Socioeconomic differences persist in use of permanent vs long-acting reversible contraception: An analysis of the National Survey of Family Growth, 2006 to 2010 vs 2015 to 2017



      Permanent contraception has historically been more prevalent among non-White women with lower education and income. Given increasing popularity of long-acting reversible contraception (LARC), we examine changing sociodemographic patterns of permanent contraception and LARC.

      Study design

      We performed a descriptive analysis of the National Survey of Family Growth (NSFG) from 2006 to 2017, with multivariable analyses of the 2006 to 2010 and 2015 to 2017 cohorts. Using multinomial logistic regression, we investigate predictors of contraceptive category (permanent contraception vs LARC, lower-efficacy contraception vs LARC) in reproductive-aged women.


      Total 8161 respondents were included in 2 distinct but analogous regression analyses: (1) the most recent survey cohort, 2015 to 2017 and (2) the cohort a decade prior, 2006 to 2010. Over this period, the prevalence of LARC increased nearly 3-fold (6.2%–16.7%), while permanent contraception use trended downwards (22%–18.6%). Yet, in adjusted models, we observed little change in the sociodemographic predictors of permanent contraception: from the early to recent cohort, use of permanent contraception (vs LARC) remained less likely among college graduates (multinomial odds ratio (OR) 0.45 [95% confidence interval 0.21, 0.97]) and Hispanic women (OR 0.41 [0.21, 0.82]). In addition, high income (>$74,999) and metropolitan residence came to predict less use (OR 0.33 [0.13, 0.84] and 0.47 [0.23, 0.97]). Multiparity, advanced age (over ≥35), and marital status remained strong predictors of permanent contraception.


      Although use of LARC nearly equals that of permanent contraception in the most recent NSFG survey, socioeconomic differences persist. Continued effort is needed to detect and address structural barriers to accessing the most effective forms of contraception for women.


      Comparing 2006–2010 to 2015–2017, reliance on female permanent contraception decreased while LARC use increased, making prevalence more similar. However, significant socioeconomic differences persist in who chooses permanent contraception, with urban, educated, higher income women more likely to use LARC. Ongoing efforts are needed to understand and reduce economic barriers to LARC.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Daniels K.
        • Daugherty J.
        • Jones J.
        Current contraceptive status among women aged 15-44: United States, 2011-2013.
        NCHS Data Brief. 2014; 173: 1-8
        • Kavanaugh M.L.
        • Jerman J.
        Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014.
        Contraception. 2018; 97: 14-21
        • Kraemer D.F.
        • Yen P.Y.
        • Nichols M.
        An economic comparison of female sterilization of hysteroscopic tubal occlusion with laparoscopic bilateral tubal ligation.
        Contraception. 2009; 80: 254-260
        • Shreffler K.M.
        • McQuillan J.
        • Greil A.L.
        • Johnson D.R.
        Surgical sterilization, regret, and race: contemporary patterns.
        Soc Sci Res. 2015; 50: 31-45
        • Mutcherson K.
        Disability, procreation, and justice in the United States.
        Laws. 2017; 6: 27
        • Page J.M.
        State-sponsored injustice.
        Soc Theory Pract. 2019; 45: 75-101
        • Nelson J.P.
        • Davis T.B.
        • Atkins L.
        Reporting and reparations: news coverage and the decision to compensate the forcefully sterilized in North Carolina.
        Stud Media Commun. 2017; 5: 1
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • Buckel C.
        • Madden T.
        • Allsworth J.E.
        • et al.
        Effectiveness of long-acting reversible contraception.
        Obstet Gynecol Surv. 2012; 67: 552-553
        • Report MW
        US medical eligibility criteria for contraceptive use. 65. 2016
        • Branum A.M.
        • Jones J.
        Trends in long-acting reversible contraception use among U.S. women aged 15-44.
        NCHS Data Brief. 2015; 188: 1-8
        • Moniz M.H.
        • Chang T.
        • Heisler M.
        • Admon L.
        • Gebremariam A.
        • Dalton V.K.
        • et al.
        Inpatient postpartum long-acting reversible contraception and sterilization in the United States, 2008-2013.
        Obstet Gynecol. 2017; 129: 1078-1085
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in use of long-acting contraceptive methods in the United States, 2007-2009.
        Fertil Steril. 2012; 98: 893-897
        • Apodaca S.N.
        • Mendez M.D.
        • Sanchez S.S.
        • Mulla Z.D.
        Correlates of long-acting reversible contraception versus sterilization use in advanced maternal age.
        Ann Epidemiol. 2018; 28: 447-451
      1. Centers of Disease Control and Prevention. About NSFG US Dep Health and Human Services. National Center for Health Statistics.

        • Curtis K.M.
        U.S. selected practice recommendations for contraceptive use.
        2nd ed. Adapted from the World Health Organization selected practice recommendations for contraceptive use. 62. 2013
        • Haeger K.O.
        • Lamme J.
        • Cleland K.
        State of emergency contraception in the U.S., 2018.
        Contracept Reprod Med. 2018; 3: 1-12
        • Jackson A.V.
        • Karasek D.
        • Dehlendorf C.
        • Foster D.G.
        Racial and ethnic differences in women's preferences for features of contraceptive methods.
        Contraception. 2016; 93: 406-411
        • Callegari L.S.
        • Aiken A.R.A.
        • Dehlendorf C.
        • Cason P.
        • Borrero S.
        Addressing potential pitfalls of reproductive life planning with patient-centered counseling.
        Am J Obstet Gynecol. 2017; 216: 129-134
      2. Sister Song.

        • Borrero S.
        • Nikolajski C.
        • Rodriguez K.L.
        • Creinin M.D.
        • Arnold R.M.
        • Ibrahim S.A.
        “Everything I know I learned from my mother or not”: perspectives of African-American and white women on decisions about tubal sterilization.
        J Gen Intern Med. 2009; 24: 312-319
        • Borrero S.
        • Zite N.
        • Creinin M.D.
        Federally funded sterilization: time to rethink policy?.
        Am J Public Health. 2012; 102: 1822-1825
        • Gilliam M.
        • Davis S.D.
        • Berlin A.
        • Zite N.B.
        A qualitative study of barriers to postpartum sterilization and women's attitudes toward unfulfilled sterilization requests.
        Contraception. 2008; 77: 44-49