Improving contraceptive use in the United States.

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.