Since 1955, when social scientists first began tracking contraceptive use patterns among US women, there have been notable shifts in the motivation to avert pregnancy and fertility control method preferences. Central has been a pattern of adoption, diffusion, reassessment, and often rejection of new technologies, followed by refined clinical research on risks/benefits and--in most cases--method re-adoption. In 1955, the 70% of married White women 18-39 years of age who had ever used contraception relied on coitus-related methods such as the condom and diaphragm or periodic abstinence. By 1965, five years after introduction of the oral contraceptive (OC), 84% of these women were ever-users and 24% were current pill users. Notable in this population by 1988 was a dramatic increase in sterilization (from 12% in 1965 to 48%) and a decline (from 42% to 17%) in coitus-related methods, while OC use--following an increase-decline-increase pattern related to health concerns--had returned to its 1965 level. At present, method use patterns are strongly related to future childbearing intentions; over half of women seeking to delay childbearing select the pill, while 61% of those who intend no more children rely on sterilization. There is a new awareness that fertility control needs change throughout the span of reproductive life. To avoid the rapid fluctuations of past decades, however, more attention is being given to identifying potential users for whom a method is not suitable. Long-acting reversible methods such as Norplant have the potential to reduce unintended pregnancy and abortion, but concerns about high up-front costs and assured access to removal remain. In the years ahead, the ability of a method to combine pregnancy and sexually transmitted disease protection will continue to be an important selection criterion. Future trends will depend as much on education, personal attitudes, service delivery patterns, and refined understanding of the dynamics of sexual relationships as on technological advances.