Primary Care in Obstetrics and Gynecology

pp 241-264

Contraception Update

  • Amitasrigowri S. MurthyAffiliated withDepartment of Obstetrics and Gynecology and Women’s Health, Jacobi Medical Center, Albert Einstein College of Medicine
  • , Bryna HarwoodAffiliated withDepartment of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women’s Hospital

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A discussion of contraceptive options would not be complete without reviewing the population that needs contraception. In the United States, 48% of the 6.3 million pregnancies that occur annually are unplanned. Approximately 50% of these unplanned pregnancies occur among the small percentage of women at risk for pregnancy who do not use contraception. There are approximately 60 million women in the United States who are in their reproductive years (ages 15–44). Of these women, 30% do not need contraception (they are heterosexually abstinent, pregnant, postpartum, or are attempting to get pregnant), 65% are using some sort of contraception, and 5% are not using but are still in need of contraception. Of the women who practice contraception, two-thirds use a method of reversible contraception, such as oral contraceptives or condoms. Among women who use the condom as their primary method of contraception, one-third report not using it with every act of intercourse. These women tend to mainly use the male condom; less than 1% report using the female condom as their primary method of barrier contraception. Condom use tends to decline as women age; only 16% of women aged 35–39 years used a condom at all. Twenty-eight percent of couples using contraception rely on tubal sterilization and 11% on male sterilization. As women and male partners age, they increasingly begin to rely on female methods of contraception, with over 44% of women aged 35–39 years relying on female contraceptive methods. Female sterilization is the most commonly used method in women who are over the age of 34 years, have been previously married, or have an income below 150% of the poverty level.