Understanding the extent of contraceptive non-use among women at risk of unintended pregnancy, National Survey of Family Growth 2011–2017

Abstract

Objective To describe characteristics of U.S. contraceptive non-users to inform tailored contraceptive access initiatives. Study design We used National Survey of Family Growth data from 2011 to 2017 to identify characteristics of contraceptive non-users compared to other women ages 15–44 at risk for unintended pregnancy. We also examined reasons for not using contraception by when non-users expected their next birth. We calculated unadjusted and adjusted prevalence ratios using two definitions of contraceptive non-use: (1) contraceptive non-use during the interview month, and (2) a more refined definition based on contraception use during the most recent month of sexual intercourse and expectation of timing of next birth. We considered p-values < 0.05 statistically significant. Results Approximately 20% ( n = 2844) of 12,071 women at risk of unintended pregnancy were classified as standard contraceptive non-users. After adjusting for all other variables, non-users were more likely to be low-income, uninsured, never married, expect a birth within 2 years, and have zero or one parity. The top reasons for contraceptive non-use were not minding if they got pregnant (22.6%), worried about contraceptive side effects (21.0%), and not thinking they could get pregnant (17.6%). After applying the more refined non-user definition, we identified 5.7% ( n = 721) of women as non-users; expecting a birth within 2–5 years and having a parity of one were associated with non-use after adjustment of all other factors. Conclusion Our more refined definition of non-users could be used in future studies examining the causes of unintended pregnancy and to inform programmatic interventions to reduce unintended pregnancy. Implications Describing contraceptive non-users and reasons for contraceptive non-use could help us better understand reasons for unintended pregnancy and inform tailored contraceptive access initiatives.

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

“…” We determined contraceptive use status according to whether respondents reported using any contraceptive method during the month of survey interview (current users) or not (nonusers of contraception). We maintain distinctions between contraceptive users and nonusers of contraception in examining our outcome of interest due to key differences in demographic and sexual and reproductive health (SRH) characteristics between these 2 groups [7] , which may have implications for our analysis.…”

“…In a 2020 national study, 25% of women who were not using their preferred method of contraception indicated that it was because they could not afford it [6] . Among women at risk of unintended pregnancy in the United States, nonusers of contraception are more likely to have lower incomes and be uninsured compared to users [7] .…”

Factors associated with long‐acting reversible contraception usage: Results from the National Survey of Family Growth

“…Using a national database, this study was able to detect small associations and have increased generalizability. Prior publications using this database addressed different perspectives on childbirth, sexual behavior, and contraceptive use 1,23,25,45–47 . The current analysis explicitly focused on factors associated with LARC use.…”

Women in larger bodies’ experiences with contraception: a scoping review

“…Moreover, five articles affirmed that women in larger bodies’ contraceptive non-use was often associated with perceived subfertility [ 42 , 56 , 57 , 59 , 65 ]. Parallel to these findings, perceived infertility has been identified as one of the leading reasons for contraceptive non-use among American women at risk of unintended pregnancy [ 74 ]. Although having a BMI ≥ 30 is associated with an elevated risk of fertility issues and miscarriage [ 75 ], studies with women who consider themselves to be less likely to become pregnant have yet to attribute this perception to weight or body size [ 76 , 77 ].…”