Trends in initiation of hormonal contraceptive methods among teenagers born between 1989 and 1997 in Norway and the United States



      To assess initiation of hormonal contraception among women aged 15-19 in the US and Norway by birth cohort.

      Study design

      We used population-based survey (US) and administrative (Norway) data to estimate the cumulative probability of age at first use of hormonal contraception for female residents born between 1989 and 1997 in 3-year birth cohorts. Differences between countries were assessed using confidence intervals, and differences between birth cohorts were assessed using survival analysis.


      At age 15, first use of any hormonal method was higher among US respondents (16%-17% US vs 10%-13% Norway), whereas for ages 16 to 19 use was higher among Norwegian women (by age 19, 60%-64% US vs 76%-78% Norway). Similar patterns were observed for pill use; however, depot medroxy-progesterone acetate (DMPA), implant, and intrauterine device (IUD) use tended to be higher among US women. In both countries, cumulative first use of the pill, patch, ring, and DMPA declined across birth cohorts while first use of implants and IUDs increased.


      Age at initiation and type of first hormonal method use differed between US and Norwegian teenagers. These differences may contribute to the lower teen birth rate in Norway.


      Age at initiation of hormonal contraception among teenagers is earlier in Norway than in the United States, and types of hormonal methods used vary. These differences may contribute to the lower teen birth rate in Norway.


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        • Sedgh G
        • Finer LB
        • Bankole A
        • Eilers MA
        • Singh S.
        Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends.
        J Adolesc Health. 2015; 56: 223-230
        • Martin JA
        • Hamilton BE
        • Osterman MJK
        Births in the United States, 2019. NCHS Data Brief..
        Natl Vital Stat Rep. 2020; 387 (. PMID: 33054913): 1-8
      1. United Nations Department of Economic and Social Affairs Population Division World Fertility Data 2019.

        • Santelli J
        • Sandfort T
        • Orr M.
        Transnational comparisons of adolescent contraceptive use: what can we learn from these comparisons?.
        Arch Pediatr Adolesc Med. 2008; 162: 92-94
        • Schalet A.
        Not under my roof: Parents, teens, and the culture of sex.
        University of Chicago Press, Chicago2011
        • Orenstein P
        • Park I.
        What will happen when Americans start having sex again? Opinion.
        New York Times, New York2021
        • Jones EF
        • Forrest JD
        • Goldman N
        • Henshaw SK
        • Lincoln R
        • Rosoff JI
        • Westoff CF
        • Wulf D
        Teenage pregnancy in developed countries: determinants and policy implications.
        Fam Plann Perspect. 1985; 17 (. PMID: 3842654): 53-63
        • Jones EF
        • Forrest JD
        • Henshaw SK
        • Silverman J
        • Torres A.
        Unintended pregnancy, contraceptive practice and family planning services in developed countries.
        Fam Plann Perspect. 1988; 20: 53-67
        • Egeland I.
        Sex education in Norway.
        IPPF Eur Reg Inf. 1978; 7: 3-4
        • Hognert H
        • Skjeldestad FE
        • Gemzell-Danielsson K
        • et al.
        Ecological study on the use of hormonal contraception, abortions and births among teenagers in the Nordic countries.
        BMJ Open. 2018; 8e022473
        • Bartz T.
        Sex education in multicultural Norway.
        Sex Edu. 2007; 7: 17-33
        • Fowler CI
        • Ahrens KA
        • Decker E
        • et al.
        Patterns and trends in contraceptive use among women attending Title X clinics and a national sample of low-income women.
        Contracept X. 2019; 1100004
        • Kavanaugh ML
        • Jerman J.
        Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014.
        Contraception. 2018; 97: 14-21
        • Bearak JM
        • Jones RK.
        Did contraceptive use patterns change after the affordable care act? A descriptive analysis.
        Womens Health Issues. 2017; 27: 316-321
        • Pace LE
        • Dusetzina SB
        • Keating NL.
        Early impact of the affordable care act on uptake of long-acting reversible contraceptive methods.
        Med Care. 2016; 54: 811-817
        • Anonymous
        Prevention of unwanted pregnancies and abortions. Guidelines for the rights of nurses and midwives to order contraceptives for young women aged 16 to 19 years. Circular I-3/2002.
        Norwegian Directorate of Health, Oslo2002
        • Anonymous
        Extended right of requisition for nurses and midwives for contraception - Nurses and midwives’ administration of long-acting, reversible contraception (LARC). Circular IS-13/2015.
        Norwegian Directorate of Health, Oslo2015
        • Almås J-O
        • Jacobsen S.
        Prevention of unwanted pregnancies and abortions among teenagers. Introduction of a fixed contribution rate for coverage of expenditure on hormonal contraception to young women aged 16 to 19 years. Circular I-1/2006.
        Norwegian Directorate of Health, Oslo2006
        • Martinez GM
        • Abma JC.
        Sexual Activity and Contraceptive Use Among Teenagers Aged 15-19 in the United States, 2015-2017.
        NCHS Data Brief. 2020; 366 (. PMID: 32487286): 1-8
        • Træen B
        • Štulhofer A
        • Landripet I.
        Young and sexual in Norway and Croatia: revisiting the scandinavian versus mediterranean gendered pattern of sexual initiation.
        Int J Sex Health. 2011; 23: 196-209
        • Stigum H
        • Samuelsen SO
        • Traeen B.
        Analysis of first coitus.
        Arch Sex Behav. 2010; 39: 907-914
        • Janis JA
        • Ahrens KA
        • Ziller EC.
        Female age at first sexual intercourse by rural-urban residence and birth cohort.
        Womens Health Issues. 2019; 29: 489-498
        • Anonymous
        ACOG Committee Opinion No. 735: Adolescents and long-acting reversible contraception: Implants and intrauterine devices.
        Obstet Gynecol. 2018; 131 (. PMID: 29683910): e130-e139
        • Henry N
        • Schlueter M
        • Lowin J
        • et al.
        Cost of unintended pregnancy in Norway: a role for long-acting reversible contraception.
        J Fam Plann Reprod Health Care. 2015; 41: 109-115
        • Santelli JS
        • Morrow B
        • Anderson JE
        • Lindberg LD.
        Contraceptive use and pregnancy risk among U.S. high school students, 1991-2003.
        Perspect Sex Reprod Health. 2006; 38: 106-111
      2. Contraceptive Efficacy. Contraceptive Technology. Figure 3-1 Comparing typical effectiveness of contraceptive methods.

        • Murray Horwitz ME
        • Ross-Degnan D
        • Pace LE
        Contraceptive initiation among women in the United States: timing, methods used, and pregnancy outcomes.
        Pediatrics. 2019; 143e20182463
      3. Healthy People 2020. Family Planning Objectives. 2020.

      4. Population Division, United Nations Department of Economic and Social Affairs, SDG indicators metadata repository, indicator 3.7: 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

        • Skjeldestad FE.
        Prescribing contraception for young women.
        Tidsskr Nor Laegeforen. 2012; 132: 292-294
      5. National Survey of Family Growth., accessed date Auugust 13, 2021.

        • Bakken IJ
        • Skjeldestad FE
        • Schøyen U
        • Husby MG.
        Strong decline in female sterilization rates in Norway after the introduction of a new copayment system: a registry based study.
        BMC Womens Health. 2007; 7: 12
        • True K
        • Bajos N
        • Bohet A
        • Moreau C.
        Timing of contraceptive initiation and association with future sexual and reproductive outcomes.
        Hum Reprod. 2014; 29: 1651-1658
        • Daniels K
        • Abma JC.
        Current contraceptive status among women aged 15-49: United States, 2017-2019.
        NCHS Data Brief. 2020; 388 (. PMID: 33151146): 1-8
        • Kearney MS
        • Levine PB.
        Why is the teen birth rate in the United States so high and why does it matter?.
        J Econ Perspect. 2012; 26: 141-166
      6. The initial reproductive health visit: ACOG Committee Opinion, Number 811.
        Obstet Gynecol. 2020; 136: e70-e80
        • Triebwasser JE
        • Higgins S
        • Secura GM
        • Zhao Q
        • Peipert JF.
        Pharmacy claims data versus patient self-report to measure contraceptive method continuation.
        Contraception. 2015; 92: 26-30
        • Lindberg LD
        • Firestein L
        • Beavin C.
        Trends in U.S. adolescent sexual behavior and contraceptive use, 2006-2019.
        Contracept X. 2021; 3100064
        • Santelli J
        • Sandfort TG
        • Orr M.
        U.S./European differences in condom use.
        J Adolesc Health. 2009; 44: 306
        • Pazol K
        • Whiteman MK
        • Folger SG
        • Kourtis AP
        • Marchbanks PA
        • Jamieson DJ.
        Sporadic contraceptive use and nonuse: age-specific prevalence and associated factors.
        Am J Obstet Gynecol. 2015; 212 (324.e1-8)