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College of Public Health

Unintended pregnancies, those that are unwanted or mistimed, represent a major public health challenge. Across the US, approximately 45% of all pregnancies are unintended.1 In the southeastern region of the US, over 50% of all pregnancies are unintended.2 Unintended pregnancies occur more frequently in young, low-income, and minority women, and are generally associated with poorer health and economic outcomes for the child, the mother, and their families.  In South Carolina, the Choose Well initiative ( is a state-wide collaboration that seeks to reduce the rate of unintended pregnancy through a range of collaborative efforts with health care systems, providers, non-profit organizations, professional associations, policy systems, and community members.

A team of researchers at ETSU has been selected to conduct an independent, external evaluation of the Choose Well initiative.  The evaluation research is informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, and uses a mixed-methods approach to data collection and analysis. This evaluation includes sub-projects that focus on the specific impact of Choose Well on:

  • Women seeking reproductive health care,
  • Primary care providers including physicians and advanced practice nurses,
  • Health system capacity and scope of services,
  • Implementing agencies and health policies, and
  • Population-based outcomes

The results of this evaluation will help to elucidate the impact of the Choose Well initiative on unintended pregnancy and its determinants; the sustainability of the initiative and its components; and the essential elements that would be necessary to launch similar initiatives elsewhere. The results will also provide important insight into how individuals and families make reproductive health decisions and how providers can more effectively counsel their patients around family planning.

For questions or additional information about this evaluation, please contact Dr. Mike Smith at 423-439-4443 or

  1. Finer, L. B. & Zolna, M. R. Declines in Unintended Pregnancy in the United States, 2008–2011. N. Engl. J. Med. 374, 843–852 (2016).
  2. Kost, K. Unintended pregnancy rates at the state level: estimates for 2010 and trends since 2002. (Guttmacher Institute, 2015).

Evaluation Team


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