Measuring contraceptive use: challenges raised in recent survey research

Measurement challenges are a longstanding concern for researchers seeking to accurately represent respondents’ knowledge, behaviour and experiences. In reproductive health, how contraceptive use is measured matters because these data shape public health and policy responses and influence how reproductive autonomy and equity are understood. Despite evolving priorities of the sexual and reproductive health field, the primary tools used to measure contraceptive use in the United States (US) at a population level, such as the National Surveys of Family Growth (NSFG)1 and the Behavioral Risk Factor Surveillance System (BRFSS),2 have changed very little. This stability is partly intentional: because these surveys track trends over time, innovations in measurement must be weighed against the loss of comparability with past data. However, the analytic approaches adopted and perpetuated over time, both by those creating survey user guides and by external scholars drawing on these data, tend to emphasise the use of highly effective contraceptive methods, often at the expense of capturing individuals’ preferences and contextual realities. Misclassification is most likely and most harmful among populations already bearing the greatest burden of reproductive health inequity.