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Contraceptive use projections: 1990 to 2010.

Abstract：

:Factors that will affect both contraceptive use and choice of method during the next 20 years are reviewed. Two factors are predictable: the changing age distribution of women and the revised upper-age limits for oral contraceptive use, with the effect of the latter as yet unknown. Less predictable factors include the number of women in each age group at risk for pregnancy, the effects of delayed childbearing and sterilization, and the impact of new contraceptive methods. Unpredictable factors include adverse publicity about oral contraceptives and breast cancer, concern about sexually transmitted diseases and acquired immunodeficiency syndrome, and changes in the availability of legal abortion. Numbers of women using oral contraception, other reversible methods, sterilization, and no method are projected from 1990 to 2010 under the assumption that use patterns in each age group resemble those observed in 1988. We conclude that discrepancies between projections of contraceptive use and fact are likely to occur because of the unpredictable nature of these few important variables. :Predictable factors affecting contraceptive use are changes in the age distribution among women of reproductive age and changes in upper age limits for oral contraceptive (OC) use. More women will be in the older cohorts over the next 20 years. The US Food and Drug Administration lifted restrictions on OC use for older women regardless of smoking and health status which will effect a change in contraceptive usage, yet it is not know to what degree physicians will prescribe OCs to older women and whether women will avoid them or use them instead of sterilization to reap the health benefits of OC use. Other less predictable factors affecting contraceptive usage are sexual activity, delayed childbearing and sterilization, and impact of new methods. Between 1982 and 1988, the percentage of sexually active 15-19 year old girls increased from 43% to 51%, and there are no indications that it will decline despite media attention about AIDS. In 1988, 67-75% of women were at risk of pregnancy. Delayed childbearing may reduce the sterilization rate and increase OC use. Unpredictable factors affecting contraceptive usage include publicity about contraceptive methods, concern about AIDS and sexually transmitted diseases (STDs), and availability of legal abortion. As long as the public perceives OCs to pose a risk for breast cancer, OC use may fall. Concerns about AIDS and STDs may increase barrier method use. Already many physicians in the US do not perform abortion even though it is still legal. Factors that reduce the availability of legal abortion or make it more expensive may result in women using more effective contraceptives. Between 1990 and 2010, projections show OC use falling somewhat through 2000 and then picking up again. Levels of other reversible methods' use will continue as they are now and then fall a bit after 2000. The number of women who use no contraceptive will not change. Sterilization will increase through 2000 and then fall.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Trussell J,Vaughan B

doi

10.1016/s0002-9378(12)90405-6

subject

Has Abstract

pub_date

1992-10-01 00:00:00

pages

1160-4

issue

4 Pt 2

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(12)90405-6

journal_volume

167

pub_type

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Contraceptive use projections: 1990 to 2010.