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Patterns of Contraceptive Use
Pages 91-125

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From page 91...
... Accordingly, this chapter explores patterns of contraceptive use as they bear on unintended pregnancy. Trends in the use of different contraceptive methods are discussed, including both sterilization and reversible contraception.
From page 92...
... In absolute numbers, this means that, in 1988, approximately 21 million women who reported using reversible methods of contraception experienced 1.5 million unintended pregnancies. And approximately 4 million women who reported that they were not actively seeking pregnancy and not using contraception at the time that they became pregnant experienced an additional 1.7 million unintended pregnancies (Mosher, 19901.
From page 94...
... Thus, unintended pregnancy derives almost entirely from two groups. It occurs among women using reversible contraception (Group B)
From page 95...
... (Group C) Total Total 84.7 15.3 100.0 Age 15-19 78.5 21.5 100.0 20-24 87.0 13.0 100.0 25-29 86.8 13.2 100.0 30-34 87.2 12.8 100.0 35-39 84.3 15.7 100.0 40-44 76.2 23.8 100.0 Marital Status Never married 80.2 19.8 100.0 Married 89.4 10.6 100.0 Formerly married 84.5 15.5 100.0 Poverty level < 100% 71.1 28.9 100.0 100-199% 82.1 17.9 100.0 > 200% 88.2 11.8 100.0 95 aThe denominator for these percentages is women who reported that they did not intend to become pregnant minus women who reported that they used contraceptive sterilization (i.e., all of the women in Groups B and C, but not those in Group A)
From page 96...
... For example, encouraging women who are currently using contraception (Group B) to be even more careful with their methods of contraception or to use more effective methods (e.g., to switch from foam to oral contraceptives)
From page 97...
... SOURCE: National Center for Health Statistics. Unpublished tables from the 1988 National Survey of Family Growth.
From page 98...
... The 1990 NSFG telephone reinterview survey and We 1992 and 1994 Ortho Birth Control Studies indicate that heavy reliance on sterilization has continued into the early l990s, and female sterilization has continued as Me predominate form (Forrest and Fordyce, 1993; Oreo Pharmaceutical Company, 1994; Peterson, 19951.4 Several factors probably account for the growing preference for female rawer than male sterilization, despite Me fact Mat the male sterilization procedure is safer and less expensive. The growing availability of quick and safe procedures such as laparoscopy during the 1970s and 1980s made it easier for women to choose sterilization, and Me legacy of medical reticence, exemplified 4Because data from the 1988 and 1990 NSFG predate the introduction of both injectable and implantable hormonal contraceptives, they are supplemented in this chapter by data from the 1992 and 1994 Ortho Birth Control Studies.
From page 99...
... are to discuss male sterilization with men. Reversible Contraception Women currently using reversible contraception" approximately 21 million in 1988-contribute slightly less than half of all unintended pregnancies (Group B)
From page 100...
... There is also no doubt that using many of the reversible contraceptive methods correctly and consistently can be very challenging. For example, Oakley (1994)
From page 101...
... The investigators suggest that rates of contraceptive failure may have increased during the 1980s, especially for some methods. Failure rates for oral contraceptives, for example, increased from 6 to 8 percent between 1982 and 1988 a trend that is particularly worrisome given the fact that under conditions of perfect use, oral contraceptives yield only about one pregnancy in 1,000 women in the first year of use.
From page 102...
... These data underscore the fact that an appreciable part of both a woman's and a man's reproductive life span is spent at risk of unintended pregnancy, using a variety of reversible contraceptive methods that are rarely, if ever, 100 percent effective. In fact, Forrest (1993)
From page 103...
... Data from the 1990 NSFG suggest a change in the rank order: female sterilization was the most frequently used method; this was followed by oral contraceptives. Data from the 1988 and 1990 NSFG do not reflect the current increase in the use of hormonal implants and injections; however, data from the 1994 Ortho Birth Control Study indicate the growing popularity of these methods (Peterson, 1995; Ortho Pharmaceutical Company, 19941.
From page 105...
... 105 Do~ Do o ~ ~ Cal o ~ o ~ _.
From page 107...
... 107 _ ~t_ o oo _ CJ ~} ~ _ o~ o t_ ~ ~_ ~t4O - , ~_ C-' ~, .
From page 108...
... Women 40 arid Over With regard to women at the other end of the reproductive life span, 92 percent of sexually active women aged 40-44 reported using some method of contraception in 1988, with a heavy reliance on contraceptive sterilization (primarily female sterilization) (Forrest, 1994a)
From page 109...
... Norplant, a contraceptive implant that releases the synthetic progestin levonorgestrel through capsules that are placed in the upper arm, provides highly effective contraceptive protection for up to 5 years; it was approved for use in the United States in 1990. Four percent of reproductive-age women who report using reversible contraception currently use this method (Or~o Pharmaceutical Company, 1994)
From page 110...
... Oral contraceptive use among women aged 35-39 who reported using reversible contraceptives also rose in 1990, from 14.7 to 29.4 percent. Oral contraceptive use was higher among low-income women than more affluent women early in the 1980s, but by 1990, economic status did not appear to affect the likelihood of oral contraceptive use among women using reversible contraception.
From page 111...
... Risks and Benefits of Reversible Contraceptive Methods Reversible methods vary in their abilities to prevent Intended pregnancy, as noted in Table 4-4, and each is also associated with different risks and side effects. In addition, each has significant noncontraceptive benefits that are discussed much less frequently in the popular literature.
From page 112...
... 112 Cal as > ._ C)
From page 113...
... 113 v' BIG D 0, 3, , 5 ~ ~ O ~ ~ ~G .= C ~ ,,, t>.o ~ ~ _ ~ ~ C I,., .= ~ a 7.~ ~ ~ ~˘ joys it, 1 ~ ~U.
From page 114...
... 114 ._ o m EM a hi: ._ C ~ Cal ~ - 0 He: C'0- O _ lo_ a ~ m i_ ;` Ct ._ .
From page 115...
... It is useful to note that withdrawal, although not very effective, is still much more effective than failing to withdraw altogether, because the 1-year pregnancy rate of withdrawal is 19 percent and the 1-year pregnancy rate of no contraception at all is 85 percent (Hatcher et al., 19941. Use of Male Methods by Married Men Although the role of men in providing contraceptive protection at first intercourse is somewhat well known, less attention has been paid to the use of male contraceptive methods by married men.
From page 116...
... One study reports that 16year-old men who are sexually active use condoms more than 19-year-olds (Sonenstein et al., 1989~. Figure 4-3 provides an example of this by showing the contraceptive method used at last intercourse for sexually active adolescent men in 1988 and for the same young men nearly 3 years later, in 1991.
From page 117...
... However, the direction of the association was unanticipated by the researchers. Adolescent men with lower socioeconomic status were expected to report lower rates of effective contraceptive use, yet it was found that, net of other variables, use of effective contraception was higher among sexually experienced men living in neighborhoods with high poverty rates and lower among more affluent men (Ku et al., 1993b; Sonenstein et al., 19921.
From page 118...
... Depending on the combination of methods selected, the use of two methods simultaneously can also reduce the risk of STDs. For example, the use of two female methods, such as oral contraceptives and foam, provides more complete - I- =~
From page 119...
... More recently, 25 percent of all women in the 1992 Ortho Birth Control Study reported using condoms concurrently with another method, and more than half of the women using less effective methods such as periodic abstinence reported using condoms as well (Forrest and Fordyce, 19931. Dual usage appears to have increased between 1992 and 1994; 46 percent of the women surveyed in the 1994 Ortho Birth Control Study reported using condoms in addition to their primary contraceptive.
From page 120...
... Finally, because sexual activity often carries a risk of both unintended pregnancy and STD transmission, the choice of contraceptive methods has become more complicated. As suggested in the previous section on dual-method use, it is often necessary to use more than one method to prevent both STDs and unintended pregnancy.
From page 121...
... 121 oo m En ._ Cal ~ V)
From page 122...
... That is, about half of all unintended pregnancies derive from women who are not actively seeking pregnancy and who are using reversible contraception; the other half derive from women who are also not actively seeking pregnancy but who nonetheless are not using contraception. Many women and couples who are not intending to become pregnant move between these two groups, sometimes practicing contraception and sometimes not.
From page 123...
... American women's sexual behavior and exposure to risk of sexually transmitted diseases. Fam Plann Perspect.
From page 124...
... Unpublished data from the 1994 Ortho Birth Control Study; 1994. Peterson L
From page 125...
... Sexual and contraceptive experience of young unmarried women in the United States, 1976 and 1971. Fam Plann Perspect.


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