Current Choices Among Reversible Methods

Women and their partners have a broad array of reversible contraceptive methods from which to choose, and the popularity of various methods has changed over time. Table 4-5 presents information about the results of these choices in 1988, showing the use of both contraceptive sterilization and reversible contraception (i.e., the women in Groups A and B in Figure 4-1). Table 4-6 supplements Table 4-5 by displaying contraceptive choices within the group of reversible methods only over the 1982–1990 interval.

Three issues stand out in reviewing Table 4-5. First, coitus-independent methods are the most popular among the women surveyed. Oral contraceptives were the most frequently used method in 1988; this was followed closely by female sterilization. Other methods, ranked in order of popularity, were condoms, male sterilization, the diaphragm, periodic abstinence, withdrawal, the IUD, and foam. Second, the rank order changes somewhat with the age of the user. For example, oral contraceptives were the most frequently used method among those 15–29 years old, but female sterilization was the most frequently used method among those 30–44 years old. Third, condom use was dramatically higher among adolescents than among older women. Data from the 1990 NSFG suggest a change in the rank order: female sterilization was the most frequently used method; this was followed by oral contraceptives. Data from the 1988 and 1990 NSFG do not reflect the current increase in the use of hormonal implants and injections; however, data from the 1994 Ortho Birth Control Study indicate the growing popularity of these methods (Peterson, 1995; Ortho Pharmaceutical Company, 1994).

It is probable that condom use is higher than is indicated by these data. The 1988 NSFG reported the more effective method when condoms were stated as being used with sterilization, oral contraceptives, IUDs, or diaphragms, thereby partially obscuring the importance of condoms. Concomitant use of condoms and any method other than these four was coded as condom use. When the data are retabulated to include all methods used, the number of women using condoms rises to 5.8 million, or approximately 17 percent of all users in 1988 (Mosher and Pratt, 1990). In addition, occasional use of condoms is not reported in the NSFG. Women are asked to report all methods they have used for 1 month or more, and thus may fail to report episodic condom use. A separate question about condom use suggests that 14 percent of women who reported condom use in response to this question did not report condoms as their current method (either alone or with another method), and this was especially true among younger women (Hatcher et al., 1994).

Because women at either end of the reproductive age span have relatively high rates of unintended pregnancy, it is useful to discuss their contraceptive use in more detail. Roughly, these two groups are women under age 20 and women age 40 and over.

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