A substantial proportion of the 11% decline in abortion rates between 1994 and 2000 resulted from women's use of emergency contraception (EC), according to a new analysis of contraceptive use among more than 10,000 U.S. women having abortions in 2000-2001. Forty-six percent of women surveyed were not using a contraceptive method in the month in which they became pregnant, whereas 54% were using a method. The analysis, conducted by The Alan Guttmacher Institute (AGI), estimates that 51,000 abortions were prevented by EC use in 2000--47,000 more than in 1994, when only 4,000 abortions were averted through EC. Overall, 110,000 fewer abortions occurred in 2000 than in 1994; increased use of EC may account for up to 43% of the total decline.
The study found that 46% of women having abortions were not using a contraceptive method in the month they became pregnant, including 8% who had never practiced contraception. Among the many reasons that women gave for not using contraceptives, the most common were that they did not think they would become pregnant (33%), they had concerns about methods (32%), including side effects and problems with methods in the past, and they did not expect to have sex (26%). Other reasons why women were not using contraceptives included the following:
• they had not thought about contraception or had not yet begun using a method (22%);
• they had problems accessing contraception (12%);
• they were ambivalent about pregnancy (5%);
• they did not want their parents to know they were sexually active (2%); and
• they were forced to have sex (1%).
More than half of women (54%) were using a contraceptive method in the month they became pregnant, mainly relying on condoms (28% of all women having abortions) and oral contraceptive pills (14%). These women commonly reported that they had become pregnant despite using a contraceptive because they had used the method inconsistently (76% of pill users, 49% of condom users). Furthermore, 42% of condom users indicated that the condom had broken or slipped out of place.
These findings do not indicate that contraception is effective only half the time. Women aged 15-44 who use the pill correctly have only a 0.1%-0.5% chance of becoming pregnant in one year. Couples who use condoms consistently and correctly have only a 3% chance of becoming pregnant in one year. Previous research indicates that 7% of all women aged 15-44 do not use contraceptives; these women account for about half of all abortions.
"Our findings indicate that women and their partners continue to need better information and resources to help them use contraceptive methods consistently and correctly," said Dr. Jacqueline E. Darroch, AGI Senior Vice President and Vice President for Science and an author of the study published in the November/December issue of Perspectives on Sexual and Reproductive Health. "EC is a particularly promising solution, especially for those women who have had sex without a contraceptive because they did not expect to have sex, or for those who realize that they used their method incorrectly."
In a related article in The Guttmacher Report on Public Policy, AGI senior policy analyst Heather Boonstra discusses some of the logistic and political barriers to women's effective use of EC to reduce the occurrence of unintended pregnancy and abortion. Advocates are focusing on several ways to make EC more accessible, such as encouraging hospitals to offer EC to women who have been sexually assaulted, motivating physicians to offer advance prescriptions and telephone prescriptions to their patients, making EC available directly from pharmacists and making EC available over the counter.
"Contraceptive Use Among U.S. Women Having Abortions in 2000-2001" by Rachel K. Jones, Jacqueline E. Darroch and Stanley K. Henshaw of AGI, published in the November/December 2002 issue of Perspectives on Sexual and Reproductive Health, is an analysis of AGI's third national survey of over 10,000 women obtaining abortions. The survey is part of a larger research effort aimed at understanding contraceptive failure rates among women experiencing an abortion or unplanned birth, and at providing accurate estimates of contraceptive effectiveness and use by various subgroups, supported by the National Institutes of Health.
"Emergency Contraception: Steps Being Taken to Improve Access," by Heather Boonstra, is published in the December issue of The Guttmacher Report on Public Policy.
Information on numbers of abortions, abortion providers and barriers to abortion in the United States will be available in the January/February 2003 issue of Perspectives on Sexual and Reproductive Health.
Also in the November/December 2002 issue of Perspectives on Sexual and Reproductive Health:
• "Chronically Homeless Women's Perceived Deterrents to Contraception," by Lillian Gelberg et al;
• "Marriage Among Unwed Mothers: Whites, Blacks and Hispanics Compared," by Deborah Roempke Graefe and Daniel T. Lichter;
• Research Note: "Sexual Intercourse and the Age Difference Between Adolescent Females and Their Romantic Partners," by Christine E. Kaestle et al; and
• Special Report: "Current Contraceptive Research," by Jill L. Schwartz and Henry L. Gabelnick.