Fifteen percent of U.S. women in a recent survey who were at risk of unplanned pregnancy had had a gap in contraceptive use of one or more months during the previous year, while 8% had not used any method, according to "Factors Associated with Contraceptive Use and Nonuse, United States, 2004," by Jennifer J. Frost et al., published in the June issue of Perspectives on Sexual and Reproductive Health. Failure to use contraceptives while remaining sexually active places women at extremely high risk for unplanned pregnancy. This study sought to assess why women experience gaps in contraceptive use and which groups of women are most affected.

Frost’s analysis found that women with less than a college education, women who were ambivalent about avoiding pregnancy and those who felt they could not call their provider with contraceptive use questions had elevated odds of having had a gap in contraceptive use or having not used any contraceptive for the entire year. Other characteristics that were strongly associated with either contraceptive nonuse or having had a gap in use included older age, being black or on Medicaid, not currently being in a relationship, having infrequent sex and being dissatisfied with one’s contraceptive method.

"The typical American woman wants—and has—two children, which means she spends roughly three decades trying to avoid becoming pregnant," says Frost, a senior research associate with the Guttmacher Institute. "It is difficult for many women to find a contraceptive method that meets their needs and to use it continuously, especially during periods of method dissatisfaction or personal transition; and it is even more difficult for some women than for others. This analysis suggests that health care providers in particular can play an important role in helping those women at greatest risk meet their contraceptive needs."

The authors recommend that health care providers be encouraged to identify those women with ambivalent attitudes toward pregnancy, those having difficulty using their method and those with an elevated risk of unplanned pregnancy because of disadvantage or relationship instability. By identifying women who are at greatest risk, providers will be better able to offer appropriate, comprehensive counseling and assistance regarding which method best fits their needs and how to avoid an unwanted pregnancy.