Who is using long-acting reversible contraceptive methods? Findings from nine countries

Megan M. Sweeney, University of California, Los Angeles
Mieke C. W. Eeckhaut, University of California, Los Angeles
Jessica D. Gipson, University of California, Los Angeles

Context: Long-acting reversible contraceptive (LARC) methods (IUDs and implants) remain the most effective, reversible methods available in preventing pregnancy. Examining how LARC users in the United States differ from those in other low-fertility countries may guide efforts to increase reliance on LARCs. Methods: Using data from married or cohabiting women in the 2008-10 National Survey of Family Growth and eight other low-fertility countries participating in the 2004-10 Generations and Gender Programme, bivariate and multinomial logistic regressions analyses were conducted to describe LARC use within each setting. Results: The proportion of contraceptive use accounted for by LARCs is much greater in Europe (10-32%), as compared to the United States (10%) and Australia (7%). Compared to other countries, U.S. LARC use is particularly low among women who are married, over age 40, or have 3+ children, yet comparatively high for women under age 25. U.S. women have higher odds of using sterilization versus LARCs if they are over age 40 (OR=3.0 for 35-39 years, OR=10.7 for 40-44 years) or have 3+ children (OR=4.9), and lower odds of using sterilization versus LARCs if they have tertiary education (OR=0.4). Conclusions: This cross-national comparison demonstrates a persistent reliance on sterilization among many subgroups in the United States for whom LARC methods would provide a less invasive option in effectively managing fertility, as well as a pattern of greater reliance on LARCs among more educated women. These findings also highlight greater potential for LARC use among nulliparous women across study settings.