State-Level Contraceptive Use and Preferences: Estimates from the US 2022 Behavioral Risk Factor Surveillance System

Abstract

Contraception plays a key role in people’s realization of their sexual and reproductive health and well-being. The factors that shape contraceptive behaviors are complex and dynamic, and there is growing recognition among reproductive health service providers and advocates that contraceptive service delivery must prioritize patients’ values and preferences to help them exercise their reproductive autonomy.1 Similarly, research and public health surveillance systems that measure not only contraceptive use and method selection but also contraceptive preferences are best suited to evaluate service quality and track progress toward meeting the needs of reproductive-aged people. Building on findings from two previous Guttmacher Institute reports describing Behavioral Risk Factor Surveillance System (BRFSS) data on contraceptive use in 20172 and 2019,3 this report uses data from the 2022 BRFSS to provide an expanded set of state-level estimates of contraceptive use and preferences. In 2022, scientists at Guttmacher collaborated with the Centers for Disease Control and Prevention (CDC) to modify existing questions and include additional questions in the BRFSS family planning module. The resulting data set allows analysis not only of people’s primary contraceptive method use but also of multiple method use, overall contraceptive preferences and method-specific contraceptive preferences. Data collection for the 2022 BRFSS occurred during a pivotal time for reproductive health and rights due to the US Supreme Court’s June 2022 ruling in Dobbs v. Jackson Women’s Health Organization, which overturned the federal right to abortion. A wave of restrictive state laws and policies have followed, and as legislation concerning sexual and reproductive health care becomes increasingly politicized, state-level policies are key determinants of the quality and accessibility of contraceptive care.4 In this environment, state-level data, especially on person-centered measures of contraceptive preferences, are of paramount importance in understanding how shifts in reproductive health policy and service delivery are felt in the population. This report finds that contraceptive use is high across all reporting jurisdictions, but there is considerable variation in whether people are realizing preferences for which contraceptives they use or whether to use at all. People who report having used a method that requires some interaction with a provider, for example, are more likely than people using exclusively provider-independent or over-the-counter methods to report their current method as their preferred method of contraception. Throughout this report, we will explore how patterns of contraceptive use and preferences vary by type of method or combination of methods and jurisdiction. Given the elevated barriers to contraception that young people have historically experienced,5,6 we also highlight differences between two age-groups (18–24 and 25–49) where possible.*