Looking inward: provider-based barriers to contraception among teens and young adults.

One of the signature public health achievements in the United States in recent years has been the decline in both the teen pregnancy and the teen birth rates. Between 1990 and 2004, the teen pregnancy rate declined 38% [1]; in a similar trend, the teen birth rate declined 31% between 1991 and 2006 [2]. This change was remarkably widespread; significant declines were documented in all states and among all racial and ethnic groups. Even so, it remains the case that one in three teen girls becomes pregnant at least once before turning 20, and the United States still has the highest rates of teen pregnancy and birth in the fully developed world. Most scholars agree that the decline was fueled by a combination of somewhat fewer teens reporting that they had had sex and, in particular, better contraceptive use among those who were having sex [3]. Recent vital statistics data, however, reveal a 3% increase between 2005 and 2006 in the teen birth rate— the first such increase in 15 years [2]— showing clearly that rates that go down can go back up. A new group of girls turns 13 each year and there is no room for complacency. Less often noted is that the broader measure of unintended pregnancy in the United States, as distinct from teen pregnancy, has shown virtually no progress since 1994. According to data from the 2001 National Survey of Family Growth, half of all pregnancies in the United States at present are unintended, accounting for nearly 3 million pregnancies annually. Moreover, the rate of unintended pregnancy actually increased among women 25–29 years old between 1994 and 2001. Half of these pregnancies were among women not seeking pregnancy who nonetheless used no method of contraception in the month they conceived; the other half were among women who were using a method inconsistently or incorrectly. Significant disparities in the rate of unintended pregnancy exist among different socioeconomic, educational, ethnic and racial groups in the United States. In essence, unintended pregnancy rates are higher among women who are poorer, less-educated, and/or are black or Hispanic [4]. In response to this challenging situation, about 18 months ago, the National Campaign to Prevent Teen Pregnancy (the Campaign) expanded its mission to include an added focus on reducing unintended pregnancy (referred to by the Campaign