Changes in Use of Long-Acting Reversible Contraceptive Methods Among U.S. Women, 2009-2012

Abstract

Objective: To examine current levels, current correlates of, and changes in long-acting reversible contraceptive (LARC) use, including intrauterine devices and implants, among females aged 15-44 years using contraception between 2008-2010 and 2011-2013 with specific attention to associations between race, income, and age and their LARC use.

Methods: We analyzed data from two rounds of the National Survey of Family Growth, nationally representative samples of females aged 15-44 years, consisting of 6,428 females in 2008-2010 and 5,601 females in 2011-2013. We conducted simple and multivariable logistic regression analyses with adjustments for the sampling design to identify demographic characteristics predictive of LARC use and changes in these patterns between the two time periods. In this cross-sectional, descriptive study, our primary outcome of interest was current prevalence of LARC use among all contraceptive users at the time of the interview.

Results: The prevalence of LARC use among contracepting U.S. females increased from 8.5% in 2009 to 11.6% in 2012 (P<.01). The most significant increases occurred among Hispanic females (from 8.5% to 15.1%), those with private insurance (7.1-11.1%), those with fewer than two sexual partners in the previous year (9.2-12.4%), and those who were nulliparous (2.1-5.9%) (all P<.01). In multivariable analyses adjusting for key demographic characteristics, the strongest associations with LARC use in 2012 were parity (adjusted odds ratios [ORs] 4.3-5.5) and having a history of stopping non-LARC hormonal use (adjusted OR 1.9). Women aged 35-44 years (adjusted OR 0.3) were less likely to be LARC users than their counterparts (all P<.001). Poverty status was not associated with LARC use. There were no differences in discontinuation of LARC methods resulting from dissatisfaction between minority women and non-Hispanic white women.

Conclusion: During the most recent time period surveyed, use of LARC methods, particularly intrauterine devices, increased almost uniformly across the population of users.

Level of evidence: III.

Fig. 1

Use of intrauterine device compared with implant by demographic characteristics among all current long-acting reversible contraceptive users (n=444). *P<.001; ^†P<.01; ^‡P<.05. Kavanaugh. Intrauterine Device and Implant Use in the United States. Obstet Gynecol 2015.

Fig. 2

Use of nonhormonal and hormonal intrauterine device (IUD) by demographic characteristics. Of current contraceptive users, 375 women reported using either the hormonal or nonhormonal IUD in the previous 2 months; six current contraceptive users reported using an IUD in the previous 2 months but did not specify the type; an additional 14 women reported using an IUD in the previous 2 months but were not current contraceptive users at the time of the survey and were excluded from this analysis. *P<.01. Kavanaugh. Intrauterine Device and Implant Use in the United States. Obstet Gynecol 2015.