Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth

Aparna Sundaram; Barbara Vaughan; Kathryn Kost; Akinrinola Bankole; Lawrence Finer; Susheela Singh; James Trussell

doi:10.1363/psrh.12017

Contraception Comparative Studies

Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth

Sundaram A, Vaughan B, Kost K, Bankole A, Finer L, Singh S, Trussell J

Published March 2017 Perspectives on Sexual and Reproductive Health, 49(1), 7-16

DOI 10.1363/psrh.12017 PMID 28245088 PMC PMC5363251

RRM Academy Synopsis

Typical-use reversible contraceptive failure fell to 10% in 2006-2010

A national survey analysis of 6,683 U.S. women found that about 10 out of 100 first-year periods of reversible method use ended in pregnancy, down from about 12 out of 100 in 2002. The IUD and implant had the lowest estimate, about 1 out of 100. Withdrawal had the highest, about 20 out of 100.

About 1 in 10 women using a reversible method became pregnant within 12 months of typical use. Source: Sundaram A et al., 2017, PMID 28245088.

Study at a glance, national survey of 6,683 U.S. women: Typical-use reversible contraceptive failure fell to 10% in 2006-2010. Source: Sundaram A et al., 2017, PMID 28245088.

Key Findings

For all reversible methods combined, the probability of failure within 12 months of use was 10.3% in 2006–2010, compared with 12.4% in 2002 and 14.9% in 1995.
Typical-use 12-month probability of failure was 1.4% for the IUD and implant (high standard error), 4.0% for the injectable, 7.2% for the pill, 12.6% for the male condom and 19.9% for withdrawal.
The male condom's 12-month probability of failure fell from 17.8% in 1995 to 12.6% in 2006–2010. For hormonal methods and the IUD combined, it fell from 8.1% to 6.0%.
Across all methods combined, failure was 17.3% for women with household income under 100% of the federal poverty level and 6.3% for women at 200% or more.
Across all methods combined, failure was 5.2% for women with no previous births, 13.6% for women with one previous birth and 14.6% for women with two or more.

Interpretation

This survey analysis drew on nationally representative data, in which U.S. women aged 15 to 44 recalled their contraceptive use month by month, and the authors adjusted the results for unreported abortions using a separate survey of abortion patients. Typical-use figures include inconsistent or incorrect use. The authors suggest the declines may reflect changes in who uses each method, stronger motivation to avoid pregnancy, and increased use of more effective methods. The authors note possible recall error as a limitation. The findings support further study of why typical-use failure rates differ across methods and population groups.

RRM Context

Fertility awareness methods track the cycle to find fertile days. Restorative reproductive medicine treats the cycle as a vital sign, and calls the pill, injectable and implant suppressive medications. This paper measures pregnancy during method use.

Our editorial summary of this paper, not the article's abstract.

Abstract

Context

Contraceptive failure rates measure a woman's probability of becoming pregnant while using a contraceptive. Information about these rates enables couples to make informed contraceptive choices. Failure rates were last estimated for 2002, and social and economic changes that have occurred since then necessitate a reestimation.

Methods

To estimate failure rates for the most commonly used reversible methods in the United States, data from the 2006-2010 National Survey of Family Growth were used; some 15,728 contraceptive use intervals, contributed by 6,683 women, were analyzed. Data from the Guttmacher Institute's 2008 Abortion Patient Survey were used to adjust for abortion underreporting. Kaplan-Meier methods were used to estimate the associated single-decrement probability of failure by duration of use. Failure rates were compared with those from 1995 and 2002.

Results

Long-acting reversible contraceptives (the IUD and the implant) had the lowest failure rates of all methods (1%), while condoms and withdrawal carried the highest probabilities of failure (13% and 20%, respectively). However, the failure rate for the condom had declined significantly since 1995 (from 18%), as had the failure rate for all hormonal methods combined (from 8% to 6%). The failure rate for all reversible methods combined declined from 12% in 2002 to 10% in 2006-2010.

Conclusions

These broad-based declines in failure rates reverse a long-term pattern of minimal change. Future research should explore what lies behind these trends, as well as possibilities for further improvements.

Topics

Contraception

Comparative Studies Contraception Versus Fertility Awareness

Contraception › Comparative Studies › Contraception Versus Fertility Awareness

Aparna Sundaram, Barbara Vaughan, Kathryn Kost, Akinrinola Bankole, Lawrence Finer, Susheela Singh, James Trussell

A Sundaram, Barb Vaughan, B Vaughan, Kathy Kost, Kate Kost, K Kost, A Bankole, Larry Finer, L Finer, S Singh, Jim Trussell, Jimmy Trussell, J Trussell

PMID 28245088 28245088 DOI 10.1363/psrh.12017 10.1363/psrh.12017 Sundaram et al. 2017, Sundaram 2017

Keywords

Abortion, Induced/statistics & Numerical Data, Coitus Interruptus, Condoms, Contraceptive Agents, Drug Implants, Equipment Failure/statistics & Numerical Data, Female, Humans, Intrauterine Devices, Pregnancy, Pregnancy Rate, Surveys and Questionnaires, Treatment Failure, United States, Contraceptive Agents, Drug Implants

Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth

Typical-use reversible contraceptive failure fell to 10% in 2006-2010

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords