Trends in Long-Acting Reversible Contraception Use in Adolescents and Young Adults: New Estimates Accounting for Sexual Experience

Abstract

Purpose: The purposes of the analysis were to compare long-acting reversible contraception (LARC) use estimates that include all reproductive age women with estimates that are limited to women at risk for unintended pregnancy and to examine trends for adolescents (15-19 years) and young adults (20-24 years).

Methods: Using the 2006-2010 and 2011-2013 National Surveys of Family Growth, we compared LARC estimates for all women with estimates limited to women at risk for unintended pregnancy (those who were sexually experienced, and neither pregnant, seeking pregnancy, postpartum or infecund). We used t tests to detect differences according to the population included and to evaluate trends for adolescents and young adults.

Results: Among adolescents and young adults, 56% and 14%, respectively, have never had vaginal intercourse, versus 1%-4% for women aged 25-44 years. Given the high percentage of adolescents and young adults who never had vaginal intercourse, LARC estimates were higher for these age groups (p < .05), but not for women aged 25-44 years, when limited to those at risk for unintended pregnancy. Among adolescents at risk, the increase in LARC use from 2006-2008 (1.1%) to 2008-2010 (3.6%) was not significant (p = .07), and no further increase occurred from 2008-2010 to 2011-2013 (3.2%); by contrast, among young adults at risk, LARC use increased from 2006-2008 (3.2%) to 2008-2010 (6.9%) and from 2008-2010 to 2011-2013 (11.1%).

Conclusions: Because many adolescents and young adult women have never had vaginal intercourse, for these groups, including all women underestimates LARC use for pregnancy prevention. Among young adults, use of LARC for pregnancy prevention has increased but remains low among adolescents.

Keywords: LARC (long-acting reversible contraception); NSFG (National Survey of Family Growth); Sexual experience; Youth-friendly services.

Figure 1

Percentage distribution of women by category of risk for unintended pregnancy and age group, National Survey of Family Growth, 2006–2010 and 2011–2013. ^*Women are considered at risk if they have ever had vaginal intercourse and are not pregnant, seeking pregnancy, postpartum, or infecund.

Figure 2

Percentage of women using LARC by age group, National Survey of Family Growth, 2006–2010 and 2011–2013. ^*Women are considered at risk if they have ever had vaginal intercourse and are not pregnant, seeking pregnancy, postpartum, or infecund.

Figure 3

Percentage of women aged 15–19 and 20–24 years at risk for unintended pregnancy^* using LARC, National Survey of Family Growth, 2006–2008, 2008–2010, and 2011–2013. ^*Women are considered at risk if they have ever had vaginal intercourse and are not pregnant, seeking pregnancy, postpartum, or infecund.