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Contraception in the 90′s: Which Methods Are Most Widely Used? And, Who Uses What? – Fact Sheet

Contraception In The ’90s

Contraceptive Use

Women of Reproductive Age (15-44)

  • There are 60 million U.S. women of reproductive age.
  • 7 in 10, or 42 million of these women, are currently at risk of unintended pregnancy: they are sexually active and do not want to become pregnant but could if they used no contraceptive method.
  • 30 million of these women are married (49%), 23 million have never been married (38%) and 8 million (13%) are formerly married (widowed, divorced or separated).
  • Three-quarters of these women have had intercourse by the time they are 20 years old.
  • The percent of teenagers who have had sexual intercourse has declined for the first time in 2 decades, from 55% of teenage girls 15-19 in 1990 to 50% in 1995.

Contraceptive Use

  • 9 in 10 women at risk of unintended pregnancy use a contraceptive method; 1 in 10 use no method.
  • Among women using contraception, 24 million women (61%) use reversible methods such as condoms or birth control pills. The remaining 15 million women users (39%) use either female or male sterilization for contraception.
  • 47% of unplanned pregnancies (1.7 million) occur to women who were using contraception, mainly because of inconsistent and incorrect use.
  • Women who were not using contraception account for over half of all unplanned pregnancies (1.9 million).
  • The health dangers associated with an unplanned pregnancy far exceed safety considerations attendant to using birth control. Although pregnancy and childbirth are largely safe, they account for 1%-2% of all deaths each year among women aged 15-44.

Contraceptive Methods Used

Method No. of Users
(in thousands) Percent of
Users
Tubal ligation 10,727 27.7 Pill 10,410 26.9 Male condom 7,889 20.4 Vasectomy 4,215 10.9 Withdrawal 1,178 3.0 Depo-Provera 1,146 3.0 Periodic abstinence 883 2.3 Diaphragm 720 1.9 Other methods 670 1.8 Norplant 515 1.3 IUD 310 0.8 Total Users 38,663 100.0
Source: “Fertility, Family Planning, and Women’s Health: New Data from the 1995 National Survey of Family Growth,” Vital and Health Statistics, Series 23, No. 19, May 1997, CDC, NCHS

Trends In Contraceptive Use 1988-1995

  • The proportion of women who used a contraceptive method at first intercourse increased from 50% (for women whose first intercourse was before 1980) to 76% (for women whose first intercourse was in the 1990s).
  • Overall condom use increased, from 15% to 20% of women using contraception, including never-married women (from 20% to 30%) and teenagers (from 33% to 37%).
  • Pill use declined slightly from 31% to 27% of all women of reproductive age using contraception.
  • 28% of contraceptive users relied on female sterilization in both 1988 and 1995.
  • Diaphragm use declined from 6% to 2%.
  • The proportion of IUD users declined overall, from 2% to less than 1%.

Sterilization

  • 50% of all women using contraception aged 40-44 have had a tubal ligation and another 20% have partners who have had a vasectomy.
  • Female sterilization is more commonly relied on by women who are over the age of 35, previously married, black or Hispanic, or who have the least education and lowest income.
  • Women most likely to rely on their sexual partner’s vasectomy for contraception are currently married women and white women.

Birth Control Pills

  • The Pill is the leading method among women in their 20s.
  • 3 in 10 Pill users report missing at least 1 pill a cycle.
  • Two in five (44%) teenage women using contraception take the Pill – more than 1 million women.
  • Teens under 18 report missing pills more often than adult women; 4 in 10 teens using the Pill report missing at least 1 pill a cycle.

Condoms & Other Barrier Methods

  • More than one-third (37%) of teens using contraception choose condoms as their primary method. The percentage of condom users declines as women age and marry.
  • Of the 9.8 million women using barrier methods such as the male condom, female condom, or diaphragm, one-third report not using them at every act of intercourse.
  • Less than 1% of contraceptive users say their primary method is the female condom.

Injectables & Implants

  • 1995 is the first time the NSFG has collected information on use of Norplant, Depo-Provera, and the female condom.
  • Among contraceptive users, women under 24 are the most likely to use the newer methods. 15% of teenagers aged 15-17 use Depo-Provera and 4% use Norplant; 4% of women aged 20-24 use Norplant.

Contraceptive Failure Rates*

Method Perfect Use Average Use No method (chance) 85.0 85.0 Spermicides 6.0 30.0 Withdrawal 4.0 24.0 Periodic abstinence 9.0 19.0 Cervical cap 9.0; 26.0** 18.0 Diaphragm 6.0 18.0 Condom 3.0 16.0 Pill 0.1 6.0 IUD 0.6 4.0 Tubal ligation 0.4 0.5 Depo-Provera 0.3 0.4 Vasectomy 0.1 0.2 Norplant 0.09 0.05
* Estimated percentage of women experiencing an unintended pregnancy in the first year of use.
** 9% for nulliparous women; 26% for multiparous.Source: Perfect use failure rates from Contraceptive Technology, 1994. Average use rates from Preventing Pregnancy, Protecting Health, 1991.

Attitudes About Contraceptives

  • Half of Americans rate condoms (56%) and male sterilization (48%) as “very safe” for the health of the user. Fewer consider other methods equally as safe: a third or fewer rate female sterilization (35%), the diaphragm (24%), the Pill (17%), or the IUD (4%) as “very safe.”
  • Many Americans are unfamiliar with the Pill’s health effects. Approximately 9 in 10 don’t know that it protects against endometrial and ovarian cancer.
  • Teenage girls who believe the Pill would affect physical appearance or health are less likely to use the Pill either consistently or at all.

Percentage of Insurance Plans Which Routinely Cover Reversible Contraceptive Methods, Sterilization, or Abortion

Method Indemnity
plans
PPOs POS
networks
HMOs Pill 33% 41% 60% 84% Depo-Provera 39% 35% 72% 74% Norplant insertion 28% 29% 54% 59% IUD insertion 26% 25% 46% 86% Diaphragm 21% 23% 46% 81% All 5 reversible methods 15% 18% 33% 39% Tubal ligation 86% 86% 90% 86% Abortion 66% 67% 83% 70%
* With more than 100 employees. Note: PPOs are preferred provider organizations, POS networks are point-of-service networks, and HMOs are health maintenance organizations.
Source: Uneven & Unequal: Insurance Coverage and Reproductive Health Services, 1995.


Sources of Data

The data in this fact sheet are from research conducted by The Alan Guttmacher Institute and the National Center for Health Statistics and by or for the Kaiser Family Foundation, and/or were published in Family Planning Perspectives. Data are from the latest year for which they are available and refer to women aged 15-44 unless otherwise specified; numbers may not add to totals because of rounding.

For More Information:

S. Harlap, K. Kost, and J. D. Forrest, Preventing Pregnancy, Protecting Health: A New Look at Birth Control Choices in the United States, New York: The Alan Guttmacher Institute, 1991.

R. A. Hatcher, et al., Contraceptive Technology, 16th Revised Edition, New York: Irvington Publishers, Inc.,1994.

Kaiser Survey on Public Perceptions about Contraception, Menlo Park, CA: Kaiser Family Foundation, 1996.

Kaiser Survey on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy. Menlo Park, CA: Kaiser Family Foundation, 1995.

P. J. Moore, N. E. Adler, and S. M. Kegeles, “Adolescents and the Contraceptive Pill: The Impact of Beliefs on Intentions and Use,” Obstetrics & Gynecology, 88 (3) Suppl, 1996.

Uneven & Unequal: Insurance Coverage and Reproductive Health Services, New York: The Alan Guttmacher Institute, 1995.

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Contraception in the ’90s:
Fact Sheet Survey Resource List