Why Is Birth Control Use Declining in U.S. Women?

In late 2004, the National Center for Health Statistics released a report analyzing contraceptive usage in the United States from 1982-2002. The report discovered an interesting statistic — the percentage of adult women who had sex in the previous three months but did not use contraception rose from 5.4 percent in 1995 to 7.4 percent in 2002.

The increase was statistically significant and occurred only in adult women over the age of 20 — contraceptive use by teens was unchanged.

The Washington Post reported on the increase noting,

Because the survey is so large (more than 7,600 women) and known for its accuracy, “an increase of even two percentage points is worrisome,” said John S. Santelli, a professor of population and family health at the Mailman School of Public Health at Columbia University. Even as he cheered the news that a growing number of teenagers are using contraception, Santelli wondered whether doctors are neglecting women.

“Maybe we’re failing with women over 21,” Santelli said.

Much of the speculation about the increase centered around the possibility that women are finding the cost of birth control to be too expensive,

Jeffrey Jensen, director of the Women’s Health Research Unit at Oregon Health and Science University, said he regularly encounters patients who have trouble affording birth control, even if their private insurance covers it.

“It is absolutely unconscionable that women have a co-pay of $20 or $25 [month] for contraceptives and men are getting off scot-free,” Jensen said. Drug companies “have cut way back” on free samples and many women turn to less effective types of birth control because of cost, he said, “running a greater risk of pregnancy as a result.”

Not sure why Jensen feels the need to turn this into a men vs. women thing (men “get off scot-free”). The last time I checked, no major insurance company covers the primary male contraceptive — condoms.

Another speculation is that there was a decline in comprehensive sex education as the abstinence movement gained steam in the 1980s and 1990s. According to the Washington Post,

Several recent studies found that as the abstinence-until-marriage movement surged, there was a “considerable drop” in comprehensive sex education from 1988 to 2000, Santelli said. “Women in their twenties have probably gotten less effective information about contraception,” he said.

Or it could simply be a one-time outlier in the sample. After all, the difference between 1995 and 2002 women who had sex without using contraception was only 129 out of the 6,493 women 20 or over interviewed in the survey.


More women opting against birth control, study finds. Ceci Connolly, Washington Post, January 4, 2005.

Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002. Joyce C. Abma, PhD.; Gladys M. Martinez, PhD.; William D. Mosher, PhD.; and Brittany S. Dawson, M.P.P., Division of Vital Statistics. December 2004.

Netherlands Ends Free Contraception Program

The Netherlands recently ended its policy of providing free contraception to all women over the age of 21.

The free contraception policy, in combination with aggressive sexual education programs, was widely credited with the Netherlands having the lowest teenage pregnancy and abortion rates in Europe.

Teen pregnancy and abortion in the Netherlands has grown in recent years, but that increase is largely due to immigration — 60 percent of abortions in the Netherlands are obtained by members of ethnic minorities.

The government cited the high cost of maintaining the birth control subsidy as the reason for eliminating it.


Dutch abandon free contraception for all. Angus Roxburgh, BBC News, January 15, 2004.

Researchers Develop Effective Male Contraceptive

Researchers at the Anzac Research Institute in Sydney, Australia, announced in October that a small clinical trial of a male contraceptive found the drug 100 percent effective and side-effect free.

The trial involved 55 men who received a combination of implants and injections designed to stop production of sperm.

The men were given injections of progestin every three months. The progestin signals the body to stop producing sperm. It also shuts down all testosterone production, so the men were also given a testosterone implant that has to be replaced every four months.

When injections and implant treatment were stopped, the men’s sperm production went back to normal levels indicating the contraceptive effect is completely reversible.

Leader researcher David Handelsman noted the significance of the trial saying that,

This is the first time a reversible male contraceptive that will suppress sperm production reliably and reversibly has been fully tested by couples. This shows the way for a final product to be a single injection containing testosterone and a progestin which will easily be given by local doctors on a three-four monthly basis and still maintain male sexual health.

Larger clinical trials of the male contraceptive will have to take place before it reaches market, but this is likely to be fast tracked if these sort of results continue to hold up.


Male contraceptive proves 100% effective. BetterHumans.Com, October 6, 2003.

Male contraceptive ‘100% effective’. The BBC, October 6, 2003.

Study of High Dose Oral Contraceptives Finds Low Death Rates

When the first oral contraceptives were introduced in the 1970s, they used relatively high doses of estrogen. Acting on the widely held view that lower doses of estrogen were safer, pharmaceutical companies gradually replaced the high dose pills with low dose versions. A new study of women who took high dose oral contraceptives, however, suggest that the concern over the high dose pills was misplaced.

Researchers at the Oxford Family Planning Association studied 17,032 women who visited family planning clinics in England and Scotland from 1968 to 1974.

Of the women how used high dose oral contraceptive, the death rate was actually 11 percent lower than for women who did not use high dose oral contraceptives. Due to the uncertainties in epidemic studies, that should not be read as implying that high dose contraceptives had a protective effect, but rather that their effect on the total death rate is not significant.

Which is not to say that high dose oral contraceptives might not contribute to some diseases. The study found that users of high dose oral contraceptives had much higher death rates from cervical cancer than non-users. But this was more than offset by a far lower risk of ovarian and other uterine cancers among users of high dose oral contraceptives.

The study confirmed that the major risk factor among the women in the study, both users and non-users of high dose oral contraceptives. Heavy smokers in the study had a death rate 100 percent higher than that of non-smokers.


Death rate low in former oral contraceptive users. Karla Gale, Reuters Health, July 18, 2003.

James Madison University Decides to Ban Distribution of Morning After Pills

The Washington Post had an interesting story in April about James Madison University’s decision to stop the dispensing of the morning after pill in its campus health center after complaints from anti-abortion activists.

The health center had been prescribing and dispensing the morning after pills for eight years. Ann Simmons, a nurse at the health center, told the Washington Post that the Food and Drug Administration classifies morning after pills as contraceptives as opposed to abortion inducing drugs such as RU-486.

But Virginia State Delegate Robert Marshall sent a letter to James Madison University President Linwood Rose objecting to the distribution of the morning after pill. From there, a little politics was added to the mix.

James Madison University board Mark Obenshain is running for Virginia Senate. A local entrepreneur who supports another candidate distributed the letter to antiabortion activists pointing out that candidate Obenshain is a board member.

In April Obenshain then demanded an explanation about the distribution of the morning after pill and then successfully pushed the board to enact a ban on the contraceptive that passed 8-6.

Students at James Madison University obtained almost 3,000 signatures on a petition to ask the board to reverse its ban on the distribution of the morning after pill. That petition was taken up at the June meeting of the board which tersely reported that,

Neither the [Education and Student Life] committee nor the full board took any action on the request.

So for the moment, James Madison University students will have to go to off-campus pharmacies to have their morning after prescriptions filled.


Pill ban gives birth to protest. Laura Sessions Stepp, Washington Post, April 24, 2003.

Summary Of Action By JMU Board Of Visitors. Press Release, James Madison University, June 6, 2003.

Argentina Judge Bans Contraception

Argentine judge Cristina Garzon De Lascano ruled in May that oral contraceptives and intrauterine devices should be banned because they constitute abortion. According to the BBC, de Lascano ordered the destruction of all existing stocks of such medications and devices.

This is not the first time de Lascano has made controversial rulings related to reproductive health. In 2001, she ordered a ban on the morning-after pill, and in February ruled that Argentina’s laws protecting women’s reproductive health could not be applied in Cordoba province. She was overruled by a higher court on that last decision.

The BBC reported that Argentine health minister Gines Gonzalez Garcia vowed to fight to reverse de Lascano’s latest judgment, characterizing it as,

. . . absurd and based on the plea of religious fundamentalists, without consulting a single a medical academic at the Health Ministry.

Abortion is illegal in Argentina, but an estimated 400,000 women have abortions every year anyway.


Argentine contraceptive ban ‘absurd’. The BBC, May 24, 2003.