Experts estimate that nearly 60 percent of all U.S. pregnancies--and 81 percent of pregnancies among adolescents--are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted. Now, current issues--health care and welfare reform, and the new international focus on population--are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts. This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs. The Best Intentions explores problematic definitions--"unintended" versus "unwanted" versus "mistimed"--and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear. Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care." The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals. May

The New York Times bestseller A New York Times Notable and Critics’ Top Book of 2016 Longlisted for the PEN/John Kenneth Galbraith Award for Nonfiction One of NPR's 10 Best Books Of 2016 Faced Tough Topics Head On NPR's Book Concierge Guide To 2016’s Great Reads San Francisco Chronicle's Best of 2016: 100 recommended books A Washington Post Notable Nonfiction Book of 2016 Globe & Mail 100 Best of 2016 “Formidable and truth-dealing . . . necessary.” —The New York Times “This eye-opening investigation into our country’s entrenched social hierarchy is acutely relevant.” —O Magazine In her groundbreaking bestselling history of the class system in America, Nancy Isenberg upends history as we know it by taking on our comforting myths about equality and uncovering the crucial legacy of the ever-present, always embarrassing—if occasionally entertaining—poor white trash. “When you turn an election into a three-ring circus, there’s always a chance that the dancing bear will win,” says Isenberg of the political climate surrounding Sarah Palin. And we recognize how right she is today. Yet the voters who boosted Trump all the way to the White House have been a permanent part of our American fabric, argues Isenberg. The wretched and landless poor have existed from the time of the earliest British colonial settlement to today's hillbillies. They were alternately known as “waste people,” “offals,” “rubbish,” “lazy lubbers,” and “crackers.” By the 1850s, the downtrodden included so-called “clay eaters” and “sandhillers,” known for prematurely aged children distinguished by their yellowish skin, ragged clothing, and listless minds. Surveying political rhetoric and policy, popular literature and scientific theories over four hundred years, Isenberg upends assumptions about America’s supposedly class-free society––where liberty and hard work were meant to ensure real social mobility. Poor whites were central to the rise of the Republican Party in the early nineteenth century, and the Civil War itself was fought over class issues nearly as much as it was fought over slavery. Reconstruction pitted poor white trash against newly freed slaves, which factored in the rise of eugenics–-a widely popular movement embraced by Theodore Roosevelt that targeted poor whites for sterilization. These poor were at the heart of New Deal reforms and LBJ’s Great Society; they haunt us in reality TV shows like Here Comes Honey Boo Boo and Duck Dynasty. Marginalized as a class, white trash have always been at or near the center of major political debates over the character of the American identity. We acknowledge racial injustice as an ugly stain on our nation’s history. With Isenberg’s landmark book, we will have to face the truth about the enduring, malevolent nature of class as well.