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Improving contraceptive use in the United States.
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2008
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Contraceptive UseHormonal ContraceptiveTeenage PregnancyOral ContraceptiveContraceptive Non-useContraceptive DiscontinuationReproductive HealthReproductive Health CounselingAverage American WomanContraceptive CoercionFamily PlanningUnited StatesPractice ContraceptionActive WomenContraceptionReproductive EthicPublic HealthSexual And Reproductive HealthPregnancy PreventionInfertilityHealth PolicyMaternal HealthSexual ResponsibilityHealthcare AccessAbortionContraception AccessContraceptive UptakeMedicineWomen's Health
In the United States, most women spend decades trying to avoid pregnancy, yet many sexually active women not seeking pregnancy use contraception poorly or not at all, driven by personal beliefs, side‑effect fears, partner influence, cultural norms, and systemic barriers, necessitating a broad‑based approach. The study aims to identify strategies to improve contraceptive use by analyzing two nationally representative surveys of women’s contraceptive experiences and clinicians’ care delivery. One survey tracked contraceptive use patterns over a year among sexually active women aged 18‑44 not seeking pregnancy, while the other surveyed public and private contraceptive providers about service protocols and perceived client difficulties. The surveys reveal a complex interplay of motivation and client‑provider interactions that hinder effective contraceptive use, and suggest that simple counseling and clinical protocol changes can help providers and policymakers improve practice.
The average American woman--who wants two children--spends about three decades trying to avoid pregnancy and only a few years trying to become or being pregnant. Sexually active women who are not seeking pregnancy may nonetheless practice contraception poorly or may not use a method at all. A wide range of reasons explain this seeming contradiction, including personal feelings and beliefs; experiences with methods; fears about side effects; partner influences; cultural values and norms; and problems in the contraceptive care system. Helping women prevent unintended pregnancy requires a broad-based approach that addresses many of these issues. To identify possible strategies for improving contraceptive use in the United States, two nationally representative surveys investigated women's contraceptive experiences and clinicians' delivery of relevant care. One survey asked sexually active women aged 18-44 who were not seeking pregnancy about their contraceptive use patterns over a one-year period. We focused on adults because many studies have examined adolescents' behavior, and relatively little is known about the contraceptive difficulties experienced by adult women--who account for more than 90% of unintended pregnancies. The second survey asked public and private contraceptive service providers to describe their service delivery protocols and their perceptions of clients' difficulties with method use. Results of these surveys reveal a complex picture of women's motivation and of client-provider interactions that sometimes hinder effective contraceptive use. They also suggest a number of measures that providers can take to help clients improve their contraceptive practice--many of which would require only simple changes in counseling practices and clinical protocols--and that policymakers, researchers and advocates can take to help in this effort.