. By 1982 the proportion of women who switched to sterilization rose to 30%, while those using nonpermanent methods fell to 29%. Among white married women who stopped OC use in 1979 or later, 6% of those who had switched to IUDs or sterilization had unintended pregnancies, 23% of those who chose periodic abstinence or withdrawal became pregnant. 10% who adopted their next method within the same month became pregnant as compared to 26% who had a break in contraceptive use.

Understanding U.S. fertility: findings from the National Survey of Family Growth, Cycle III.

PIP: The 1st overview of findings from Cycle III of the National Survey of Family Growth, the latest of 7 such surveys of US fertility since 1955 and the 1st to cover all women of childbearing age in the conterminous US is presented. Interviews between August 1982 and February 1983 with 7969 women, representative of 54 million women aged 15-44, reveal that sterilization is now the leading contraceptive method in the US, used by 33% of all contraceptors in 1982 (22%, female sterilization; 11% male sterilization), followed by the pill (29%), condom (12%), diaphragm (8%), and IUD (7%). Linked to this is the continuing decline in unwanted births since the baby boom peak in 1957, which accounted for nearly 1/2 of the drop between 1973 and 1982 in ever-married women's children ever born, from 2.2 to 1.9/woman. However, births conceived sooner than planned increased slightly among younger married women, probably due to the large drop in pill use since 1973 and increased use of the less effective diaphragm and condom among couples still intending to have more children. Black women are now more likely than white women to use the most effective female methods: female sterilization, pill, and IUD. Only 45% of women aged 15-44 in 1982 had used a contraceptive method at 1st intercourse. 4 out of 5 women married for the 1st time between 1975 and 1982 had intercourse before marriage. However, premarital sexual activity may be leveling off among white teenagers after a steep rise since the early 1970s and declining moderately among black teenagers. 16% of 1st marriages among ever-married women aged 15-44 in 1982 had been dissoved within 5 years, mostly by divorce or separation. 59% of black women with children in 1982 had their 1st birth before marriage, compared to 11% of white mothers. The proportion of babies who were breastfed more than doubled between 1970-71 and 1980-81, from 24 to 53%.^ieng

Infertility and age: an unresolved issue.

PIP: Reply to the criticism in a recent paper of a study which concludes, based on the study by Martin Vessey, that women who postpone having their 1st child until after age 30 encounter only a "modest" increase in risk that they will not be able to conceive. Refutes arguments claiming flaws in the design of the study. Defended are the choice of population for the study, the extrapolation of fertility data from married, mostly parous women to nulliparous women in estimating infertility, as well as the method for calculation of age-specific 1-year conception rates. The author concludes that the modest estimate of actual levels of infertility arrived at earlier are a true representation of the actual fact.^ieng