Contraceptive Use Among Women at Risk for Unintended Pregnancy in the Context of Public Health Emergencies — United States, 2016

Abstract

Ensuring access to and promoting use of effective contraception have been identified as important strategies for preventing unintended pregnancy (1). The importance of ensuring resources to prevent unintended pregnancy in the context of public health emergencies was highlighted during the 2016 Zika virus outbreak when Zika virus infection during pregnancy was identified as a cause of serious birth defects (2). Accordingly, CDC outlined strategies for state, local, and territorial jurisdictions to consider implementing to ensure access to contraception (3). To update previously published contraceptive use estimates* among women at risk for unintended pregnancy† and to estimate the number of women with ongoing or potential need for contraceptive services,§,¶ data on contraceptive use were collected during September–December 2016 through the Behavioral Risk Factor Surveillance System (BRFSS). Results from 21 jurisdictions indicated that most women aged 18–49 years were at risk for unintended pregnancy (range across jurisdictions = 57.4%–76.8%). Estimates of the number of women with ongoing or potential need for contraceptive services ranged from 368 to 617 per 1,000 women aged 18–49 years. The percentage of women at risk for unintended pregnancy using a most or moderately effective contraceptive method** ranged from 26.1% to 65.7%. Jurisdictions can use this information to estimate the number of women who might seek contraceptive services and to plan and evaluate efforts to increase contraceptive use. This information is particularly important in the context of public health emergencies, such as the recent Zika virus outbreak, which have been associated with increased risk for adverse maternal-infant outcomes (2,4–6) and have highlighted the importance of providing women and their partners with resources to prevent unintended pregnancy.

Need for Contraceptive Services Among Women of Reproductive Age — 45 Jurisdictions, United States, 2017–2019

“…†† Women were considered to be at risk for unintended pregnancy unless they reported 1) not being sexually active with a male partner, 2) being currently pregnant or seeking pregnancy, 3) not minding being pregnant, or 4) having had a hysterectomy. This approach is consistent with prior evaluation of BRFSS contraceptive use data ( 4 ). The proportion and total number of women aged 18–49 years with ongoing or potential need for contraceptive services, defined as women considered to be at risk for unintended pregnancy who were not using permanent contraception (female sterilization or male partner vasectomy), were also estimated.…”

Healthcare system indicators associated with modern contraceptive use in Ghana, Kenya, and Nigeria: evidence from the Performance Monitoring and Accountability 2020 data

“…This trend reflects a high proportion of unmet need for contraception in sub-Saharan Africa compared to other regions; in 2015 the prevalence of unmet need for contraception among women (aged 15-49) in a union was 24.2% in sub-Saharan Africa, 12% in southeast Asia, and 7.3% in northern Europe. Furthermore, scientific evidence points to the higher odds of unmet need for contraception and limited contraceptive use among women who report an unintended pregnancy [3][4][5][6][7]. Therefore, to decrease unmet need for contraception in sub-Saharan Africa, experts must continue to examine factors that promote the use of modern contraceptives.…”

State-Level Estimates of Contraceptive Use in the United States, 2017

“…[17][18][19] The CDC, on the other hand, categorizes ambivalent women as not at risk of unintended pregnancy in its most recent analyses of BRFSS data. 7 Among women who did not use contraceptives at last sex, the proportion citing "don't care if [I] get pregnant" ranged from 2% in Louisiana to 9% in New York (not shown).…”

“…§5,6 The contraceptive effectiveness classifications used in this report align with designations used by the CDC. 7 Women at risk of unintended pregnancy who did not specify the type of contraceptive they used were included in estimates of overall contraceptive use but excluded from estimates where contraceptive use is grouped by the effectiveness of the method used: Estimates that did not meet reliability standards established for BRFSS by the CDC have been suppressed (i.e., a relative standard error greater than 30% or an unweighted denominator of fewer than 50 respondents). 8 Estimates for certain methods did not meet the criteria for reliability in some jurisdictions and were therefore further grouped with other methods in their respective contraceptive effectiveness classifications: injectables, patches and rings were grouped together under "other non-LARC hormonal," and emergency contraception, diaphragms, cervical rings, cervical caps, rhythm method, natural family planning and spermicidal methods were grouped together under "other."…”