Gap In Contraceptive Use Research Articles

Contraception knowledge among college women in the Southeast United States

Objectives: The purpose of this study was to explore contraceptive awareness among college women in the Southeast United States. This study sheds light on the gaps in contraceptive use found in college women and can be used to improve educational interventions on college campuses. Participants: College-age women ages 18–25 completed in-depth qualitative interviews over Zoom. Methods: Interviews examined levels of awareness by asking participants to list the contraceptive methods they were aware of, followed by probes that assessed their understanding of different contraceptive methods. Results: Prominent themes (n = 44) included high awareness of condoms, the pill and IUD, positive attitudes toward contraceptive options, fear and emotional anxiety from hormonal contraceptives and inability to explain how contraceptives work in the body. Conclusion: Results from this study will inform future contraceptive education campaigns for college women.

Decomposing the Gap in Contraceptive Use Among Female Adolescents and Young Women Aged 15-24 in India: An Analysis of Appended Datasets of NFHS-4 and 5.

Owing to the reproductive health needs of the budding adolescent and young population, the present study aims to determine the factors associated with and decomposing the gap in contraceptive use among adolescents and young women in India. Cross sectional design.SettingThe present study is based in India using the appended datasets (IV and V rounds) of the Indian Demographic Health Survey (DHS), also known as National Family Health Survey (NFHS) conducted in 2015-16 and 2019-21. The adequate sample size was 475,294 adolescents and young women in NFHS-4 and 229,705 in NFHS-5, totaling 704,999 adolescents (appended for NFHS-4 and 5) for the present study. Sociodemographic, sexual and reproductive history and contraceptive measures. Descriptive statistics, chi-square tests, and a binary logistic regression model were executed. Additionally, a decomposition technique called Fairlie decomposition was employed to identify the primary causes of the difference in the prevalence of contraceptive use between the two survey periods. Almost 96% of young women aged 15-24 knew about contraception, but only 12% used it. Regression analysis revealed that contraceptive use was associated with higher age (AOR 1.09), higher education (AOR 1.28), married adolescents (AOR 4.08), richest wealth quantile (AOR 2.95), joint decision making (AOR 4.40), knowledge of ovulatory cycle (AOR 1.47), interaction with a health worker about any methods of family planning (AOR 3.29) and three and above children ever born (AOR 18.54). Decomposition analysis showed that factors like decision-making of contraception, age, interaction with family planning worker, the intention of last pregnancy, place of residence and age at first sex contributed to increasing the probability of contraceptive use from NFHS-4 to 5. A target-based approach dedicated to understanding the mindset of adolescents and keeping up with their unique needs is the need of the hour.

P055Contraceptive use among medicare enrollees with a disability

<h3>Objectives</h3> Medicare insures 1.7 million reproductive-aged females living with a disability but does not cover contraception for pregnancy prevention. National survey data estimate 45.3% of disabled women use contraception; however, contraceptive use among disabled Medicare enrollees is unknown. We examine Medicare-reimbursed contraceptive use and enrollee characteristics associated with use. <h3>Methods</h3> From the Medicare enrollee file, we identified females aged 20–49 from 2017 to 2019, excluding dual-Medicaid enrollees. We identified any contraceptive use (pill, patch, ring, injectable, implant, intrauterine device (IUD), and sterilization) from inpatient, outpatient, and pharmacy claims using drug and procedure codes. We estimated the predicted probability of contraceptive use by enrollee characteristics using age-adjusted logistic regression. <h3>Results</h3> Of 895,468 enrollees, 3.5% had Medicare-reimbursed contraception. Contraceptive users were slightly younger than non-users (35.1 ± 8.0 vs. 40.4 ± 7.4). Enrollees living in New England (4.8%; [95% CI, 4.6–5.0]) and East South-Central regions (3.1%; 95% CI, [2.9–3.2]) had the highest and lowest probability of contraceptive use, respectively. Indigenous (4.5%; 95% CI, [4.1–4.9]), Black (3.7%; 95% CI, [3.6–3.8]), and White (3.5%; 95% CI, [3.5–3.6]) enrollees were most likely, while Hispanic (2.8%; 95% CI, [2.7–2.9]), and Asian (2.7%; 95% CI, [2.5–3.0]) enrollees were least likely to use contraception. People with both a physical and cognitive disability had a slightly higher probability of contraceptive use (4.3%; 95% CI, [4.2–4.4]), than those with cognitive (4.0%; [95% CI, 3.9–4.1]) or physical (3.5%; 95% CI, [3.4–3.6]) disability alone. <h3>Conclusions</h3> We found a considerable gap in contraceptive use among Medicare enrollees relative to national estimates of self-reported use (3.5% vs. 45.3%). Understanding who is and is not using Medicare-reimbursed contraception is critical, as people with disabilities already experience substantial barriers to reproductive healthcare.

83. Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Adolescents

<h3>Background</h3> Approximately 1.6 million US youth under age 18 experience housing insecurity annually. These adolescents are at higher risk for negative reproductive health outcomes than their sheltered peers. Few studies have examined the relationship biopsychosocial factors have with sexual activity and contraception use in this population. This study aimed to address this gap. We hypothesize that biopsychosocial factors have relationships with sexual activity and contraceptive utilization among homeless adolescents. <h3>Methods</h3> An IRB-approved, retrospective cohort study was conducted on adolescents who presented between 2/21/2015-8/27/2019 for state mandated physical exams at a youth crisis shelter in Bethlehem, Pennsylvania. Statistical analyses were performed using univariate and multivariable techniques to describe the population and determine the relationship age, gender identity, substance use, and childhood trauma history have with sexual activity and contraceptive utilization. <h3>Results</h3> Medical records for 440 adolescents were reviewed. Of those, 53.7% (n=233) reported sexual activity and 65.2% (n=148 of 227) of sexually active youth reported using contraception. Sexual activity was significantly related to age (mean age 15.8+1.4 years in sexually active vs. 14.7+1.6 years in not sexually active youth, p<0.001); remote history of self-harm behavior (RR 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001) (Figure 1). Gender identity was related to contraceptive utilization, with 55.68% of sexually active females vs. 42.50% of sexually active males reporting contraception use (p=0.01). After adjusted analysis, older age and substance use remained significantly associated with sexual activity (AOR 1.58 [95% CI 1.36-1.84]; p<0.001 and AOR 5.25 [95% CI 3.33-8.28]; p<0.001, respectively). <h3>Conclusions</h3> Adolescents experiencing homelessness face challenges engaging in safe sex practices and are at higher risk for poor reproductive health outcomes compared to their housed peers. This analysis demonstrates that specific characteristics have significant relationships with sexual behaviors in this population. Older adolescents were one and a half times more likely and substance users were five times more likely to be sexually active. Further, a significant gap in contraceptive use existed between female and male-identifying youth. Understanding the potential risk factors for unsafe sex practices can inform interventions, careful history taking and further inquiry into methods to reduce poor outcomes and facilitate safe sexual behaviors in this at-risk population.

Knowledge, Attitude and Practices towards contraceptive Use among Unmarried Females Students at Mount Kenya University Rwanda

Background: Contraceptive use is one of the effective means for preventing unintended pregnancies and is highly affected by cultural and social demographic background especially in premarital or unmarried females. Rwanda has made great effort to promote women’s health and to decrease the maternal mortality and morbidity, but there is still a long journey to prevent post abortion morbidity and mortality. This study aimed to assess knowledge, attitude and practices towards contraceptive use among female students. Methods: This is a quantitative cross sectional study conducted among 313 female students recruited using a stratified sampling method combined with a simple random sampling. Online questionnaire was used to collect data from study participants. Obtained data was processed and analyzed using SPSS version 25. Descriptive statistics was used to get background information of the study population, and multivariate analysis was used to evaluate factors influencing contraceptive use. Results: The mean age of participants was 25.6±3.3SD, Undergraduates respondents represented 92.7%, 7.3% of respondents were in postgraduates. The results showed that the knowledge of unmarried female students is generally good and their attitudes towards contraceptives are positive. Among 313 participants, 65.8% reported to be sexually active, 76.7% had used any modern contraceptive and 76.2% had practiced unprotected sexual intercourse at least once. A total of 11.5% have had unintended pregnancies at least once. The most commonly known and used methods were condoms and pills. Fear of side effects (55.6%) and lack of information about contraceptives (18.5%) have been reported as factors influencing the non-use of contraceptives. Conclusion: This study concluded that there is still a gap in contraceptive use among sexually active unmarried female students, and recommended the university needs to increase awareness of university students towards contraceptive use.

Closing the Poor-Rich Gap in Contraceptive Use in Rwanda: Understanding the Underlying Mechanisms.

Evidence suggests that as Rwanda has strengthened its family planning program, disparities in contraceptive use by socioeconomic status have narrowed. However, the changes in these gaps, and the mechanisms that underlie them, are not well understood. Data from the 2005, 2010 and 2015 Rwanda Demographic and Health Surveys on 19,028 in-union women aged 15-49 were analyzed to examine trends in socioeconomic disparities in contraceptive use. Descriptive statistics and multivariate regression with interaction terms were used to identify changes in these disparities, as well as to describe trends in desired fertility, and in types and sources of contraceptives used. Between 2005 and 2015, the prevalence of modern contraceptive use rose from 11% to 48%. In the regression analysis, interaction terms indicated that prevalence increased to a lesser extent among women who were wealthy, had a least a secondary education or lived in urban areas than among those who were poor, were uneducated or lived in rural areas (odds ratios, 0.5-0.7). In parallel, declines in desired fertility were greater among women with no education than among those with at least a secondary education (by 0.7 vs. 0.5 children); among the poorest than the richest women (by 1.0 vs. 0.5 children); and among rural than urban residents (by 0.9 vs. 0.4 children). The shrinking of gaps in contraceptive use by socioeconomic status coincided with narrowing of disparities in demand for children and with improvements in family planning services, suggesting that disadvantaged populations may have especially benefited from public programs to increase contraceptive access.

Contraceptive patterns after use of emergency contraception among female undergraduate students in Brazil

Objective: The aim of our study was to describe contraceptive patterns 30 days after use of emergency contraception (EC) among female undergraduate students in São Paulo, Brazil. Methods: This study was part of a larger project conducted in 2015 among 1679 female students aged 18–24 enrolled at the University of São Paulo. Analysis was restricted to the 916 students who reported lifetime use of EC. Logistic regression models were used to examine factors related to the use of contraception within the 30 day period following the last use of EC, changes in contraceptive behaviour before and after EC use, and gaps in contraceptive use within 30 days after EC use. Results: Most women (75.4%) used contraception after accessing EC; 92.9% who used contraception prior to EC exposure resumed use of contraception afterwards, compared with 40.7% who did not use contraception prior to EC exposure. Only 6.3% of women switched to a less effective contraceptive method after EC use. Few women (7.5%) reported post-EC gaps in contraception. Conclusions: The results of this study suggest that EC may serve as a potential precursor to regular contraception among undergraduates in Brazil, with few women reporting contraceptive gaps after EC use. These patterns may contribute to reducing the risk of unintended pregnancy in this population.

Possibilities of Planned Small Families in Communities with Lack of Awareness and Scarce Resources

Each day, more than 800 women die due to pregnancy, birth related causes. Most deaths are preventable through birth control, prevention of unwanted pregnancies and increased interval between pregnancies. Objectives: To get information related to possibilities of small families in communities with extreme poverty with mission of future research and advocacy for small families. Methodology: Information was collected by simple review of relevant literature, studies, reviews, commentaries. Personal observations were added. Evidence: It is not very well known whether people with extreme poverty really want to have large families while living with resource crunch, which makes their survival difficult. Rich-poor gap in contraceptive use is large, because of gap in use of modern spacing methods which is much higher in rich compared to poor. Women from poor families tend to have more children, as they give birth at young age, continue childbearing beyond 40 and are less likely to use contraceptive with more unmet need. High fertility has significant implications on welfare of family. Burden of large family perpetuates vicious cycle of poverty, less contraception, more children and more poverty. Reasons given by respondents for non-use of contraception suggest that accessibility of family planning services is not always a barrier even among poorest and there are other factors which result in relatively low use. Women who receive comprehensive factual family planning education are more likely to use contraceptives. Contraceptives with greater side effects or negative cultural perceptions are less likely to be used. Unmet need of contraception due to lack of resolve to practice contraception is not known. Possibilities: It is essential to know whether couples/women with extreme poverty ever think about planned small family. If no, why, if yes, why action is not taken. Providing culturally sensitive, family centered, accessible sustainable system is essential. There is need of women centered environment that respects their beliefs and helps them have small, planned families

Making the Most of the Affordable Care Act's Contraceptive Coverage Mandate for Privately-Insured Women

Under the Patient Protection and Affordable Care Act of 2010 (ACA), most women of reproductive age with private health insurance have, or will soon have, first-dollar coverage of contraception and contraceptive counseling. The need for contraceptive coverage is great, because most American families want two children, resulting in the average woman spending three decades of her reproductive life trying to avoid pregnancy (Guttmacher Institute, 2012; Finer & Philbin, 2014). Contraceptive coverage without cost sharing is a sea change in women’s health insurance. This policy change has the potential to dramatically shift contraceptive use patterns, to reduce the U.S. unintended pregnancy ratedwhich stands at approximately half of all pregnancies (Finer & Zolna, 2014)dand to improve the health of women and families. In this commentary, we argue that realizing the potential of this policy change requires more action on the part of public health practitioners, insurers, health care providers, and researchers than is currently evident, andwe offer some suggestions for making the most of first-dollar contraceptive coverage.

Differential effect of wealth quintile on modern contraceptive use and fertility: evidence from Malawian women

BackgroundHigh fertility and wide inequality in wealth distribution are phenomenal problems in sub-Saharan Africa. Modern Contraceptives (MC) are useful for limiting fertility, but are not always easily accessible in Malawi. This study examines the gap in MC use and fertility between women in the richest and poorest Wealth Quintile (WQ).MethodsThe study was cross-sectional in design and utilized Malawi DHS dataset, 2010. It focused on women of reproductive age. The dependent variables are ever and current use of MC. Chi-square and multinomial logistic regression were used for the analysis.ResultsMean children ever born by women in the poorest and richest WQs were 3.94 ± 2.7 and 2.82 ± 2.3 respectively (p < 0.001). The adjusted total fertility rate (Adj.TFR) was higher among women in the poorest (Adj.TFR = 7.60) WQ than the richest (Adj.TFR = 4.45). The prevalence of ever use of MC was higher among women in the richest WQ (82.4%) than the poorest (66.8%) (p < 0.001). Similar pattern exists for current use of MC; 58.5% and 45.9% for women in the richest and poorest WQs respectively (p < 0.001). Women in the richest WQ were more likely to ever use (OR = 2.36; C.I = 2.07-2.69, p < 0.001) and currently using (OR = 1.66; C.I = 1.40-1.97, p < 0.001) MC than their counterparts in the poorest WQ. Slight reduction in odd-ratio of MC use among women in richest WQ resulted when socio-demographic variables were used as control.ConclusionFertility was higher and the use of MC was lower among women in the poorest than their counterparts in the richest WQ. Ensuring availability of MC at little or no cost may bridge the gap in contraceptive use between women in the poorest and richest WQ in Malawi.

Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?

Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?

Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?

IntroductionKenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor.MethodsWe use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya.ResultsThere was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993–1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09.ConclusionThe narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.

Contraceptive Insurance Mandates and Consistent Contraceptive Use Among Privately Insured Women

Half of the states in the United States mandate that health insurers cover contraceptives. Health care reform includes recommendations to extend these mandates nationally through the essential benefits package. This study evaluates the association of state-level insurance mandates and consistent contraceptive use among privately insured women aged 15-44. The National Survey of Family Growth (2006-2008) included 2276 privately insured women at risk for unintended pregnancy. Multilevel logistic regression models provided estimates of the association between state-level insurance coverage mandates and consistent contraceptive use. Among privately insured women, 18% reported a ≥1-month gap in contraceptive use. Compared with women living in states with no mandates, those in states with comprehensive mandates had increased odds of consistent contraceptive use among privately insured women [adjusted odds ratio (aOR), 1.64; 95% confidence interval (CI), 1.08-2.50], but not uninsured women (aOR, 0.77; 95% CI, 0.38-1.55). Partial mandates were not associated with consistent contraceptive use. Consistent contraceptive use among women with private insurance is higher in the states with mandates compared with those without mandates.

Adolescent Mothers' Postpartum Contraceptive Use: A Qualitative Study

Effective contraceptive use among first-time adolescent mothers can reduce the risk of a rapid repeat pregnancy and associated negative maternal and child health outcomes. Many adolescent mothers begin using a highly effective method after delivery; however, their rates of contraceptive discontinuation are high. Little research has explored the factors that influence adolescents' postpartum contraceptive use. In-depth interviews were conducted with 21 black, white and Latina adolescent first-time mothers from rural and urban areas of North Carolina between November 2007 and February 2009. In addition, interviews were conducted with 18 key informants-professionals who work closely with adolescent mothers. Interviews explored adolescent mothers' health behaviors, including contraceptive use, before and after pregnancy. Content analysis was used to identify key themes and patterns. Teenagers' use of contraceptives, particularly injectables, IUDs and implants, increased postpartum. Reasons for this improvement included improved clarity of intention to avoid pregnancy and improved contraceptive knowledge, support and access after delivery. However, this increased access often did not continue long after delivery, and levels of method switching were high. Among the barriers to postpartum contraceptive use that key informants cited were lack of information and parental support, as well as the loss of Medicaid and continuity of care. Ongoing follow-up may help reduce adolescent mothers' risk of contraceptive discontinuation postpartum. Increasing use of long-acting methods also may help reduce their vulnerability to gaps in contraceptive use and discontinuation, which increase the risk of unintended pregnancy.

Early age at first intercourse and subsequent gaps in contraceptive use.

Sexual debut before age 15 years has been associated with increased sexual risk behaviors among teens, but little is known about its effects beyond adolescence. This study examines the relationship between the age at first intercourse and subsequent contraceptive gaps. We identified 3538 sexually active, fertile women participants from the 2006-2008 National Survey of Family Growth. Women were classified as consistent contraceptive users or inconsistent/nonusers. Age at first intercourse with a man was determined by self-report and categorized as <15, 15-17, and ≥18 years. Twenty-three percent reported gaps in contraceptive use in the year prior to interview. Compared with women who were 18 or older at first intercourse, women who were <15 years of age at the time of first intercourse were nearly two times as likely to report a gap in contraceptive use (adjusted odds ratio: 1.93; 95% confidence interval: 1.23-3.00). Age at first intercourse is associated with inconsistent or nonuse of contraceptives in later life. Primary prevention efforts should be established to empower girls to make informed and autonomous decisions about sexual debut. Personalized contraceptive counseling has been demonstrated as being effective in increasing contraceptive use and compliance and should be offered to all women, with particular focus on women who report an early age at first intercourse or other factors associated with inconsistent contraceptive use.

Intra-urban differentials in the utilization of reproductive healthcare in India, 1992-2006.

This paper examines trends in three reproductive healthcare indicators- namely, antenatal care, medical assistance at delivery, and contraceptive use among the urban poor and non-poor in India using data from the National Family Health Surveys, 1992-1993 and 2005-2006. The urban poor and non-poor are derived from composite wealth indices based on a set of economic proxies. Results indicate that the estimates of poor and non-poor are reliable. During the last 14 years, the service coverage in all three indicators has increased in the country, among both the urban poor and non-poor. However, the utilization of reproductive health services is concentrated among the urban non-poor cutting across the states, with the exception of Kerala. While the non-poor/poor gap in antenatal care and medical assistance at delivery remained large over the years, the gap in contraceptive use has narrowed down cutting across states. After adjusting for other confounders, household poverty was found to be a significant barrier in the utilization of reproductive healthcare services across the states. It has been observed that the utilization of reproductive healthcare services followed a continuum of rural total, urban poor, and urban non-poor.

EXAMINING THE GEOGRAPHICAL HETEROGENEITY ASSOCIATED WITH RISK OF MISTIMED AND UNWANTED PREGNANCY IN GHANA

After a decade of fertility decline, Ghana's fertility and the level of unmet need for contraception stalled in mid-transition in the late 1990s. Although the literature acknowledges this, the geographical patterns in unmet need have not been adequately documented. Spatial analysis of unmet need can reveal differences in usage and provision of contraceptive commodities, thereby pointing to geographical areas where contraceptive programmes should be strengthened. This study examines the geographical variation of the risk of mistimed and unwanted pregnancies between rural communities and also between urban communities of the three ecological zones of Ghana. The study also investigates if geographical differences in the risks of mistimed and unwanted pregnancies changed during the period when unmet need stalled at the national level. A multilevel regression model was applied to pooled data from the 1998 and 2003 Ghana Demographic and Health Surveys to examine the determinants of the risk of unintended pregnancies, while controlling for clustering of outcomes within communities. The results show that between the two surveys, there was no significant change in the levels of risk of mistimed and unwanted pregnancy. However, geographical heterogeneity in the risk of mistimed and unwanted pregnancy was observed, after controlling for relevant predictors. This showed concentration of mistimed pregnancies in some rural communities relative to others, and variation in the risk of unwanted pregnancies between urban communities. The results give a clear indication that bridging the inequality gap in contraceptive use requires programmes that are area-specific.

Unmet need for contraception among sex workers in Madagascar

Background The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers. Study Design We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months. Results Women ( N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having “unmet need” for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4–3.0] and low self-efficacy to negotiate condom use (age- and site-adjusted PR: 2.0; 95% CI: 1.4–3.0). Conclusions Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers.

U.S. Women’s One‐Year Contraceptive Use Patterns, 2004

Unintended pregnancies occur far too often in the United States, and half occur when couples fail to practice contraception. Improved measures of the continuity of women's contraceptive use, nonuse and switching patterns can help identify ways to reduce unintended pregnancy. A nationally representative sample of 1,978 adult women at risk of unintended pregnancy was surveyed by telephone in 2004. Respondents provided detailed information about contraceptive use and periods of stopping or switching methods during the past year. A typology of patterns of contraceptive use was created, classifying women into mutually exclusive categories according to their exposure to pregnancy risk. Twenty-three percent of women at risk of unintended pregnancy were exposed to a high risk of pregnancy because of gaps in contraceptive method use in the year prior to the survey--8% were consistent nonusers, and 15% experienced 1-11 months of nonuse while at risk. More than half of women used a method during each of the previous 12 months-38% used the same method or methods all year, and 24% switched methods. Fifteen percent of women had gaps in contraceptive use when they were not at risk. Women reported a variety of reasons for their gaps in contraceptive use, including method-related difficulties and side effects, infrequent sex and being ambivalent about avoiding pregnancy. Strategies for reducing gaps in contraceptive use include improved counseling to help women both choose the right method and continue method use, especially when they have periods of infrequent sexual activity or are experiencing method-related side effects or problems.