1. 1 Anjani Chandra, Ph.D, National Center for Health Statistics Presented at NAPHSIS, Cincinnati, Ohio June 8, 2005 The National Survey of Family Growth (NSFG) as an extension of the Vital Statistics System

2. 2 The NSFG The first survey was done in 1973. Is intended to respond to Sec 306 of the PHS Act: “NCHS...shall collect statistics on family formation, growth, and dissolution.” Extends the birth registration system by providing data on behaviors that help to explain birth and pregnancy rates--- e.g. sexual activity, contraception, infertility, & breastfeeding. Serves the needs of other DHHS programs that help NCHS pay for it and plan it—e.g., NIH, OPA, ASPE, Children’s Bureau, CDC’s DRH and CDC’s HIV Prevention Program.

3. 3 Live births Social factors Intercourse variables: Timing of first intercourse Percent who have ever had intercourse Time spent in marriage (separation, divorce) Frequency of intercourse Intermediate variables Race/ethnicity Religion Labor force participation Education Income Access to health care Family background Community environment (economic, social, etc) Pregnancy outcome (gestational) variables: Miscarriage and stillbirth Induced abortion Conception variables: Contraceptive use Sterilization Infertility Fertility

4. 4 NSFG history in brief CycleYearScope Number of Interviews Over-Samples Average Length Incentive Payment 11973 Ever-Married Women 15-44 9,797Black Women60 MinutesNo 21976 Ever-Married Women 15-44 8,611Black Women60 MinutesNo 31982All Women 15-447,969 Black Women Teens 60 MinutesNo 41988All Women 15-448,450Black Women70 MinutesNo 51995All Women 15-4410,847 Black Women Hispanic Women 100 Minutes$20 62002 Women 15-44 Men 15-44 (First time) 12,571 W = 7,643 M = 4,928 Blacks Hispanics Ages 15-24 W = 85 Min M = 60 Min $40

5. 5 How the 2002 NSFG data were collected Contractor: Institute for Social Research (ISR), University of Michigan Independent sample in 120 areas Blacks, Hispanics, teens over-sampled In-person interviews using laptop computers Interviews in both English and Spanish (1,794 in Spanish) Informed consent procedures  Signed consent for adults (18-44)  Signed assent & signed parental consent for minors (15-17) ACASI for most sensitive questions

6. 6 Sources of data for this presentation 2 reports released in December 2004:  “ Use of Contraception & Use of Family Planning Services in the US, 1982-2002,” Advance Data No. 350. Dec, 2004.  “Teenagers in the US: Sexual Activity, Contraceptive Use, & Childbearing,” Vital & Health Statistics, Series 23, No. 24. Reports to be published later this year on:  Sexual Behavior  HIV Testing  Fertility, Family Planning, Reproductive Health (Women)  Fertility, Contraception, & Fatherhood (Men) Other reports: Series 1 & 2 on survey methods

7. 7 What do we learn with NSFG data that can’t be learned as readily with vital statistics? Circumstances of births that may help to explain variations in birth rates Information on social factors and the “intermediate variables” that can impact pregnancy and birth rates

8. 8 Circumstances of births, not currently available through vital statistics Marital or cohabiting status Wantedness at time of conception Contraceptive use prior to pregnancy Payment for delivery Maternity leave Breastfeeding

9. 9 Percent distribution of first births by marital and cohabiting status of mother at first birth: US, 2002 Births to cohabiting women are a significant proportion of births to unmarried women.

10. 10 Pregnancies can be categorized by “wantedness at time of conception.” Wantedness is associated with several key pregnancy behaviors and outcomes Wantedness is also associated with women’s education, marital/cohabiting status, and other characteristics. Intended = Mistimed + Unwanted Mistimed pregs classified by “how much too soon”

11. 11 Percent distribution of births in the last 5 years by whether wanted by the mother at the time of conception: US, 1995 and 2002 Unintended childbearing continues to be a serious concern for maternal and infant health.

12. 12 Wantedness at conception for recent births, by education: lower education  more unwanted & seriously mistimed births Education Women 22-44 UnwantedMistimed Less than 2 years 2 or more years Less than HS19%23 715 High School16%20 812 Some college14%1911 8 BA or higher 6%9 6 2 SOURCE: Chandra A, et al. Fertility, Family Planning, and Reproductive Health of US Women: Data from the 2002 NSFG. Vital and Health Statistics, Series 23, No. 25. Forthcoming, 2005.

13. 13 Percent of recent pregnancies with delayed prenatal care, by wantedness at time of conception: U.S., 2002

14. 14 Percent of women who smoked during their most recent pregnancy: US 2002 Women’s most recent (non-abortion) pregnancies 1997-2002 Percent SOURCE: Chandra A, et al. Fertility, Family Planning, and Reproductive Health of US Women: Data from the 2002 NSFG. Vital and Health Statistics, Series 23, No. 25. Forthcoming, 2005.

15. 15 Percent of women relying on Medicaid or government assistance to pay for their most recent delivery Age and marital/cohabiting status at delivery

16. 16 Percent of babies breastfed at all: single births 1990-93 and 1997-2000 SOURCE: Chandra A. New Data on Breastfeeding. DataSpeak Web Conference, May 11, 2005. Data from NSFG Cycles 5 and 6.

17. 17 Percent still breastfeeding at selected months, by race & Hispanic origin SOURCE: Chandra A. New Data on Breastfeeding. DataSpeak Web Conference, May 11, 2005. Data from 2002 NSFG, single births, 1997-2000.

18. 18 Complementing birth data with information on… Sexual activity, focusing on heterosexual vaginal intercourse Contraception Use of family planning & medical services Pregnancy outcomes besides live birth Childlessness – voluntary and nonvoluntary Infertility and impaired fecundity; Infertility services Adoption and foster care Non-coital sexual activity Data directly obtained from men/fathers

19. 19 Percent of ever married women had first sex 5 or more years before marriage, by year of marriage: US 2002 The gap between 1 st sex and 1 st marriage is growing  longer period of risk for premarital fertility.

20. 20 Percent of never married females and males 15-17 years of age who have ever had intercourse: US, 1988, 1995, 2002 Teens are delaying sex…

21. 21 Percent who used any method at first sex, by year of first sex & race/origin. And using contraception more at 1 st sex (& last sex), when they do have sex.

22. 22 Female SterilizationPill Percent of contraceptors 22-44 who were currently using female sterilization or the pill, by education: US, 2002 Contraceptive choice is closely tied to age, education, and income.

23. 23 Trends in Contraception, 1995-2002 Typical Pattern :  condom at 1st sex, pill to delay/space, female sterilization to stop.  racial & socio-economic variations are large; some getting larger. Use at first sex:  increasing overall  dual use (condom & pill, eg.) is growing Current use:  College graduates (more likely to delay 1 st birth): pill users  Less educated (who generally have kids at younger ages): Depo or condoms when young, female sterilization when 30+

24. 24 Percent of women 15-44 years of age who are voluntarily childless: US, 1982-2002 (have no children, expect none, & are physically able to have children) There are different types of childlessness, and they can be measured.

25. 25 Percent Impaired fecundity compared with 12 month infertility among married women 15-44: US, 1982-2002 Trend analysis

26. 26 Infertility Services Ever Received: 1995 and 2002

27. 27 Collecting data on sex in CAPI & ACASI In CAPI (interviewer administered): We collect data only on Heterosexual vaginal intercourse. Sex  Babies In ACASI (self-administered), we ask about:  Opposite sex and same sex partners  All types of sexual activities (vaginal, oral & anal) Sex  risks for STDs and HIV

28. 28 Risk Measures Collected in the Self-administered part of the 2002 NSFG Focus on behaviors in last year Drug-related risk:  Injection of illicit drugs  Use of marijuana, cocaine, crack cocaine Sex-related risk:  If male: sexual contact with other males; If female: sex with men who have had sex with men  Sex with an HIV-positive partner  Sex with an IV drug user  Number of sexual partners in last year  Exchange of sex for drugs or money  Testing or treatment for sexually transmitted infection

29. 29 Percent tested for HIV in last year, by risk status and gender: US, 2002 Any risk=Crack or IVDU, sex-related (e.g, 5+ partners in last year), recent STI testing or treatment Percent

30. 30 Percent of recently pregnant women tested for HIV in last year Any risk=Crack or IVDU, sex-related (e.g, 5+ partners in last year), recent STI testing or treatment

31. 31 Data obtained directly from men include: Biological & adoptive fatherhood Wantedness of recent births Nonmarital fertility Paternity establishment for nonmarital births Sexual activity; marriage & cohabitation Contraception and family planning services Infertility

32. 32 NSFG data available Public use files from Cycles 1 thru 6 are available free on CD- ROM: NSFG@cdc.govNSFG@cdc.gov Cycle 6 public use data and documentation can be downloaded from the web site. Questionnaires from Cycles 1-6 are at: http://www.cdc.gov/nchs/nsfg.htm ACASI data files available on request. User must sign a confidentiality agreement. Contextual (geographic) data for 1995 available through the NCHS Research Data Center; for 2002, available soon.

33. 33 Contact us at:  NSFG@cdc.gov or 301-458-4222 NSFG@cdc.gov  NCHS, Room 7318, 3311 Toledo Road  Hyattsville, MD 20782 Visit: www.cdc.gov/nchs/nsfg.htm Questions? THANK YOU!