New Measure of Self-Defined Need for Contraceptive Services in the United States, 2023

Introduction

Information on the numbers and characteristics of individuals who desire contraceptive services over the course of a year, along with estimates of those who may need publicly supported care, is critical for the design and implementation of contraceptive services and policies. This information, by improving access to care, will ultimately help women meet their reproductive goals and maintain their sexual and reproductive health.

For decades, the Guttmacher Institute has made periodic estimates of contraceptive need in the United States using a conventional metric based on the proportion of women assumed to be at risk for unintended pregnancy because they are sexually experienced, able to get pregnant and report not wanting a pregnancy at the time of the survey.^1–3 Recently, researchers from Guttmacher and the University of California, Berkeley, in concert with a panel of experts facilitated by the Coalition to Expand Contraceptive Access (CECA), collaborated to develop an alternative, more person-centered contraceptive need metric. To be truly person-centered, a measure should assess an individual’s self-identified values, needs or preferences and also ensure that individuals themselves determine whether or not their desired outcome has been met.⁴

The new metric⁵ developed during this process moves toward person-centeredness but does not fully meet this definition. It is based on women’s own reports of, or behaviors indicating, their need for contraceptive services and more directly measures women’s interest in obtaining contraceptive services currently or at some point over an entire year. The conventional metric was primarily focused on estimating the need for contraceptive services to prevent unintended pregnancy. The new metric expands this focus to estimate the need for contraceptive services for any reason, not solely for pregnancy prevention.

This report uses the self-defined metric to make US contraceptive need estimates for 2023. The methodology for calculating these estimates is similar to the one developed and refined over decades to measure need using the conventional metric. This approach uses population data from the US Census and the American Community Survey to estimate numbers of women by age, income level, race and ethnicity, and marital status, nationally and by state. Then, proportions derived from the survey data are used to estimate how many women in each sociodemographic group may need contraceptive services over a one-year period. This report uses the new metric to generate the proportions of women in each group who indicate a self-defined need for contraceptive services.

Methodology

Data sources

We estimated the number of US women in 2023 with a self-defined need for contraceptive services and supplies and, among those, the number who likely needed public support for this care by age and by income level, using three data sources:

• US Census Bureau reports for the number of women in each US county in 2023, by age-group (15–17, 18–19, 20–29 and 30–49) and by race and ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and other or multiple races);⁶
• Analysis of the 2019–2023 American Community Survey (ACS) to obtain distributions of women according to marital status (married and living with husband or not married) and family income as a percentage of the federal poverty level (FPL; less than 100%, 100–137%, 138–199%, 200–249% and 250% or more) for each age-group by race and ethnicity;⁷ and
• Analysis of the 2022–2023 National Survey of Family Growth (NSFG),* a nationally representative cross-sectional survey of 5,586 women aged 15–49 conducted by the National Center for Health Statistics, to estimate the annual proportion of women who may seek contraceptive services (because they report current, recent or prospective contraceptive method or service use) for each demographic group (by age, race and ethnicity, marital status and income level as a percent of FPL).⁸

Summary of estimation process

Self-defined need. Estimates were produced by combining 2023 population data from the US Census Bureau with information on income level and marital status from the 2019–2023 ACS and characteristics of women from the 2022–2023 NSFG. We calculated the proportion of women in various population groups who met the specified criteria (detailed above in Key Definitions and further in the Methodology Appendix) indicating they had a self-defined need for contraceptive services and supplies during the year using the 2022–2023 NSFG. For each population group—defined by age, marital status, income level, and race and ethnicity in each county—we multiplied the national proportion of women with a self-defined need for contraceptive services in that population group by the number of women in that population group in each county. Estimates were made at the county level and then summed to obtain state and national estimates. See the Methodology Appendix for further details.

Need for publicly supported contraceptive services. Estimates for the numbers of women who had a likely need for publicly supported contraceptive care were then made by summing the relevant population groups—all women younger than 20 and adult women whose family income fell below 250% of FPL. The income level used in this definition was based on Title X eligibility guidelines, which classify patients whose income is at or below 250% of FPL as eligible for reduced-fee services. Patients whose income is below 100% of FPL (less than $24,860 for a family of three in 2023) are eligible for free services. Eligibility for adolescents is based on their own (not their parents’) resources, so most are eligible for free services at Title X clinics. Publicly supported services can be provided by clinics that receive Title X or other federal, state or local funding to provide care or by Medicaid insurance coverage. It is important to note that other public programs, such as Medicaid, use different income levels in their eligibility criteria that are set by state policy and are typically lower than 250% of FPL. To accommodate variation in how these estimates are used, detailed income-level groups are presented that allow users to estimate the likely need for public support for services according to income levels that may be different from the ones used here. See the Methodology Appendix for further details.

Age ranges included in different reports

This report is based on data for women aged 15–49, rather than 13–44 or 13–49 as in prior estimates. Under the conventional metric, estimates of contraceptive need for 13–14-year-olds were determined using survey data on the age of first sex (asked among respondents aged 15 and older). It is not possible to make estimates of self-defined contraceptive need for those younger than 15, since the NSFG includes only those aged 15 and older and does not ask about contraceptive use or receipt of contraceptive services for periods prior to the current year. This difference does not have a large impact on the results. In 2020, although there were 4.4 million women aged 13–14 in the United States, only 8.7% were estimated to be sexually experienced and therefore in need of contraceptive care (approximately 384,000 adolescents younger than 15).

Self-Defined Need for Contraceptive Services

In 2023, there were nearly 75.9 million women aged 15–49 in the United States (Table 1). More than two-thirds (68%) of women (51.9 million) were estimated to have a self-defined need for contraceptive services and supplies because they were current or recent contraceptive method users, reported recent receipt of contraceptive services or responded that they would like to use a contraceptive method if they “did not have to worry about cost and could use any method available.”

Need for publicly supported services

In 2023, 21.5 million US women were likely in need of public support for contraceptive services, 41% of those needing care overall (Table 1).

• Nearly 16.6 million women who likely needed public support for contraceptive services and supplies were adults, aged 20–49, living below 250% of the FPL; 5.9 million of these women had incomes below 100% of the FPL (Table 2).
• Young women aged 15–19 accounted for 23% (4.9 million) of those who likely needed public support for contraceptive services, because of their limited financial resources and the increased likelihood that they desired confidential care without having to depend on their families’ resources.
• Of all women who likely needed public support for contraceptive services and supplies, 10.1 million were non-Hispanic White, 4.0 million were non-Hispanic Black, 5.4 million were Hispanic, and 1.9 million were members of other or multiple racial and ethnic groups (Table 3).

State variation

The proportion of all women estimated to have a self-defined need for contraceptive care in 2023 varied little across states, from 65% (in New Mexico and Hawaii) to 72% (in New Hampshire), with 34 states centered on the average of 67–69% (Table 1).

The proportion of those with self-defined need who likely needed public support for care exhibited larger variation across states, varying from 29% (in the District of Columbia) to 57% (in Mississippi). In 10 states, 35% or fewer of such women likely needed public support, while in three states, 51% or more may have needed public support for contraceptive care.

Variation by sociodemographic characteristics

Although more than two-thirds (68%) of all women aged 15–49 were estimated to have a self-defined need for contraceptive services in 2023, the proportion varied according to key characteristics (Tables 4 and 5). Lower proportions of women aged 15–17 had a self-defined need for contraceptive services (38%) than older women. Women aged 20–29 had the highest proportion reporting self-defined contraceptive need (76%); this share dropped to 70% for women over 30 and to 57% for women aged 18–19.

Women with family incomes at or above 250% of the FPL had a higher proportion reporting self-defined contraceptive need (76%) than women with family incomes below that level (varying from 64% for those under 100% of FPL to 68% for those at 200–249% of FPL).

A higher proportion of non-Hispanic White women reported self-defined contraceptive need (72%) than both non-Hispanic Black and Hispanic women (64%).

Data are also available on the total numbers of women and the numbers of those with a self-defined need for contraceptive services by age, income level, and race and ethnicity for all US counties (Supplementary Tables 1 and 2; available as an additional download).

Conclusion

For 2023, we have produced updated national, state and county estimates of the need for contraceptive services using a new, more person-centered metric that focuses on women’s self-defined need for contraceptive care for any reason. Prior reports, going back decades, looked at contraceptive need among those aged 13–44 using a conventional metric that focused on contraceptive need to prevent unintended pregnancy based on women’s assumed risk for pregnancy. Some differences in the current results and past reports are due to the difference in age range (15–49 vs. 13–44) and the broadening of contraceptive service need for any reason. But most of the differences are due to adoption of the new metric that operationalizes contraceptive need as self-defined need for care, based on women’s actual use of contraception or contraceptive services in the past year or their report of wanting to use contraception. (See Appendix below for a comparison of national numbers from this report with our prior report that used the conventional need metric to produce estimates for 2020.)

Overall, nearly 52 million US women were classified as having a self-defined need for contraceptive services in 2023 using the new, more person-centered contraceptive need metric. Some 21 million women likely needed public support for this care based on being an adult woman with a family income below 250% of FPL or being younger than 20 at any income level. There is little variation between states in overall need for contraceptive care, but considerable variation when looking at the likely need for publicly supported care. The latter differences mirror variation among states in the proportions of women living in families with low income levels. There is also considerable variation in the proportions of all women of reproductive age who had a self-defined need for contraceptive services across different age-groups. Adolescents aged 15–17 had the lowest self-defined need for contraceptive services (38%) and women aged 20–29 had the highest (76%), reflecting adolescent women’s lower likelihood of either using contraception or having recently made a visit to a provider to receive contraceptive services.

These estimates are available at the national, state and county levels with details by age-group, income level, and race and ethnicity. The findings, based on women’s own self-defined needs for contraceptive services, offer more accurate estimates than the conventional metric for the numbers of women who may seek contraceptive care during a one-year period and can be used by policymakers and program planners to ensure the availability of care at various levels.

Appendix: Comparison Between the Self-Defined and Conventional Need Metrics

Variation in estimates of women across reports

To understand if or how the shift away from a conventional contraceptive need metric to a self-defined need metric might affect the overall estimates of contraceptive need in the United States, we compared the national results from the May 2025 report on 2020 data¹ (“the previous report”) with the national estimates of self-defined need in this report. To make the previous estimates comparable with the current estimates, we used the national numbers of women aged 13–49, published in the Supplementary Tables to the previous report,⁹ and excluded adolescent women aged 13–14 (Appendix Table 1).

• Overall, the total number of women aged 15–49 in the previous report (75.1 million) was virtually the same as in this report (75.9 million), a 1% difference. Therefore, any differences in numbers of women in need of contraceptive services can be attributed primarily to the different need metrics being used and not to population differences between 2020 and 2023.
• The number of women reported to need contraceptive services in 2020 was 44.9 million in the previous report, and 51.9 million for 2023 in this report—a 16% increase primarily due to the shift to the self-defined need metric.
• Among age-groups, there was a large difference in need for contraceptive services among young women (under age 18) and among older women (aged 30 and over) between the two reports. For example, in the previous report, 26% of women younger than 18 and 54% of women 30 and older were estimated to need contraceptive services using the conventional metric; 38% and 70%, respectively, of women in those age-groups were estimated to have a self-defined need for contraceptive services in the current report.
• Higher income women and non-Hispanic White women had higher proportions of self-defined need in the current report than those groups had using the conventional need estimates in the previous report.
• The estimated number of women likely to need public support for contraceptive services was 9% higher in the current report using the self-defined need metric (21.5 million) than in the previous report estimate (19.7 million) based on the conventional need metric.

Variation in self-defined need according to contraceptive use status

To better understand some of the reasons for the higher levels of need based on the self-defined need metric than the conventional metric, we examined the 2022–2023 NSFG. Appendix Table 2 presents the distribution of different categories of women according to whether they reported self-defined contraceptive service need based on (1) their current use of a reversible contraceptive method or partner sterilization, (2) their recent or potential method or contraceptive service use, or (3) no reported need for contraceptive services.

• Among women relying on female sterilization (all of whom were assumed to have no need for contraceptive services under the conventional metric, and likely to be primarily older women), 32% reported a self-defined need for contraceptive services—10% reported current use of a reversible contraceptive method, in addition to sterilization, and 22% reported reversible method or service use in the past 12 months.
• Similarly, among women who were pregnant, seeking pregnancy or postpartum, some 63% reported a self-defined need for contraceptive services, as did 57% of those who reported being sterile or having a partner who was sterile for non-contraceptive reasons. Under the conventional metric, much lower percentages of women in these groups would have been classified as needing care—a small percentage of women estimated to spend less than a full year pregnant, seeking pregnancy or postpartum are considered to need contraceptive services under the conventional metric, as are sterile women who are currently using a reversible method. Under the self-defined need metric, pregnant or postpartum women may be using methods for non-contraceptive reasons or seeking contraceptive services to receive counseling and methods before or after their pregnancy. Women who report being sterile or have difficulty getting pregnant may have used methods or services in the past that are not considered when estimating need using the conventional metric.
• Among women who had never had intercourse (another group assumed to have no need based on the conventional metric, and likely to be primarily young women), some 19% did report having a self-defined need for contraceptive services based on use of services in the past 12 months.
• On the other hand, among sexually experienced women who were not currently using a method (all of whom would have been classified as needing contraceptive services under the conventional metric), only 65% reported a self-defined need for contraceptive services and 35% reported no self-defined need. Some of these women reported they prefer not to use any method or are ambivalent about pregnancy, while others may only have sex occasionally and do not feel a need to use contraceptive methods or services.

Summary of key differences between metrics

Differences between need estimates based on the conventional versus the new metric are most pronounced among younger (<18) and older women (30+). Although women younger than 18 are the age-group least likely to be classified as needing contraceptive services in both reports, higher proportions were estimated to be in need in the current report (38%) than in the previous report (26%). This is likely because some young women do have a self-defined need for contraceptive services prior to becoming sexually active, either for non-contraceptive reasons or to get information and supplies prior to sex.

Among women older than 30, considerably higher proportions had a self-defined need for contraceptive services with the self-defined metric (70%) than those classified using the conventional metric in the previous report (54%). These differences are likely due to the different ways of classifying sterilization among both women and their partners (methods or conditions most common among women aged 30 and older). The conventional need metric assumes no need for contraceptive services among all women who are themselves or who have partners who are sterile for contraceptive or non-contraceptive reasons. In contrast, the self-defined need metric treats partner sterilization as similar to other long-acting methods used by women themselves, classifying all as potentially needing contraceptive information or services to support method switching or continuation over the course of a year. Women who are themselves sterile were classified based on whether they had used other reversible methods or contraceptive services during the year—some 32% of such women had done so and therefore were classified as being in need of contraceptive services.

Women in the middle age-groups (18–19 and 20–29) were slightly less likely to be classified as in need of contraceptive services using the self-defined metric as in the previous report using the conventional metric (57% and 76% for 2023 and 63% and 80%, respectively, for 2020). This is likely related, in part, to how women are classified under each metric if they are sexually experienced but are not using a contraceptive method. The conventional metric classifies all such women as in need, while the self-defined metric only does so if the women themselves report having a need for care, and 35% of women who are sexually experienced and not using a method did not report a need for contraceptive care. This difference between the metrics is likely the main one applicable for women aged 18–19 and 20–29.