The pill remains most common method of birth control, US report shows
Among the two-thirds of women aged 15 to 44 who used birth control between 2011 and 2013, approximately 16 percent used the pill.
Female sterilization, where women have their fallopian tubes closed or blocked, was used by 15.5 percent of women, while 9.4 percent used male condoms, according to the report published Dec. 11 by the U.S. National Center for Health Statistics (NCHS).
But intrauterine devices (IUDs) and implants, both types of long-acting reversible contraceptives, are close on the heels of these other forms of birth control, with 7.2 percent of women using them.
"Use of long-acting reversible contraceptives is becoming more popular," said report author Kimberly Daniels, of the NCHS. Their use has nearly doubled since the last report on findings from five years earlier, when approximately 3.8 percent of women were using them, Daniels said.
The most popular long-acting reversible contraception is the IUD, used by 3.5 percent of women in 2006 to 2010 and by 6.4 percent of women in 2011 to 2013, according to Daniels. The IUDs available in the United States include two hormonal versions, Mirena and Skyla, and one containing copper, ParaGard.
This increase in long-acting reversible contraception has followed changes in guidelines by leading health care organizations that now recommend their use to younger women and those without children, said Laura Lindberg, a senior research associate at the Guttmacher Institute.
When IUDs came out years ago, there were concerns they might raise the risk of pelvic infection and jeopardize a woman's fertility. But IUDs currently on the market don't carry those risks, according to the American Academy of Pediatrics.
The academy now recommends these contraception devices as the first option for teens.
But Lindberg added that they do not protect against sexually transmitted infections (STIs).
"Currently, male and female condoms are the only methods on the market that prevent both pregnancy and sexually transmitted infections," Lindberg said. "Until such time as other options become available, continuing to promote and support the use of these methods, either alone or in conjunction with a hormonal method, is critical to reducing the risk of STIs."
Studies have shown that long-acting reversible contraceptive methods are more effective than the pill, patch or ring, even in young women, according to Dr. Vanessa Cullins, vice president for external medical affairs at Planned Parenthood Federation of America.
"They're a great birth control option if you want to preserve your fertility—you think you may want kids in the future but not right now—but also desire long-term, highly effective pregnancy prevention," Cullins said. "Their very low failure rates are because women who use them do not have to remember to do anything before sex, or daily or monthly or even every three months—once it's been inserted, you can pretty much forget about it."
The report found condom use to be similar, about 9 percent, across whites, blacks and Hispanics, but other contraceptive forms showed differences across various race/ethnicity groups.
Female sterilization, for example, was higher among black women, at 21 percent, than it was in white women, at 14 percent. But use of the pill by white women, at 19 percent, was almost double the use by Hispanic (11 percent) and black women (10 percent).
The reason for these differences relates to health care access, Cullins said.
"We know that black and Hispanic women are less likely to have access to regular affordable health care, less likely to have insurance, and access to contraception is part of that," Cullins said. "Cost is a huge barrier. When a woman has to make a choice between her birth control and feeding her kids, birth control is going to get short shrift."
Similarly, until the Affordable Care Act, uninsured women only qualified for insurance while pregnant or immediately postpartum, leading many to opt for sterilization while the health insurance was available to pay for it as a contraception method, Cullins said.
This situation applies to differences seen in educational levels as well: 27 percent of women with only a high school diploma or G.E.D. were using sterilization, compared to 10 percent of women with a bachelor's degree or higher.
"This is one of the many reasons that the Affordable Care Act is so important," Cullins said. "Because of the ACA's birth control benefit, millions more women have access to no-copay birth control, so cost is no longer a barrier."
Cullins said the popularity of the pill is predominantly due to familiarity—it has been around longer than most other methods—and pharmaceutical company marketing. But she said it's important to recognize that women's birth control needs change over time, so they need to pick the method that best fits their lives.
"Women who use a birth control method that fits their needs are more likely to prevent pregnancy because they are more likely to continue using their method," Cullins said. "The easier it is for women to prevent unintended pregnancies, the better they are able to plan their futures, start their families when they're ready, have healthy relationships with their life partners and take care of their health—and that's good for all of us."
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