Abstract
Objectives
The risk of pregnancy is estimated to be 20 times as high among women who use oral
contraception, and 90 times as high among condom users, as among women who use certain
long-acting contraceptive methods. We explored the population-level implications of
this variation in contraceptive efficacy.
Study design
We used the FamilyScape 3.0 microsimulation model to study the effects on the nonmarital
pregnancy rate of movements along two different margins of contraceptive behavior:
the extensive margin, which captures decisions about whether to initiate use of any
method of contraception among noncontraceptors; and the intensive margin, which captures
the choice of methods among contraceptors. The model is populated with a nationally
representative sample of 50,000 women who are of childbearing age.
Results
The impact on the number of nonmarital pregnancies would not be substantially different
if noncontraceptors adopted long-acting methods than if they began using oral contraception.
Moreover, the nonmarital pregnancy rate would be reduced by about twice as much if
a subset of noncontraceptors began using condoms as if an equal number of pill users
took up long-acting methods.
Conclusions
The prevailing emphasis on long-acting contraception is somewhat misplaced. Policymakers
and practitioners will have the largest effects on fertility outcomes if they can
change the behavior of sexually active women who neglect to use birth control when
they are not seeking pregnancy.
Implications
Women's decisions about which methods to use are less impactful than their decisions
about whether to use contraception at all. The policies that affect method choice
are likely to differ from the policies that address the underlying motivations of
noncontraceptors who are not seeking pregnancy.
Keywords
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Article Info
Publication History
Published online: March 29, 2016
Accepted:
March 23,
2016
Received in revised form:
March 18,
2016
Received:
June 19,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
