Increased Use of Intrauterine Contraception in California, 1997 to 2007

Abstract

Background: Modern intrauterine contraception (IUC) is safe and highly effective, but is used by fewer than 4% of women in the United States. Once recommended only for women with at least one child, it is now recommended for most women regardless of parity or age.

Methods: This study used data representative of California women from 10 years of the California Women's Health Survey (1997-2007) to describe how IUC users differ from women using other contraceptives, and assess changes in IUC users' characteristics over time.

Findings: Overall 4.9% of women in California used IUC. Multivariable logistic regression modeling showed IUC users were more likely to be born outside the United States (odds ratio [OR], 1.7), have a college degree (OR, 1.5) or postgraduate degree (OR, 2.2), and be married (OR, 2.6) or in an unmarried partnership (OR, 2.4). IUC users were 71% less likely to be nulliparous (OR, 0.29). Use of IUC almost doubled over the study period from 4.0% to 7.2%, and this growth was accompanied by significant changes in user characteristics: Young women, women born in the United States, women without a college degree, and Asian women experienced the greatest increases. IUC use among nulliparous women did not increase.

Conclusion: IUC use in California is higher than the national average and growing. We found higher IUC use among ever-married women and foreign-born women, and disproportionately low use among nulliparous women. Efforts to inform women of IUC's high effectiveness and safety, as well as efforts to ensure that health care providers have the necessary clinical skills, are timely and important.