Using any form of contraception dramatically reduces a woman’s chance of having an unintended pregnancy, and the most effective methods virtually eliminate that risk. But finding the right method can be challenging for many women, and using contraceptives consistently and correctly over a lifetime is difficult. The typical American woman, who only wants two children, spends about three decades trying to avoid pregnancy and only a few years trying to become or being pregnant.
New research from the Guttmacher Institute finds that, each year, half of women seeking to avoid pregnancy remain at risk—some use no contraceptive at all (8%), some have periods of nonuse (15%) and some use their method inconsistently or incorrectly (27%). While some birth control methods are difficult to use consistently and correctly because they must be used at the time of intercourse (for example, condoms and the diaphragm), even remembering to take a birth control pill every day can be challenging: New data show that two-fifths of pill users had missed at least one pill during the previous three months.
"Helping women who do not want to become pregnant to use contraceptives more effectively is sound public policy that will reduce unintended pregnancy," says study author Jennifer Frost, senior research associate at the Guttmacher Institute. "In order to do that, it is critical to have a better understanding of what is preventing women from using contraception consistently and correctly–or even at all."
The new Guttmacher research, which surveyed women and family planning providers nationwide, uncovered a number of factors that impede women’s ability to use contraceptives consistently and correctly over the long term. These include
- Life changes: For more than half of women who have a gap in use of at least one month, the period of nonuse coincides with an important life event, such as the beginning or end of a relationship, a move to a new home, a job change or a personal crisis.
- Method problems: Nearly four in 10 contraceptive users are not very satisfied with their current method. Dissatisfied users are more likely to put themselves at high risk for unintended pregnancy, by missing birth control pills or not using a condom every time.
- Ambivalence: Nearly one in four women who are not trying to become pregnant say that they would be very pleased if they found out they were pregnant. Women who are the least motivated to avoid pregnancy are also the least likely to be using oral contraceptives or to be using the method consistently.
- Access: Many women report difficulty accessing contraceptive services or say they cannot afford the more effective, prescription methods of contraception.
- Disparities: Having a low level of education, belonging to a racial or ethnic minority or being on Medicaid are associated with contraceptive behavior that is likely to increase women’s risk for unintended pregnancy. However, more important than poverty status and race or ethnicity are women’s attitudes toward pregnancy, their satisfaction with their method and their experiences with contraceptive service providers.
Providers recognize many of the challenges women face in using contraceptives consistently and correctly; both public and private providers report that one of the most important things they could do to improve patients’ contraceptive use is to provide more and better counseling. Nearly half of private providers report that changing insurance reimbursement to allow more time for counseling would facilitate this goal.
The authors suggest that health care providers have a key role to play in offering better ongoing support to women to help improve their contraceptive use. This role includes addressing women’s shifting attitudes toward pregnancy and changing contraceptive needs over time; educating women about the risks and benefits of various methods and dispelling myths about side effects; and addressing logistical and cost barriers, particularly for poor and low-income women. Additionally, policymakers and private insurers can work to increase public funding and private insurance coverage for family planning services, particularly counseling services that can help identify the factors in women’s lives that put them at increased risk of unintended pregnancy.
"Finding the ‘right’ contraceptive method is not a one-time decision—rather it’s a series of choices as women’s life circumstances and contraceptive needs change," says Dr. Frost. "Helping women decide which contraceptive method to use can be a starting point for providers to offer ongoing counseling and support to their patients. The more we can remove the remaining barriers to consistent use, the better we will be at ensuring that all women can avoid unwanted pregnancies and plan the children they want, when they want them."
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