Contraceptive Use

WHO NEEDS CONTRACEPTIVES?

• 62 million U.S. women are in their childbearing years (15-44). 1

• 43 million women of reproductive age, or 7 in 10, are sexually active and do not want to become pregnant, but could become pregnant if they or their partners fail to use a contraceptive method. 2

• The typical U.S. woman wants only 2 children. To achieve this goal, she must use contraceptives for roughly 3 decades of her life. 3

WHO USES CONTRACEPTIVES?

• Virtually all women (98%) aged 15-44 who have ever had intercourse have used at least one contraceptive method. 4

• Overall, 62% of the 62 million women aged 15-44 are currently using a contraceptive method. 5

• 31% of the 62 million women do not need a method because they are infertile; are pregnant, postpartum or trying to become pregnant; have never had intercourse; or are not sexually active. 6

• Thus, only 7% of women aged 15-44 are at risk of unwanted pregnancy but are not using contraceptives. 7

• Among the 42 million fertile, sexually active women who do not want to become pregnant, 89% are practicing contraception. 8

WHICH METHODS DO WOMEN USE?

• 64% of reproductive-age women who practice contraception use reversible methods, such as oral contraceptives or condoms. The remaining women rely on female or male sterilization. 9

CONTRACEPTIVE METHOD CHOICE AMONG U.S. WOMEN WHO PRACTICE CONTRACEPTION, 2002
Method	No. of users (in 000s)	% of users
Pill	11,661	30.6
Tubal sterilization	10,282	27.0
Male condom	6,841	18.0
Vasectomy	3,517	9.2
3-month injectable	2,024	5.3
Withdrawal	1,513	4.0
IUD	774	2.0
Periodic abstinence (calendar)	450	1.2
Implant, 1-month injectable, patch	461	1.2
Periodic abstinence(natural family planning)	133	.4
Diaphragm	99	.3
Other*	354	.9
TOTAL	38,109	100.0
* Includes the sponge, cervical cap, female condom and other methods.

• Contraceptive choices vary markedly with age. For women younger than 30, the pill is the leading method. By age 35, more women rely on sterilization. 10

• The pill and female sterilization have been the two leading contraceptive methods overall in the United States since 1982. However, sterilization is the leading method among black women and Hispanic women, while the pill is the leading method for white women. 11

• Female sterilization is most commonly relied on by women who are aged 35 or older, women who are currently or have previously been married and women with less than a college education. 12

• 50% of all women aged 40-44 who practice contraception have been sterilized, and another 18% have a partner who has had a vasectomy. 13

• The pill is the method most widely used by women who are in their teens and 20s, never-married women and and women with at least a college degree. 14

• Women in their teens and 20s are more likely to rely on the 3-month injectable than are older women. Women aged 25-29 are more likely than women in other age-groups to rely on the implant, 1-month injectable or patch. 15

• Compared with non-Hispanic white women, Hispanic and black women are less likely to rely on their partner's vasectomy or the pill, and more likely to rely on the 3-month injectable or no method.

• Poor and low-income women are more than twice as likely as higher income women to use the 3-month injectable. 16

• 7.3 million women use barrier contraceptives, such as the male condom. 17 Condom use is especially common among teenagers, 20-24-year-olds, childless women and never-married women. 18

• 15% of contraceptive users rely on dual methods (most often the condom combined with another method). The proportions using more than one method are greatest among teenagers and never-married women. 19

TEEN CONTRACEPTIVE USE

• Teenagers (aged 15-19) who do not use a contraceptive at first sex are twice as likely to become teen mothers as are teenagers who use a method. 20

• 27% of teenage women using contraceptives choose condoms as their primary method. Condom use declines as women grow older and marry. 21

• Of the 3.1 million teenage women who use contraceptives, 53% - more than 1.5 million women - rely on the pill. 22

• 45% of teenage women who practice contraception use condoms, either alone (19%) or with another method (25%). 23

CONTRACEPTIVE USE AT FIRST INTERCOURSE

• The proportion of women who used a contraceptive method the first time they had sex has nearly doubled, from 43% in the 1970s to 79% in 1999-2002. The change is mostly due to an increase - from 22% to 67% - in the proportion using the male condom at first sex. 24

• The proportion of women using contraceptives at first intercourse increases as age at first intercourse increases. 55% of women who first had sex before age 16 used a method, compared with 70% who first had sex at age 19 or older. 25

• 67% of non-Hispanic white women used a method at first intercourse, compared with 60% of black women and just 46% of Hispanic women. 26

TRENDS IN CONTRACEPTIVE USE

• The proportion of women aged 15-44 currently using a contraceptive increased from 56% in 1982 to 64% in 1995, and then declined slightly to 62% in 2002. 27

• The proportion of women who are at risk of unwanted pregnancy but not using a method increased from 5% in 1995 to 7% in 2002. 28

• Among teenagers who are sexually active and able to become pregnant, but do not want to become pregnant, the proportion who are not using contraceptives has remained steady at about 7%. But older women are now more likely to fall into this category, with an increase from 5% in 1995 to 8% in 2002 among 25-29-year-olds and from 4% to 7% among 30-34-year-olds. 29

•The proportion of women using contraceptives who rely on condoms decreased between 1995 and 2002 - from 20% to 18% among all women and from 30% to 23% among never-married women. However, use was still higher among both groups in 2002 than it was in 1988. 30

• Between 1995 and 2002, the proportion of use accounted for by the pill increased slightly, from 27% to 31%. 31

• 27% of contraceptive users relied on female sterilization in 2002, compared with 28% in 1988 and 1995. 32

• The proportion of all users relying on the diaphragm declined from 6% in 1988 to 2% in 1995, and to nearly zero by 2002. On the other hand, the proportion of all users relying on the IUD increased slightly, from less than 1% in 1995 to 2% in 2002. 33

 

FIRST-YEAR CONTRACEPTIVE FAILURE RATES
Method	Perfect use*	Typical use†
Pill (combined)	0.3	8.0
Tubal sterilization	0.5	0.7
Male condom	2.0	15.0
Vasectomy	0.1	0.2
3-month injectable	0.3	3.0
Withdrawal	4.0	27.0
IUD Copper-T	0.6	1.0
IUD Mirena	0.1	0.1
Periodic abstinence	1.0-9.0‡	25.0
1-month injectable	0.05	3.0
Implant	0.05	1.0
Patch	0.3	8.0
Diaphragm	6.0	16.0
Sponge §	15.0	25.0
Cervical cap **	18.0	24.0
Female condom	5.0	27.0
Spermicides	18.0	29.0
No method	85.0	85.0
*Most perfect-use rates have been clinically evaluated, but some are based on clinical expertise or "best guesses" (such as some forms of periodic abstinence, withdrawal and no method use). † Typical-use rates for the implant, the injectable, the pill, the male condom, the diaphragm, periodic abstinence, withdrawal and spermicides are based on 1991-1995 data from the 1995 National Survey of Family Growth, as calculated by Fu et al. Typical-use rates for the IUD, sterilization and the female condom are from Hatcher et al., and are adjusted by the ratio of the corrected and standardized failure rate in the first 12 months for all methods (12.9%) to the uncorrected failure rate for all methods (9.9%), as reported in Fu et al. Other typical-use rates are from Hatcher et al. ‡ Rates range from 1% for the postovulation regime to 9% for the calendar method. Sponge § Weighted average of the rates for nulliparous and parous women, weighted by the proportion of sponge users who fell into each of those two categories in the 1988 National Survey of Family Growth (41% were nulliparous, 59% were parous). The 1995 and 2002 National Surveys of Family Growth had too few sponge users to permit recalculation of this proportion. **Simple average of the rates for nulliparous and parous women. Sources: Perfect use - Hatcher RA et al., eds., Contraceptive Technology, 18th rev. ed., New York: Ardent Media, 2004, Table 9-2. Typical Use - Ibid.; and Fu H et al., Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth, Family Planning Perspectives, 1999, 31(2):56-63.

WHO PAYS FOR CONTRACEPTION?

• One-quarter of the more than 20 million American women who obtain contraceptive services from a medical provider receive care from a publicly funded family planning clinic. 34

• In 2001, 6.7 million women, including 1.9 million teenagers, received contraceptive services from publicly funded family planning clinics in the United States. 35

• Federal employees are guaranteed insurance coverage for contraception. 36

• 9 in 10 employer-based insurance plans cover a full range of prescription contraceptives, which is 3 times the proportion just a decade ago. 37

• 21 states now have laws in place requiring insurers to provide contraceptive coverage if they cover other prescription drugs. 38

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© copyright 2005, The Alan Guttmacher Institute