After the Supreme Court’s decision in the Dobbs V. Jackson Women’s Health Clinic case, access to abortion shifted from being a constitutional right to an issue controlled at the state level. The court’s ruling also placed renewed attention on contraception.

On July 21, the House of Representatives approved a bill that would prohibit restrictions on contraception access, but the legislation is stalled in the Senate.

Around 65% of women aged 15-49 were using contraception, according to a survey conducted from 2017 to 2019 by the Centers for Disease Control and Prevention (CDC). Contraceptive use rates are relatively constant across women of different educational attainment levels and races but varied more by age. About 39% of women in the 15-19 age group used contraception, but this rate nearly doubled to about 75% among women in their 40s.

The CDC study only surveyed the contraceptive use of females who identified as women. The type of contraception used by individuals is based on the person’s sex, not their gender. The survey doesn’t account for transgender individuals.

What is contraception?

Contraception, commonly called birth control, refers to various methods used to prevent pregnancy. This includes oral contraceptives (commonly known as “the pill”), male condoms, male or female sterilization (referring to various surgical procedures[1] to make someone incapable of causing or having a pregnancy), and long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) or implants.

The most common type of contraception used by women was female sterilization, which was used by 18.1% of all women. About 14% of women used the pill as their primary form of birth control, 10% used LARCs, and 8% relied on the male condom.[2]

Of the 35% of women who were not using contraception, half of them cited not having sex in the past three months as the reasoning. About a fifth of women who do not use contraception are pregnant, postpartum, or trying to get pregnant.

What types of contraception are covered by health insurance?

Federal law mandates that almost all public and private health insurance plans must cover doctor-prescribed birth control. The law mandates coverage of 18 methods of birth control including the pill, implants, IUDs, and female sterilization. The law does not mandate coverage of abortions, vasectomies, or condoms.

Plans sponsored by religious employers such as churches, houses of worship, and nonprofit religious organizations such as religious hospitals or universities can get exemptions from these requirements.

How does contraception use vary by educational attainment?

Women with more education use female sterilization at lower rates than women with less education. About 40% of women without a high school diploma are sterilized compared with 12% of women with a bachelor’s degree or higher. The use of oral contraception increased with educational attainment. About 6% of women with no high school diploma used the pill compared with 18% of women with a bachelor’s degree or higher. Rates of condom usage hovered just below 10% across all educational levels.

The likelihood of undergoing female sterilization decreases as educational attainment level increases.

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How does contraception use vary with age?

The most common type of contraception used by women depends in part on their age. Use of female sterilization increases significantly among older women. Almost 40% of women 40-49 years old use female sterilization, while less than 3% of women under the age of 29 had the procedure.

Several factors can explain the disparity. For example, it’s illegal under federal law for a woman under 21 years of age to be sterilized. Also women in their 40s or those with a family history of ovarian cancer may get a tubal ligation (also known as “tying the tubes”) to decrease their risk of developing cancer at some point. About 3% of all births in 2020 were from women in their 40s compared with 47% from women in their 20s and 45% from women in their 30s.

The pill is most used by younger women. Around 20% of women aged 15-29 years old use the pill.

Male condom and LARC usage remained more constant across age groups but women in the 20-39 age group were most likely to use these methods.

Women in their 20s are most likely to be using the pill as their primary form of birth control.

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How does contraception use vary by race?

Non-Hispanic white women used the pill at higher rates than Hispanic and Non-Hispanic Black women. Non-Hispanic white women used male condoms as their primary form of birth control at lower rates than Hispanic and Non-Hispanic Black women. Rates of usage of female sterilization and LARCs were similar across the three racial groups.[3]

White women use the pill at twice the rate of Hispanic or Black women.

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[1]

The CDC report did not include data about Asian American, American Indian or Alaska Native or Native Hawaiian or Other Pacific Islander groups.

[2]

Women who used more than one method of contraception simultaneously were classified by the more effective method.

[3]

This includes procedures such as vasectomies, tubal ligations, and hysterectomies.

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