# Improving Methods and Measures of Reproductive Health Outcomes

> **NIH NIH R01** · GUTTMACHER INSTITUTE · 2021 · $498,330

## Abstract

Project Summary
Use of contraception for pregnancy prevention is among the most important behaviors affecting fertility in a
population, and determining the trajectory of individual lives. But, contraceptive failures contribute to
unintended, and often unwanted, conceptions. Almost all U.S. women use contraception at some point in their
lives and millions of individuals rely on scientifically-valid estimates of the risk of failure. Clinicians also rely
on these key measures to counsel clients in their choice of method as well as to establish broad practice
guidelines with wide-reaching influence. And, because of the high quality of U.S. population data, contraceptive
failure rates based on the experience of U.S. women are used in international research and policy applications.
Indeed, few other products of demographic research are as widely used as contraceptive failure rates.
In spite of their significance to public health and research, no new methodological advances have been offered
in this area of work in almost 30 years and virtually no research exists to illuminate factors that account for
variation in the risk of contraceptive failure across individuals, populations, locations or time. To address
limitations of prior studies, improve the quality of failure rate estimates and forge a new path for research, we
propose five linked aims. Aim 1 will advance understanding of factors that contribute to differential
experiences with contraceptive failure by developing a novel theoretical framework specifically focused on
individuals' perceptions, beliefs, relationships and external influences on the risk of contraceptive failure. We
will exploit a wealth of existing qualitative data to inform development of the framework and then design and
analyze new survey questions to test that framework in a large nationally representative survey of reproductive
age women. In Aim 2, we will advance the measurement of contraceptive failure by developing a new approach
for estimating failure rates using Bayesian statistics to more fully utilize existing knowledge and to surpass
prior approaches that have limited our understanding of variation in failure rates across population groups. In
Aim 3, we will use these new subgroup estimates to identify the factors that led to change over time in method-
specific failure rates and the role of more effective use of contraception in recent declines in U.S. unintended
pregnancy rates. This work has important implications not only for changes in the U.S. population, but could
also inform new approaches to examining the impact of contraceptive use worldwide. In Aim 4, we expand our
investigation to structural influences on contraceptive failure by examining the extent to which state policy
climates and the socioeconomic characteristics of their residents are associated with variation in contraceptive
failure for women who share similar demographic traits but live in different states. In Aim 5, we will work with
an advisory...

## Key facts

- **NIH application ID:** 10159287
- **Project number:** 5R01HD092396-04
- **Recipient organization:** GUTTMACHER INSTITUTE
- **Principal Investigator:** Kathryn L Kost
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $498,330
- **Award type:** 5
- **Project period:** 2018-09-05 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10159287

## Citation

> US National Institutes of Health, RePORTER application 10159287, Improving Methods and Measures of Reproductive Health Outcomes (5R01HD092396-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10159287. Licensed CC0.

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