Use of Highly Effective Contraceptives in the U.S. Continues to Rise, with Likely Implications for Declines in Unintended Pregnancy and Abortion

The time is now. Will you stand up for reproductive health and rights?

First published online:

New U.S. government data show that while the overall level of contraceptive use among reproductive-aged women has held steady, the proportion of contraceptive users who rely on the most effective methods increased. In particular, the use of long-acting, reversible contraceptive (LARC) methods has jumped to almost 12%, the highest level ever recorded in the United States.

Guttmacher calculations based on new data released by the U.S. Centers for Disease Control and Prevention (CDC) show that during 2011–2013, 90% of U.S. women aged 15–44 who wanted to avoid pregnancy used contraceptives. That percentage is virtually unchanged from 2006–2010. However, the new data also document an ongoing shift in the contraceptive method mix toward more effective methods. Significantly, use of LARC methods, such as intrauterine devices (IUDs) and contraceptive implants, increased. The proportion of all contraceptive users who relied on LARC methods reached 12% in 2011–2013. By contrast, only 2.4% of contraceptive users relied on LARC methods in 2002, rising to 3.7% by 2007 and 8.5% by 2009. LARC methods now represent the third most commonly used category of reversible contraceptives, after the pill (26%) and condom (15%).

LARC methods have several important strengths: They are more than 99% effective at preventing pregnancy, can provide protection for up to 12 years, and do not require women to remember to use their method every day or every time they have sex. The shift to these methods—which virtually guarantee consistent and correct use—can play an important role in reducing unplanned pregnancy and abortion, given that the more than two-thirds of women (68%) who use contraceptives consistently and correctly over the course of a year account for only 5% of unintended pregnancies. It’s important to note that women weigh many factors when choosing a contraceptive method, and it is essential that this choice be made voluntarily and with the woman’s informed consent.

Guttmacher reported earlier this year that the U.S. abortion rate declined 13% between 2008 and 2011, prompting differing explanations of the likely reasons behind this trend. Antiabortion activists argued that state-level abortion restrictions were responsible and dismissed the idea of contraception playing a role. However, not only did the abortion decline mostly predate the wave of new abortion restrictions, but it was also accompanied by an even steeper drop in births, indicating that pregnancies were down overall and that births were not replacing abortions during that period. The new CDC data showing a sustained increase in use of highly effective contraceptive methods, combined with these declines in births and abortions, suggest that the unintended pregnancy rate may also be declining after an earlier period of stagnation and even increase.

Shifting contraceptive preferences underscore women’s and couples’ ongoing desire to use the contraceptive method that best meets their needs, which can change over time. The advent of the Affordable Care Act (ACA), which guarantees coverage of contraception for most women without out-of-pocket costs, may mean that even more women will be able to access these highly effective methods

Policymakers should respect Americans’ wishes by protecting recent gains in contraceptive access and not erecting new barriers that raise the cost of birth control or otherwise interfere with women’s ability to use the contraceptive method that is right for them. Policymakers should prioritize:

  • Protecting the Affordable Care Act’s (ACA) contraceptive coverage guarantee: Guttmacher research shows sharp increases in the proportion of privately insured U.S. women who paid nothing out of pocket for contraception, including LARC methods, after the guarantee went into effect. Removing cost as a barrier helps women pick and use the method they feel is right for them.
  • Adequately funding publicly supported family planning services: Publicly supported contraceptive care (under programs like Title X and Medicaid) enables disadvantaged women to avoid 2.2 million unintended pregnancies each year; absent these services, U.S. rates of unintended pregnancy, unplanned birth and abortion would be two-thirds higher than they are. These services also save taxpayers $7.09 for every $1 invested.
  • Implementing the ACA’s Medicaid expansion in all states: Medicaid offers a robust package of contraceptive services to enrollees and is key to making high-quality contraceptive care available to women at high risk of unintended pregnancy.

For more information:

Analysis: U.S. Abortion Rate Continues to Decline While Debate over Means to the End Escalates
Analysis: Guarding Against Coercion While Ensuring Access: A Delicate Balance
Research: Privately Insured U.S. Women Increasingly Able to Obtain Prescription Contraceptive Methods With No Out-Of-Pocket Costs
Research: Return on investment: A fuller assessment of the benefits and cost savings of the US publicly funded family planning program