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Imagine a world in which every child is wanted and couples feel secure in making choices about when to have children and how many to have. Unfortunately, the United States has one of the highest rates of unintended pregnancy among the world's most developed nations and the highest rate of teen pregnancy. The political and emotional nature of the discussions regarding reproduction and sexuality, especially abstinence and abortion, hinder progress toward change that will significantly impact unintended pregnancy rates in the United States. The charged national conversation limits the federal funding available for research investigating effective interventions and suppresses development of national prevention guidelines (Taylor, Levi, & Simmonds, 2010). Without strong national guidelines on prevention and management of unintended pregnancies, state policies widely vary, and according to recent reports, the majority of states consistently do not serve to protect the reproductive health of women (Institute Of Medicine, 2010; National Women's Law Center, 2010).

Because millions of women‘s and their families’ lives are affected by unintended pregnancy each year, including health, social, and economic consequences, a national priority to address this problem is needed. Only with a combination of easily accessible, coordinated reproductive health services and new information about root contributors to unintended pregnancy that is translated into improved education for both women and their providers can the United States move us toward achieving relevant national reproductive health goals.

In this In Focus series my colleagues and I discuss the role of nurses and reproductive health professionals to improve access to coordinated, evidence-based, and culturally competent reproductive health care. We propose a comprehensive, culturally appropriate public health framework to reduce unintended pregnancy in which primary, secondary, and tertiary prevention measures are implemented and evaluated for effectiveness in culturally diverse populations, compiled into nationally supported clinical guidelines, incorporated into standard primary care competencies for all health professionals, and supported by state and federal policies. Such an approach has been effective for influencing other national health goals.

In spite of the frequency of and significant costs associated with unintended pregnancy, evidence-based clinical guideline development for prevention of unintended pregnancy has lagged behind other important health threats resulting in a system-wide failure to successfully provide care to individuals of reproductive potential who are at risk of unintended pregnancy. In the first article, Levi and Dau summarize the literature on the problem, the disparities, and impact of unintended pregnancy in the United States, including federal efforts to improve intended pregnancy rates through national health goals, reproductive health policy, and the promise of health care reform.

In the second article of this series, James and I propose an evidenced-based blueprint for a coordinated system of primary, secondary and tertiary prevention for use by nurses and other health professionals who provide care for patients at risk for unintended pregnancy. In this model, primary prevention strategies have the best empirical evidence (Moos, 2003). Unfortunately, little attention has been given to linking secondary and tertiary prevention interventions within a coordinated system of best practices that assures the quick return of patients back to primary prevention. Goals and essential prevention services are described for primary, secondary and tertiary prevention of unintended pregnancy.

In the third article of this series, Simmonds and Likis address the gaps in the clinical practice guidelines and core competencies necessary for secondary prevention of unintended pregnancy. With limited evidence for best practices, they provide an important contribution by describing professional responsibilities for nurses and other primary care clinicians. These suggested responsibilities include appropriate assessment of a mistimed or unwanted pregnancy, options counseling, provision of or referral for desired services, care coordination, and prevention efforts aimed at decreasing future unintended pregnancies. The authors summarize a number of expert-developed strategies and resources from across disciplines and national borders.

In the final article, Cappiello, Beal and Hudson-Gallogly articulate the ethical competencies for the care of a woman with an unintended pregnancy. Cappiello and colleagues fill a critical gap in the framework for prevention and management of unintended pregnancy by formulating clinical competencies based on ethical principles of respect, autonomy, beneficence and fairness; professionals’ right of conscience; and a social justice model of activism and advocacy. Regardless of where we practice, the competencies described in this article address how clinicians can be responsive to patient needs when disparities arise between the professional's and patient's values.

Although current fragmentation and politicization of reproductive and gender-based health care may be ubiquitous, established evidence shows that an organized effort, combining federal resources, public health advocacy, and established prevention guidelines can lead to health behavior improvements. In the delicate relationship that is established when a woman seeks care related to an unintended pregnancy, nurses provide essential services that have the potential to change outcomes in profound and meaningful ways. By providing non-judgmental, non-directive education about options, actively facilitating access to desired services, and following up to evaluate outcomes and promote continuity of care, nurses have a critical role to play in the prevention of unintended pregnancies. Furthermore, incorporating ethical practice competencies in provider education will strengthen the capacity of health care professionals to promote preconception and overall reproductive health. This education promises to empower individuals to exercise intention over contraceptive and pregnancy decision-making.

REFERENCES

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  2. REFERENCES
  3. Biography

Biography

  1. Top of page
  2. REFERENCES
  3. Biography
  • Diana Taylor, RNP, PhD, FAAN, is a professor emerita in the School of Nursing, University of California San Francisco (UCSF) and Research & Evaluation Director, UCSF Primary Care Initiative, Advancing New Standards in Reproductive Health Program (ANSIRH), UCSF Bixby Center for Global Reproductive Health, Oakland, CA.