Use of Contraception and Use of Family Planning Services in the United States: 1982–2002

Report

By: William D. Mosher, et al.

Date: 2004

Source: Mosher, William D., et al. "Use of Contraception and Use of Family Planning Services in the United States: 1982–2002." Advance Data from Vital and Health Statistics. Centers for Desease Control and Prevention, December 10, 2004.

About the Author: William D. Mosher is a researcher at the National Center for Health Statistics in Hyattsville, Maryland. The Centers for Disease Control and Prevention funds research into disease causes, prevention, and treatment.

INTRODUCTION

For most of human history, pregnancy and childbirth have been impossible to reliably prevent or plan, although numerous methods have been tried. Some, such as walking over the graves of deceased female ancestors, have no effect; others, such as male withdrawal before ejaculation, are relatively effective but fail often. Without a basic understanding of human physiology and reproductive anatomy, family planning advice throughout history ranged from absolutely useless to surprisingly effective. For most families, consistent family planning remained difficult or impossible.

While numerous methods of contraception have been devised, information about them was not always readily available. Because of the moral dilemmas often associated with sexual activity, some critics believed that public discussion of contraception should be forbidden, and in 1874 the U.S. Congress passed legislation defining contraception information as obscene. Despite the ban, primitive contraceptives continued to be manufactured and sold, and in 1880 the production of animal-skin condoms began. Condoms were legalized in the United States in 1918 after U.S. troops began bringing them home from World War I.

The 1920s marked the first decade in which birth control methods appear to have significantly impacted birth rates; despite the low reliability of available methods, families frequently employed multiple techniques, resulting in a measurable drop in pregnancies, which continued through the 1940s. Speeding the adoption of birth control were activists such as Margaret Sanger, who worked to extend birth control access to poor and working-class women. Sanger, who was frequently arrested for publicly discussing birth control, continued her efforts on behalf of women throughout her life. Despite her work, birth control of any kind remained illegal in some states, even for married couples; a prohibitive statute in Connecticut remained on the books until 1965 when the U.S. Supreme Court struck it down.

With the spread of AIDS during the 1980s, massive educational campaigns were launched in order to educate Americans about disease prevention. As a result, condoms for the first time entered the public vocabulary, and today they are widely advertised and sold in a variety of styles. Female birth control is also readily available in numerous forms and at little or no cost, allowing women to choose their preferred method of contraception.

PRIMARY SOURCE

Contraceptive use in the United States is virtually universal among women of reproductive age:

98 percent of all women who had ever had intercourse had used at least one contraceptive method. In 2002, 90 percent had ever had a partner who used the male condom.

82 percent had ever used the oral contraceptive pill, and 56 percent had ever had a partner who used withdrawal.

The leading method of contraception in the United States in 2002 was the oral contraceptive pill. It was being used by 11.6 million women 15-44 years of age; it had ever been used by 44.5 million women 15-44 years of age. The second leading method was female sterilization have been the two leading methods in the United States since 1982.

Between 1982 and 2002, the percentage of women who had ever had a partner using the male condom rose from 52 percent in 1982 to 90 percent in 2002. The percent whose partner had ever used withdrawal increased from 25 to 56 between 1982 and 2002. In contrast, the percentage who had ever used the Today sponge, intrauterine device (the IUD), the Diaphragm, calendar rhythm, and spermicidal foam decreased between 1995 and 2002.

Non-Hispanic Black or African American women and Hispanic or Latina women were somewhat less likely to have ever used the oral contraceptive pill than non-Hispanic white women, but these groups were more likely than white women to have used the 3-month injectable contraceptive called Depo-Provera.

The percentage of women who used a method of contraception at their first premarital intercourse increased from 43 percent in the 1970s to 79 percent in 1999–2002. Most of this increase was due to an increase in use of the male condom at first premarital intercourse, from 22 percent in the 1970s to 67 percent in 1999–2002, although use of the pill also increased.

About 62 percent of the 61.6 million women 15-44 years of age—5 out of 8—were currently using contraception in 2002. Most of those who were not using contraception were currently pregnant, trying to become pregnant, sterile for medical (noncontraceptive) reasons, unable to conceive, or had not had intercourse recently (or ever).

The percentage of all women 15-44 who were sexually active and not using contraception increased from 5.4 percent in 1995 to 7.4 percent in 2002. This represents an apparent increase of 1.43 million women between 1995 and 2002, and could raise the rate of unintended pregnancy, particularly among women 20 years of age and over, and black women.

Non-Hispanic Black and Hispanic women were more likely to use female sterilization as a method of contraception than Non-Hispanic white women, but white women were more likely to rely on male sterilization.

The percentage of contraceptors 22-44 years of age who chose female sterilization as a method of birth control varied sharply by education. Female sterilization accounts for 55 percent of users without a high school degree in 2002 compared with just 13 percent of contraceptors with a 4-year college degree.

While contraceptors with less education tend to rely on female sterilization, contraceptors with more education tend to rely on the oral contraceptive pill: just 11 percent of contraceptors without a high school degree used the pill in 2002, compared with 42 percent of contraceptors with a 4-year college degree.

This report also shows the extent of use of the condom with other methods of birth control. About 10 percent of never married women had a partner who was using male condoms as their most effective method of contraception in 2002, but another 7 percent were using condoms along with a more effective method—such as the pill or Depo-Provera—so a total of 17 percent were using the condom. Among married women, however, this kind of combination use was much less common.

About 42 percent of women 15-44 years of age received one or more family planning-related medical services from a medical care provider in the 12 months before the 2002 survey. The pattern of use of these services by age closely coincides with the pattern of oral contraceptive use by age: 63 percent of women 20-24 years of age and 20 percent of women 40-44 used such services in the year before the survey.

The percentage of women 15-44 years of age who used family planning services in the last 12 months increased from 33 percent in 1995 to 42 percent in 2002. About 29 percent of females 15-19 years of age received some family planning services in 1995 compared with 40 percent in 2002. Increases also occurred in other age groups.

SIGNIFICANCE

When this report was published in 2004, birth control had become an accepted and widely used option. Most significantly, the study found that the vast majority of sexually active women, with the exception of those for whom pregnancy was desired or impossible, were choosing to use birth control. The type of birth control varied widely across demographic groups, with college educated women more likely to use oral contraceptives than high school dropouts, and less likely to opt for female sterilization.

Minority women were also more likely to use Depo Provera, a hormone injection which prevented pregnancy for three months. A significant number of women also reported having received family planning services in the previous twelve months, suggesting that family planning and birth control advice and services had become widely available.

Some women's rights advocates claim that female sexual issues frequently receive inferior support compared to male sexual issues. Following the introduction of Viagra and other drugs designed to enhance male sexual performance in the late 1990s, insurance companies appeared to be following a double standard, paying up to $10.00 per pill for the male drugs but often refusing to pay the monthly costs of female birth control pills. States quickly began passing legislation requiring insurers to pay for birth control pills, which cost about $30.00 per month.

As of 2006, female birth control was available in multiple methods, including permanent sterilization, implanted hormone capsules good for five years, monthly injections, and a variety of barrier methods. In 2001, Johnson and Johnson introduced a weekly birth control patch that prevented pregnancy by providing a steady dose of hormones through the skin. In some cases federal and private programs pay some or all of the cost of birth control supplies, making family planning an option for lower income women.

Male birth control remained limited to two options: condoms and sterilization. Pharmaceutical companies continued their efforts to develop an oral or injectable male contraceptive, and several drugs were in the testing phase. While development of the female birth control pill was relatively trouble-free, drug makers found the male alternative far harder to create. In particular, scientists struggled to synthesize drugs effective at stopping sperm production without inhibiting other aspects of male sexual performance.

Easy access to contraception has had a marked impact on birth rates in the United States. Despite far better health care and longer life expectancies, which would tend to raise birth rates, U.S. birth rates in 2000 had fallen to 14.7 per 1,000, or less than half their 1910 rate of 30.1

FURTHER RESOURCES

Books

Hatcher, Robert A., et al. Contraceptive Technology, 18th Revised Edition. New York: Ardent Media, 2004.

Marks, Lara V. Sexual Chemistry: A History of the Contraceptive Pill. New Haven, Conn.: Yale University Press, 2001.

Watkins, Elizabeth S. On the Pill: A Social History of Oral Contraceptives, 1950–1970. Baltimore, Md.: Johns Hopkins University Press, 1998.

Periodicals

"Anthony Comstock and His Adversaries: The Mixed Legacy of the Battle for Free Speech." Communication Law & Policy 11 (2006): 317-366.

Friedman, Lawrence M. "Griswold v. Connecticut: Birth Control and the Constitutional Right of Privacy." Journal of Interdisciplinary History 37 (2006): 161-163.

Tanne, Janice Hopkins. "Gap in Contraceptive Use Between Rich and Poor is Growing in U.S." British Medical Journal 332 (2006): 1170.

Web sites

ABC News. "Erections Get Insurance; Why Not the Pill?" June 19, 2002. 〈http://abcnews.go.com/US/story?id=91538〉 (accessed July 22, 2006).

Michigan State University. "Margaret Sanger and the 1920s Birth Control Movement." 2000. 〈http://www.msu.edu/course/mc/112/1920s/Sanger/index.html〉 (accessed July 22, 2006).

U.S. Food and Drug Administration. "Birth Control Guide." December 2003. 〈http://www.fda.gov/fdac/features/1997/babytabl.html〉 (accessed July 22, 2006).