A Century of Contraceptive Use in America: Lessons from the Past, Challenges of the Future Jacqueline E. Darroch, Ph.D. Seattle, WA Society of Family Planning October 1, 2009 Los Angeles, CA

American women’s average number of children fell from 7 in 1800 to 3.6 in 1900 and 2.1 in 2000.

3 The risk of dying from pregnancy and childbirth fell from almost 1 in 1,000 in 1900 to 1 in 100,000.

4 The timing and character of women’s early reproductive lives has changed. Menarche 14.7 Menarche 12.6 Marriage 21.9 First birth 23.7 First birth 26.0 Marriage 25.1 Intercourse 17.4 Median age at key events

Skuy, 1995.

6 First Half of the 1900s: Condom, Douche and Withdrawal 1978 retrospective survey of white, ever married women born , who were in their prime reproductive ages in the 1920s and % of women had used a contraceptive; another 16% had used douche for hygiene; 11% never used either. 35% of women used a contraceptive before their first birth. 4% had used contraceptive sterilization, but 9% had been surgically sterilized by age 35 and 23%, by age 45.

7 Women born used a variety of contraceptive methods, especially condom, douche and withdrawal.

9 Mid-1900s: Condom, Diaphragm and Periodic Abstinence 1955 Growth of American Families surveyed white married women % had used a contraceptive; 34% before their first pregnancy Family planning clinics in some areas had started to offer diaphragms, spermicides and condoms

10 Contraceptive users in 1955 had the same choice of methods as earlier; most common were diaphragm, condom and rhythm.

11 bestcontraceptionmethods.com 1960s: New methods – pill, IUD, office-based sterilization and more…..

12 Condom, diaphragm or periodic abstinence were the most commonly used methods in 1955.* *White married women aged 18-39;

13 Method use changed dramatically in the 1960s, with advent of the pill, IUD and office-based sterilization. 1955: White married women aged 18-39; other years: all married women

14 Pill and IUD use dropped after the mid-1970s with concerns about health impacts; sterilization rose steeply. 1955: White married women aged 18-39; other years: all married women

15 Starting in the 1980s, more users chose condoms, the pill and new long-acting methods. 1955: White married women aged 18-39; other years: all married women

16 Most never-married contraceptors rely on the pill. In the mid- 1990s, condom use peaked and long-acting method use rose :All never-married women : Non-cohabiting never-married women,

17 A Century of Change Social and sexual behavior Health risks of pregnancy Methods available Patterns of method use

18 Men’s participation accounted for 53% of contraceptive use in 1955, but for 32% in Married white women All women Married white women All women 15-44

19 Episodic methods were 94% of use in 1955, but 24% in 2002; long-acting methods rose from 6% to 45% of total use Married white women All women Married white women All women 15-44

20 Access to clinical providers was required for 30% of method use in 1955, but 76% of use in Married white women All women Married white women All women 15-44

21 Lessons from the past, Challenges of the Future Balancing expectations and reality of contraceptive methods Assuring access to a wide range of methods, including higher-cost and long-acting methods Focus on both use and use-effectiveness, especially for episodic and user-controlled methods Negotiating control of method use: user—partner—provider Technology affects method choice and use.

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