Contraceptive Need, Use and Preferences in the United States

Contraception, often more commonly known as birth control, is a key tool for people to exercise agency in their lives and achieve sexual and reproductive well-being. People use contraception for a range of reasons, including pregnancy prevention, management of health conditions, prevention of sexually transmitted infections or a combination of these.

This fact sheet highlights national-level evidence among US women^* aged 15‒49 regarding contraception, including contraceptive need, contraceptive use, and contraceptive preferences.^† In conjunction, these three metrics provide critical insight into whether people have bodily autonomy and are able to achieve sexual and reproductive well-being. In this fact sheet, contraceptive methods encompass condoms, oral contraceptive pills, injectable contraceptives (such as Depo-Provera), intrauterine devices (IUDs), vaginal rings, subdermal implants, transdermal patches, permanent methods (sterilization, tubal ligation, hysterectomy or vasectomy), and emergency contraceptive pills, as well as non-prescription coital methods such as withdrawal and fertility-awareness based methods.

Need for Contraception

Who has a potential need for contraception?

In 2022–2023, there were 74.9 million women aged 15–49 in the United States.

Nearly 52 million US women aged 15–49 were estimated to have a self-defined need for contraceptive services and supplies (for any reason, including but not limited to pregnancy prevention) in 2023.

More than 40% of these women (21.5 million) were likely in need of public support for contraceptive services, either because of their low family income or because they were younger than 20 and more likely to need confidential care independent of family resources. (In 2022‒2023, there were 16.6 million US women aged 20–49 living below 250% of the federal poverty level and 4.9 million women in the United States aged 15–19).

In 2022–2023, 36.3 million US women aged 15–49 were sexually active and not seeking to become pregnant, suggesting a group in potential need of contraception for pregnancy prevention (see table in “Use of Contraception” below).

The average number of children US adults think is ideal is 2.7. To achieve this family size, a sexually active woman must use contraceptives for roughly three decades.

Use of Contraception

How common is contraceptive use?

As of 2019, more than 99% of sexually experienced US women aged 15–44 reported having used at least one contraceptive method over their lifetime.
Almost all women who identify as religious have used contraceptive methods at some point in their life. This includes 99% of mainline Protestants, evangelical Protestants, and Catholics, and 98% of people with other religious affiliations. (Among respondents with no religious affiliation, 99% have used contraception.)
In 2022‒2023, 57% of US women aged 15–49, or 42.8 million, were using a contraceptive method.
Among sexually active women aged 15–49 who were not seeking pregnancy, 87% were using a contraceptive method in 2022–2023.

What methods are used?

Among female contraceptive users aged 15–49 in 2022–2023, the five most commonly used methods were: oral contraceptive pills (23%), male condoms (21%), female permanent methods (20%), withdrawal (19%), and IUDs (16%).
These five methods represent a diversity of contraceptive methods used by millions of women, from permanent methods (12.8 million), to long-acting (8.7 million), short-acting (11.9 million), and coital-dependent ones (16.3 million). The popularity of methods across these categories signals the importance of having a full range of contraceptive methods available; there is no one best contraceptive method for everyone.
In 2022‒2023, about one-quarter (22%) of female contraceptive users, or 9.4 million, reported using more than one method in the last month.
Condoms and withdrawal were two of the five most commonly used methods overall. Such coital-dependent methods are frequently employed in tandem with other methods.

Contraceptive methods used in the past month by US women, 2022–2023

METHOD		No. of women^*	% of women aged 15–49	% of sexually active women aged 15–49 not seeking pregnancy (N=36,302,341)	% of women aged 15–49 using contraception (N=42,807,566)
Any use		42,807,566	57.1	87.2	100
Any permanent method		12,830,950	17.1	27.4	30.0
	Female permanent method	8,608,998	11.5	17.9	20.1
	Male permanent method	4,476,659	6.0	10.2	10.5
LARC method		8,652,657	11.5	17.2	20.2
	IUD	6,756,855	9.0	13.5	15.8
	Implant	1,929,140	2.6	3.7	4.5
SARC method		11,855,745	15.8	20.6	27.7
	Pill	9,912,191	13.2	17.4	23.2
	Injectable, contraceptive patch, vaginal ring	2,147,544	2.9	3.6	5.0
Any coital dependent method		16,345,630	21.8	37.1	38.2
	Male condom	8,850,000	11.8	20.4	20.7
	Withdrawal	8,183,074	10.9	19.1	19.1
	Fertility awareness-based method	3,094,780	4.1	7.3	7.2
	Emergency contraceptive pill^†	562,938	0.8	1.3	1.3
	Other method	334,730	0.4	0.4	0.8
Multiple methods		9,404,833	12.6	21.7	22.0
No method		32,129,352	42.9	12.8	na
Total		74,936,918	100	100	100
In this fact sheet, we refer to the contraceptive users (potential and actual) for whom we have data as “women” to reflect the terminology used in our data sources. However, we recognize that data collection processes do not always accurately or comprehensively capture participants’ gender, and eligible contraceptive users may miss an opportunity to participate in surveys because of their gender expression. We encourage readers to consider that contraceptive users’ gender identities are diverse, despite the limitations of this language and survey process. †The prevalence of use of emergency contraception overall is likely higher given that other methods, such as the IUD, can be used as emergency contraception and is not included here. Notes:* Respondents reported using a method in the past month and can report up to four methods. “Sexually active women not seeking pregnancy” includes all women who report sexual activity in the previous three months; are not currently pregnant, seeking to become pregnant or postpartum; and are not noncontraceptively sterile. “Contraceptive users” refers to respondents who identified as women and is not restricted to those who have recently been sexually active. “LARC” refers to long-acting reversible contraception while “SARC” refers to short-acting reversible contraception. “Female permanent method” includes tubal ligation and hysterectomy for contraceptive reasons and “Male permanent method” refers to vasectomy. “Fertility awareness-based methods” include calendar-based, cervical mucus-based, temperature-based and sympto-thermal-based methods and cycle apps. “Other method” includes female condom, diaphragm, foam, sponge, jelly or cream, as well as other methods. “Multiple methods” refers to use of more than one method, either concurrently or sequentially, in the past month.

What are the most common methods and who uses them?

Oral contraceptives

Also known as “the Pill,” oral contraceptives are taken daily and contain hormones to prevent pregnancy. They are available in a range of formulations with different levels of hormones (either combined estrogen and progestin, or progestin-only), and most are available only by prescription.^‡

Overall, 23.2% of female contraceptive users in 2022‒2023 had used the oral contraceptive pill during the previous month.

Among those users, pill use was more common among those aged 15–29 (with 34‒56% opting for this method) compared to those aged 40–49 (with only 14% using the pill).

Contraceptive users with incomes 300% of the federal poverty level or higher had higher levels of pill use (28%) compared to those with incomes under 200% of the poverty level (15‒16%).

Contraceptive users who identify as non-Hispanic white had higher levels of pill use (27%) compared to those who identify as Hispanic (19%).

Contraceptive users who were neither married nor cohabiting had higher levels of pill use (34%) than those who were married (16%).

Contraceptive users who had never given birth more commonly used the pill (41%) compared to those who had given birth (12%).

There were minimal to no differences in levels of pill use across nativity, sexual orientation, education, insurance status or expectations of future births.

Condoms

Condoms are physical barriers used during sexual activity that can protect against both pregnancy and STIs. They are available in a variety of materials and sizes, and include both external condoms (used by people with penises) and internal condoms (used by people with vaginas), although the former is the older and more widely known version. Data regarding condom use below pertain only to external condoms and reflect female respondents’ reports of a partner’s condom use.

Overall, 21% of contraceptive users in 2022‒2023 had used a condom during the previous month; it was the most commonly reported coital-dependent method used.

Contraceptive users under age 40 had the highest levels of condom use (22% among 15–19-year-olds, 30% among 20–29-year-olds, and 22% among 30–39-year-olds) compared with those aged 40–49 (12%).

Contraceptive users had higher levels of condom use if they identified as non-Hispanic Black (24%) and non-Hispanic other or multiple races (33%) compared to those who identified as non-Hispanic white (18%).

Contraceptive users who were born outside of the United States had higher levels of condom use than those born in the United States (28% vs. 19%).

Contraceptive users with a college degree had higher levels of condom use (22%) compared to those with some college (16%) and similar levels of use compared to those with no college (20‒22%).

There were minimal to no differences in levels of condom use across income levels, relationship status, sexual orientation, insurance status, having given birth or expectations of future births.

Female permanent methods

Sometimes called female sterilization, these permanent methods include tubal ligation (sometimes referred to as having one’s “tubes tied”) and hysterectomy for contraceptive reasons, and do not involve hormones.

Twenty percent of contraceptive users aged 15–49 in 2022‒2023 reported use of a female permanent method during the previous month.

Female permanent methods were most common among contraceptive users aged 40‒49 (39%), while 19% of those aged 30‒39 relied on these methods. (Estimates for 15‒29-year-olds are likely lower, but they are unreliable due to fewer younger people using this method.)

Contraceptive users at lower income levels (under 300% of the federal poverty level) relied on female permanent methods more than those above that income level (22‒31% vs. 13%).

Use of female permanent methods was higher among those with a high school degree or less (29‒31%) and non-college graduates (23%), compared to their use among college graduates (14%).

Contraceptive users who were uninsured had higher levels of female permanent method use (31%) than those with private insurance coverage (15%).

About one in three contraceptive users who had given birth (31%) relied on female permanent contraception compared to only 3% of users with no previous births.

There were minimal to no differences in the use of female permanent methods across race/ethnicity, nativity, relationship status, sexual orientation or expectations of future births.

Withdrawal

A coital-dependent method used by sexual partners at the time of intercourse that involves pulling the penis out of the vagina prior to ejaculation, withdrawal is sometimes called the “pull-out method" or “pulling out.”

Nineteen percent of contraceptive users aged 15–49 in 2022‒2023 had included withdrawal as part of their contraceptive strategy during the previous month, meaning they may have used it by itself or in tandem with other methods.

Contraceptive users under age 40 had the highest levels of withdrawal use (28% of 20–29-year-olds used this method, as did 22% of 15–19-year-olds, and 19% of 30–39-year-olds) compared to 40–49-year-olds (11%).

Among contraceptive users, withdrawal was more common among non-Hispanic Black contraceptive users (22%) compared to non-Hispanic white users (18%).

Among contraceptive users aged 15–49, those who expected a future birth were more likely to use withdrawal (30%) than those who did not (14%).

There were minimal to no differences in the use of withdrawal across income level, nativity, relationship status, sexual orientation, education, insurance status or having given birth.

Intrauterine devices

Most commonly known as IUDs, intrauterine devices are available in either hormonal or non-hormonal formulations, with several different versions of the former. IUDs are inserted into the uterus by a clinician, require infrequent user engagement, and can be effective in preventing pregnancy for 3 to 12 years.

Sixteen percent of contraceptive users aged 15‒49 in 2022‒2023 reported using an IUD during the previous month.

Users identifying as non-Hispanic white reported the highest use of IUDs (18%) compared to those identifying as non-Hispanic Black (9%) or other or multiple races (13%).

Users who identified as belonging to a sexual minority group reported higher use of the IUD (22%) compared to those who did not (14%).

Contraceptive users with a college degree had higher levels of IUD use (20%) than those with some high school or college (11% and 14%, respectively).

There were minimal to no differences in levels of IUD use for users aged 20‒49^§ and across income level, nativity, relationship status, insurance status, having given birth or expectations of future births.

Multiple method use

Contraceptive use can entail the use of more than one method, either concurrently or sequentially. Using more than one method at a time can offer protection against both pregnancy and STIs when it involves a barrier method such as a condom, or it can offer additional security by increasing the level of actual or perceived pregnancy prevention.

One in five contraceptive users in 2022‒2023 had used more than one contraceptive method during the previous month.

Among contraceptive users, multiple method use was higher among those under 40 years old (27% among 15‒19-year-olds, 34% among 20‒29-year-olds, and 20% among 30‒39-year-olds) compared to those 40 or older (13%).

There were minimal to no differences in the use of multiple methods across income level, race/ethnicity, nativity, relationship status, sexual orientation, education, insurance status, parity or expectations of future births.

Characteristics of users of methods other than the top five most commonly used are available in Guttmacher’s latest publication on contraceptive methods.

Contraceptive Preferences

How common is it that people are not using their preferred method?

Thirteen percent of contraceptive users in 2022‒2023, excluding those using only female permanent methods, reported wanting to use a different method if cost were not an issue. Guttmacher’s research categorizes this as people having “unfulfilled contraceptive preferences due to cost.”

Thirty-one percent of those not using contraception in 2022‒2023 reported wanting to use a method if cost were not an issue (i.e., they had unfulfilled contraceptive preferences due to cost).

In another national survey conducted in 2022, 25% of current and prospective contraceptive users aged 15‒44 reported there was another method they would like to use.

Who reports not using their preferred methods?

Among contraceptive users in 2022‒2023, those identifying as sexual minorities reported higher levels of unfulfilled contraceptive preferences due to cost (20%) compared to those not identifying as sexual minorities (12%). No other characteristics among contraceptive users were associated with differences in unfulfilled contraceptive preferences.

Among individuals not using contraception in 2022‒2023, those younger than age 40 reported higher levels of unfulfilled contraceptive preferences due to cost (30‒43%) than those aged 40 or older (22%).

Also among individuals not using contraception in 2022‒2023, those who were married reported lower levels of unfulfilled contraceptive preferences due to cost (24%) compared to those who were neither married nor cohabiting (42%).

Why aren’t people using their preferred method of contraception?

In a 2022 national sample of 15‒44-year-olds assigned female at birth, those who reported not using their preferred method of contraception cited reasons that included: side effects (28.8%), sex-related reasons (25.1%), logistics/knowledge barriers (18.6%), safety concerns (18.3%) and cost (17.6%).

Among representative samples of 15‒44-year-olds from four states (Arizona, Iowa, New Jersey and Wisconsin) who were surveyed in 2018‒2020, the primary reasons for not using preferred methods among those reporting unfulfilled contraceptive preferences were: systems-level reasons, such as cost and access barriers (42%), and interpersonal/individual ones, such as side effects, infrequent sex or partner/family concerns (41%).

Methodology

The data in this fact sheet primarily come from analyses of the 2022‒2023 National Survey of Family Growth (NSFG) and apply to US women aged 15‒49, unless otherwise noted.^* Contraceptive use estimates reflect use of up to four methods during the month of the survey interview—an analytic shift from similar analyses of contraceptive use drawing on prior NSFG data that focused on the single most effective method used. In this fact sheet, we highlight characteristics of users of the five most commonly used contraceptive methods that are statistically significantly different across categories based on multivariable logistic regression models.

Estimates of unfulfilled contraceptive preferences represent whether an individual reported they would like to use a method, or a different method, if cost were not a concern. Preferences among contraceptive users exclude individuals who reported sole use of female permanent methods because NSFG survey skip pattern issues resulted in incomplete data on preferences among this group.

Data for contraceptive use and non-use, method-specific use, and contraceptive preferences are drawn from the female respondent file of the NSFG in recognition that the majority of contraceptive methods available are designed to be used by those with the capacity for pregnancy. Given changes in the 2022‒2023 NSFG data collection procedures and corresponding NSFG guidance cautioning against comparing findings from these data to findings from previous years, we do not directly compare 2022‒2023 estimates to estimates from previous rounds of the NSFG.

*In this fact sheet, we refer to the contraceptive users (potential and actual) for whom we have data as “women” to reflect the terminology used in our data sources. However, we recognize that data collection processes do not always accurately or comprehensively capture participants’ gender, and eligible contraceptive users may miss an opportunity to participate in surveys because of their gender expression. We encourage readers to consider that contraceptive users’ gender identities are diverse, despite the limitations of this language and survey process.

†Data on contraceptive need come from Frost JJ, Douglas-Hall A and Olson H, New Measure of Self-Defined Need for Contraceptive Services in the United States, 2023, New York: Guttmacher Institute, 2026, https://www.guttmacher.org/report/new-measure-self-defined-need-contraceptive-services-united-states-2023.

When not otherwise specified or linked, data highlighted in this fact sheet come from: Zolna M, Chiu DW and Kavanaugh ML, Contraceptive use and unfulfilled preferences among women ages 15–49 years in the United States, 2022–2023, F&S Reports, 2026, https://doi.org/10.1016/j.xfre.2026.05.002.

‡Estimates presented in this fact sheet reflect pill use when available pill options were primarily prescription only. OPill, a progestin-only oral contraceptive pill, became available over the counter in July 2023.

§Information on IUD use among 15‒19-year-olds does not meet the National Center for Health Statistics reliability standards and is not reported.

Acknowledgments

Megan L. Kavanaugh and Mia R. Zolna. It was edited by Ian Lague.

Contraceptive Need, Use and Preferences in the United States

Need for Contraception

Who has a potential need for contraception?

Use of Contraception

How common is contraceptive use?

What methods are used?

Contraceptive methods used in the past month by US women, 2022–2023

What are the most common methods and who uses them?

Oral contraceptives

Condoms

Female permanent methods

Withdrawal

Intrauterine devices

Multiple method use

Contraceptive Preferences

How common is it that people are not using their preferred method?

Who reports not using their preferred methods?

Why aren’t people using their preferred method of contraception?

Methodology

Footnotes

Acknowledgments

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