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标题：National Needs of Family Planning Among US Men Aged 15 to 44 Years
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作者：Arik V. Marcell ; Susannah E. Gibbs ; Ifta Choiriyyah 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2016
卷号：106
期号：4
页码：733-739
DOI：10.2105/AJPH.2015.303037
语种：English
出版社：American Public Health Association
摘要：Objectives. To estimate national need for family planning services among men in the United States according to background characteristics, access to care, receipt of services, and contraception use. Methods. We used weighted data from the 2006–2010 National Survey of Family Growth to estimate the percentage of men aged 15 to 44 years (n = 10 395) in need of family planning, based on sexual behavior, fecundity, and not trying to get pregnant with his partner. Results. Overall, 60% of men were in need of family planning, defined as those who ever had vaginal sex, were fecund, and had fecund partner(s) who were not trying to get pregnant with partner or partner(s) were not currently pregnant. The greatest need was among young and unmarried men. Most men in need of family planning had access to care, but few reported receiving family planning services (< 19%), consistently using condoms (26%), or having partners consistently using contraception (41%). Conclusions. The need for engaging men aged 15 to 44 years in family planning education and care is substantial and largely unmet despite national public health priorities to include men in reducing unintended pregnancies. Unintended pregnancy rates in the United States are high, especially among adolescents and young adults. 1 Pregnancy prevention efforts have typically focused primarily on women, with few programs addressing family planning with men. Although measures of need for pregnancy prevention are described for US women 2,3 this approach has not been conducted for men. One recent study that used this approach found that 40% of US men aged 35 to 39 years are in need of family planning. 4 Although this study provides preliminary insight into male need for family planning, it is limited by a narrow age range and therefore provides a partial estimate of reproductive-aged males’ need for family planning. The National Survey of Family Growth (NSFG) is a unique data set for examining family planning needs among a wider age range of men (15–44 years). Strategies to meet men’s family planning education and care needs necessitate a better understanding of the prevalence of men in need of family planning and factors associated with this need. Consistent measurement and tracking of men in need of family planning can assist in meeting public health goals such as the Healthy People 2020 objective to increase family planning service use among men. 5 In 2013, estimates for women indicated that 56% of reproductive-aged US women were in need of family planning, which is defined as sexually active, fecund, and not pregnant or trying to get pregnant. 3 From 2000 to 2013, need for family planning has increased among both female adolescents (aged < 20 years) and young adults (aged 20–29 years). 3 No similar estimates of levels of need or trends over time exist for men. The measure for women has been used to identify the magnitude of need for publicly funded contraceptive services by state and federal region. 3 It has also been used to highlight the inadequacy of current service provision by publicly funded clinics; only 42% of need for publicly funded contraceptive services was met in 2013. 3 An alternate measure of unmet need for family planning widely used for women—defined as the proportion of women desiring to delay or stop childbearing and not using a contraceptive method—has long been a standard indicator in developing country contexts and has been applied to the United States. 6 No similar national estimates of men’s met or unmet need for family planning services in the United States have been examined or proposed. The limitations of excluding men from measures of need for family planning have been recognized in previous work that applied modified definitions of unmet need to men and to couples in developing countries. 7 Unmet need for family planning among men has not been widely studied in the United States. Previous work has found that among men aged 35 to 39 years in need of family planning, the majority are not using condoms and have a partner who is not using hormonal contraception. 4 Research on need met through family planning service provision for men in the United States is lacking. Despite the dearth of research in this area, previous work indicates that men are concerned about preventing pregnancy, talk with their partners about fertility intentions, and are involved in pregnancy prevention. 8–10 Understanding the correlates of male individuals’ need for family planning can provide important guidance for program planning and strategies to improve education and access to health care. Previous work on understanding men in need of family planning has focused mainly on adolescents and young adults. 11,12 Analysis of the National Survey of Adolescent Males demonstrates that even men in their mid-30s are in need, and that need for family planning varies by marital status, partner age, and sexually transmitted infection (STI) risk. 4 Previous research indicates that few men have discussed contraception with a health care provider but almost all are willing to have the conversation in the clinical setting. 13 Recent analysis of 2006–2008 NSFG data indicates that only 12% of men aged 15 to 44 years received birth control services in the previous year, 14 but this estimate includes men who may not be in need of family planning for a variety of reasons ranging from infecundity to actively seeking pregnancy. Until now there have been no national US estimates of the percentage of men aged 15 to 44 years, commonly targeted in reproductive health research, who are in need of family planning. These estimates could help to refine the evaluation of the Healthy People 2020 objective that recognizes the need to engage men in addressing unintended pregnancies. 5 The current analysis addresses gaps in our understanding of male individuals’ family planning needs and expands previous work to estimate the percentage of US men aged 15 to 44 years in need of family planning overall and by their background characteristics, access to care, receipt of services, and use of contraceptive methods by using the 2006–2010 NSFG, a nationally representative household-based survey.