Contraception in the United States: A Closer Look at Experiences, Preferences, and Coverage
Contraceptive care is an important component of overall health care for many people. Federal and state policies shape access to and the availability of contraceptive care, but factors such as provider characteristics, as well as individual preferences and experiences also impact contraceptive choices and use. This report provides a close examination of reproductive age (18-49) females’ (including those who identify as women and other genders) experiences with contraception, insurance coverage, contraceptive preferences, and interactions with the health care system based on an analysis of the 2022 KFF Women’s Health Survey, a nationally representative survey of females ages 18 to 64 in the U.S.
Use of Contraceptives
The majority of females 18 to 64 (90%) have used contraception at some point in their reproductive years and many have used more than one contraceptive method throughout their lifetime (76%). People’s needs and preferences for different types of methods can change and speaks to the importance of having a broad range of contraceptive options available. Not surprisingly, most people use contraception to prevent pregnancy (85%), but four in ten also say that they use contraception for another reason such as managing a medical condition or preventing a sexually transmitted infection (STI).
Not all people who want to prevent pregnancy use contraceptives. One in six (17%) sexually active females who say they are not trying to get pregnant are not using contraception. There are many reasons why people may not use contraceptives, ranging from concerns about side effects, lack of desire to use a method, to those who aren’t trying but would not mind if they got pregnant or have religious reasons.
Although the ACA has required contraceptive coverage for over a decade, many still do not know about the policy and some privately insured females are still paying for their contraceptives. Four in ten (41%) females of reproductive age do not know that most insurance plans are required to pay the full cost of birth control for women.
While most females (70%) with private insurance say their insurance covered the full cost of their most recent birth control method, a quarter say they paid at least part of the cost out-of-pocket. Of those who paid out of pocket, 16% say it was because they wanted a certain brand of contraception that was not covered by their plan (even though their plan should cover it if their provider recommends it for them). Others say it is because their prescribing provider (10%) or pharmacy (5%) was out of network. Half did not know why they had to pay.
Cost can be a barrier to contraceptive use for some. One in five uninsured females of reproductive age say they had to stop using a contraceptive method because they couldn’t afford it. A smaller share of those on Medicaid (6%) or with private coverage (3%) cited cost as a barrier to continued use. For low-income women, 17% said cost was the leading reason they weren’t using their preferred method.
Contraceptive Preferences and Side Effects
Overall, one quarter of females who are using contraception are not using their preferred method. The leading reason for this is concern about side effects, a theme that comes up in many aspects of contraceptive care. Almost one-third of contraceptive users (31%) say they are experiencing side effects from their current method, and just over half (52%) say the side effects are more severe than they expected.
Just 30% of females say they received all the information they needed before choosing their birth control method. This is even lower among Asian/Pacific Islander females, just 12% of whom say they had all the information they needed before choosing a method, compared to more than a quarter of Hispanic (26%) and Black (28%) females and one-third of White females (34%). Person-centered contraceptive counseling is a key element to assuring people can select the contraceptive method that suits them. However, only 40% of those receiving contraceptive care rate their most recent contraceptive counseling as “excellent.”
The majority of reproductive age females get their birth control care at a doctor’s office (77%) and prefer to get their care there, even as more services have become available online with growing numbers of online contraception platforms. Many also rely on clinics and health centers for their care, particularly those who are low-income, uninsured, Black or Hispanic. Far fewer (7%) have received a prescription or obtained a health care service from an online company in the prior 12 months. Convenience is the main reason those who would prefer to get their birth control care from an online company cite for their preference.
Emergency contraceptive pills (EC) are an effective form of back up birth control, but a sizable minority of people who might benefit from them don’t know where to get them or that they’re available over the counter. Emergency contraceptive pills, which can be taken to prevent pregnancy after a contraceptive failure or unprotected sex, have been available over the counter for more than 15 years. One in four reproductive age females (27%) either don’t know EC pills are available over the counter or have never heard of them. Among those who have heard of EC pills and could become pregnant, three in ten (31%) don’t know where they could get it.
Not only was there a lack of awareness about where to get emergency contraceptive pills, but even before the Supreme Court overturned Roe v. Wade, few knew where they could get an abortion if they needed one. Prior to the ruling in Dobbs, just one-quarter (26%) of females ages 18-49 said they knew what clinic or health care provider they could go to for an abortion if they wanted or needed one. Smaller shares of females living in rural areas, where services are more limited, knew where they could go to get an abortion compared to females living in more urban areas (16% vs. 28%).
Access to abortion and contraception continues to remain at the center of policy debates across the nation. Not only has abortion access been banned in many states, but access to effective methods to prevent pregnancy, like emergency contraceptive pills and long-acting reversible contraception (such as IUDs), may also become restricted. Doctors and health care providers are trusted sources of information for many people, which means they could play an important role in filling information gaps and addressing misinformation. While the ACA preventive services coverage requirement has markedly improved the affordability of contraceptives, the policy is being challenged yet again in the courts by those who object to preventive services such as contraception on religious or moral grounds. The outcomes of these debates, along with state, federal and private sector actions will continue to shape the availability and use of contraceptive care for millions in the years to come.
This work was supported in part by Arnold Ventures. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.