Estimates of use of preferred contraceptive method in the United States: a population-based study

Anu Manchikanti Gomez; Ariana H Bennett; Jennet Arcara; Lisa Stern; Jamie Bardwell; Denicia Cadena; Aisha Chaudhri; Laura Davis; Christine Dehlendorf; Brittni Frederiksen; Catherine Labiran; Raegan McDonald-Mosley; Whitney S Rice; Tara B Stein; Ena Suseth Valladares; Megan L Kavanaugh; Cassondra Marshall

doi:10.1016/j.lana.2023.100662

Estimates of use of preferred contraceptive method in the United States: a population-based study

Lancet Reg Health Am. 2024 Jan 19:30:100662. doi: 10.1016/j.lana.2023.100662. eCollection 2024 Feb.

Authors

Anu Manchikanti Gomez¹, Ariana H Bennett¹, Jennet Arcara¹, Lisa Stern², Jamie Bardwell³, Denicia Cadena⁴, Aisha Chaudhri⁵, Laura Davis⁶, Christine Dehlendorf⁷, Brittni Frederiksen⁸, Catherine Labiran⁹, Raegan McDonald-Mosley¹⁰, Whitney S Rice¹¹, Tara B Stein¹², Ena Suseth Valladares¹³, Megan L Kavanaugh¹⁴, Cassondra Marshall^{1

15}

Affiliations

¹ Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA.
² Coalition to Expand Contraceptive Access, Washington, DC, USA.
³ Converge, Ridgeland, MS, USA.
⁴ Independent Consultant, Albuquerque, NM, USA.
⁵ Illinois Caucus for Adolescent Health, Chicago, IL, USA.
⁶ Advocates for Youth, Washington, DC, USA.
⁷ Person-Centered Reproductive Health Program, Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
⁸ KFF, San Francisco, CA, USA.
⁹ Independent Consultant, Brooklyn, NY, USA.
¹⁰ Power to Decide, Washington, DC, USA.
¹¹ Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹² New York City Department of Health and Mental Hygiene, New York, NY, USA.
¹³ California Latinas for Reproductive Justice, Los Angeles, CA, USA.
¹⁴ Guttmacher Institute, New York, NY, USA.
¹⁵ School of Public Health, University of California, Berkeley, Berkeley, CA, USA.

Abstract

Background: In the U.S. and globally, dominant metrics of contraceptive access focus on the use of certain contraceptive methods and do not address self-defined need for contraception; therefore, these metrics fail to attend to person-centeredness, a key component of healthcare quality. This study addresses this gap by presenting new data from the U.S. on preferred contraceptive method use, a person-centered contraceptive access indicator. Additionally, we examine the association between key aspects of person-centered healthcare access and preferred contraceptive method use.

Methods: We fielded a nationally representative survey in the U.S. in English and Spanish in 2022, surveying non-sterile 15-44-year-olds assigned female sex at birth. Among current and prospective contraceptive users (unweighted n = 2119), we describe preferred method use, reasons for non-use, and differences in preferred method use by sociodemographic characteristics. We conduct logistic regression analyses examining the association between four aspects of person-centered healthcare access and preferred contraceptive method use.

Findings: A quarter (25.2%) of current and prospective users reported there was another method they would like to use, with oral contraception and vasectomy most selected. Reasons for non-use of preferred contraception included side effects (28.8%), sex-related reasons (25.1%), logistics/knowledge barriers (18.6%), safety concerns (18.3%), and cost (17.6%). In adjusted logistic regression analyses, respondents who felt they had enough information to choose appropriate contraception (Adjusted Odds Ratio [AOR] 3.31; 95% CI 2.10, 5.21), were very (AOR 9.24; 95% CI 4.29, 19.91) or somewhat confident (AOR 3.78; 95% CI 1.76, 8.12) they could obtain desired contraception, had received person-centered contraceptive counseling (AOR 1.72; 95% CI 1.33, 2.23), and had not experienced discrimination in family planning settings (AOR 1.58; 95% CI 1.13, 2.20) had increased odds of preferred contraceptive method use.

Interpretation: An estimated 8.1 million individuals in the U.S. are not using a preferred contraceptive method. Interventions should focus on holistic, person-centered contraceptive access, given the implications of information, self-efficacy, and discriminatory care for preferred method use.

Funding: Arnold Ventures.

Keywords: Contraception; Family planning; Health care access; Health care quality; Person-centeredness; United States; Unmet need.