U.S. women are increasingly turning to highly effective long-acting reversible contraceptive (LARC) methods—particularly IUDs. According to "Changes in Use of Long-Acting Reversible Contraceptive Methods Among United States Women, 2009–2012," by Guttmacher Institute researchers Megan L. Kavanaugh and colleagues, use of the IUD and the contraceptive implant by 15–44-year-old female contraceptive users increased from about 9% in 2009 to nearly 12% in 2012. Comparison with previous studies shows that this increase is a part of a decade-long trend: In 2002, only about 2.4% of U.S. women using contraception were using LARC methods.
The authors analyzed data from the 2008–2010 and 2011–2013 rounds of the Centers for Disease Control and Prevention’s National Survey of Family Growth. They found that while LARC use increased across nearly every group of women studied, the most significant increases were among Hispanic women, those with private insurance, those with fewer than two sexual partners in the past year and those who had never had children.
With failure rates of less than 1% per year with typical use, LARCs are the most effective reversible methods available. "LARC methods have the potential to significantly decrease unintended pregnancy in the United States because they are ‘set and forget,’ meaning they require no intervention from women, resulting in greater effectiveness," says Kavanaugh, the study’s lead author.
Because past research has shown great differences by race and income in the use of LARC methods—and has raised concerns about possible coercion or the targeting of certain groups with these methods—the authors paid special attention to associations between use and these characteristics. Their findings address the concern that LARC methods may be promoted specifically to black women: There was no increase in use among this group, while use did increase among women of other racial and ethnic groups. Further, in 2012, there were no differences in LARC use according to women’s poverty status.
"Unintended pregnancy is concentrated among poor and low-income women and women of color. These elevated rates are symptomatic of larger overarching inequalities that result in reduced access to reproductive health care and services. While LARC methods alone do not address these inequalities, understanding how the use of these methods differs among different groups of women is an important first step toward ensuring that all women have access to the most effective contraceptive methods," Kavanaugh explains.
Further, the researchers caution that there is no single best contraceptive method for all women. They recommend that women be provided with accurate information about the full range of contraceptive methods, including LARC methods. "It is important that each woman’s stated preferences and childbearing goals be prioritized, so each can choose the method that is best for her," Kavanaugh notes.
Although the data analyzed in this study predate the implementation of the Affordable Care Act’s contraceptive coverage guarantee, the authors note that this provision will likely contribute to a continued increase in women’s access to and use of the IUD, which would otherwise have high upfront costs.
"Initiating use of an implant or IUD can cost a month’s salary for a woman working full time at minimum wage," says Kinsey Hasstedt, a public policy associate at Guttmacher. "More women who want to use these highly effective contraceptive methods should now be able to access them without out-of-pocket costs."
"Changes in Use of Long-Acting Reversible Contraceptive Methods Among United States Women, 2009–2012" by Megan L. Kavanaugh et al. of the Guttmacher Institute, is currently available online and will be published in the forthcoming issue of Obstetrics & Gynecology.