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Contraceptive Use Among Postpartum Women --- 12 States and New York City, 2004--2006

Postpartum use of highly effective contraceptive methods can prevent unintended pregnancies and ensure adequate birth spacing. Unintended pregnancies and short interpregnancy intervals are associated with adverse maternal and infant outcomes (1,2). In 2001, the year for which the most recent data are available, 49% of all pregnancies were unintended (3), and 21% of women gave birth within 24 months of a previous birth (4). Two Healthy People 2010 goals are to increase the percentage of intended pregnancies to 70% (objective 9-1) and to reduce the percentage of births occurring within 24 months of a previous birth to 6% (objective 9-2) (5). To estimate the prevalence and types of contraception being used by women 2--9 months postpartum, CDC analyzed data from the 2004--2006 Pregnancy Risk Assessment Monitoring System (PRAMS) from 12 states and New York City. This report summarizes those results, which indicated that 88.0% of postpartum women reported current use of at least one contraceptive method; 61.7% reported using a method defined as highly effective, 20.0% used a method defined as moderately effective, and 6.4% used less effective methods. Rates of using highly effective contraceptive methods postpartum were lowest among Asian/Pacific Islanders (35.3%), women who had wanted to get pregnant sooner (49.9%), women aged ≥35 years (53.0%), and women who had no prenatal care (54.5%). State policy makers and health-care providers can use these results to promote use of highly effective contraception among postpartum women and target interventions for those with particularly low rates of usage, including women with no prenatal care.

PRAMS began in 1987 as an ongoing, state- and population-based surveillance system designed to monitor maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live infants. The system currently is active in 39 reporting areas in the United States. PRAMS uses a mixed mode data-collection methodology; up to three self-administered questionnaires are mailed monthly to a stratified random sample of mothers selected from birth certificates 2--4 months after delivery (median = 3.7 months). Nonresponders receive follow-up telephone interviews. Self-reported survey data are linked to birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets.*

The PRAMS questionnaire in each state includes core questions that appear on all PRAMS surveys, optional standard questions, and questions developed by the state. The 2004--2006 surveys incorporated various topics, including current contraceptive practices. Respondents were asked, "Are you or your husband or partner doing anything now to keep from getting pregnant?" (core question) and "What kind of birth control are you or your husband or partner using now to keep from getting pregnant?" (standard question). Participants who responded "no" to the first question were classified as using no method and were not asked the second question, which included response options for 13 specific contraceptive methods and "other," with instructions to "check all that apply." The standard question about postpartum contraceptive method type was used by 14 reporting areas; however, to minimize bias resulting from nonresponse, this report only includes data from 13 reporting areas that achieved overall weighted response rates of ≥70% for at least 1 year of the study period. Responses from Arkansas, Florida, Louisiana, Michigan, Mississippi, North Carolina, Nebraska, New York, New York City, Oregon, Rhode Island, South Carolina, and West Virginia were assessed for this report. To focus on postpartum women at risk for unintended pregnancy or short interpregnancy interval, responses from women who were currently pregnant (n = 362) or not currently sexually active (n = 3,615) were excluded. Respondents who answered "yes" to the core question and either did not respond to the second question (n = 267) or only responded "other" (n = 310) also were excluded.

Contraceptive methods were categorized by effectiveness based on published effectiveness rates for typical use (6). Women reporting use of more than one contraceptive method were classified as using the more effective method based on a hierarchy of effectiveness rates during the first year of typical use (6). Contraceptive effectiveness was categorized as highly effective (<10% of women experience an unintended pregnancy; includes sterilization, intrauterine device, shot, pill, patch, and ring), moderately effective (10%--15% failure rate; includes condoms), and less effective (>15% failure rate; includes diaphragm, cervical cap, sponge, rhythm, and withdrawal). Chi-square testing was used to identify statistically significant differences between subcategories of maternal characteristics.

Among 43,887 postpartum women in the sample, 88.0% reported current use of at least one method of contraception during 2004--2006 (Table 1). Women with the lowest rates of using at least one method included those with no prenatal care (76.9%), women who reported that for their most recent pregnancy they wanted to get pregnant sooner (80.1%), Asian/Pacific Islanders (82.8%), and women aged ≥35 years (83.2%) (Table 2). Among all respondents, 61.7% reported using highly effective contraceptive methods, 20.0% relied on moderately effective methods, 6.4% used less effective methods, and 12.0% used no method. Prevalence of using highly effective contraceptive methods varied from 43.2% in New York City to 79.3% in Mississippi (Table 1). Use of highly effective postpartum contraceptive methods also varied by the respondent's age, ranging from 53.0% among women aged ≥35 years to 72.9% among those aged <20 years; and by race, ranging from 35.3% among Asian/Pacific Islanders to 71.3% among black women and 71.5% among American Indian/Alaska Native women (Table 2). Women with Medicaid coverage before pregnancy had a higher rate of using highly effective methods (67.8%) than women without Medicaid (60.6%), and women with no prenatal care had a lower rate of using highly effective methods (54.5%) than women with early (60.5%) or late (66.5%) entry into prenatal care.

Reported by: M Whiteman, PhD, K Curtis, PhD, S Hillis, PhD, L Zapata, PhD, DV D'Angelo, MPH, SL Farr, PhD, Y Zhang, PhD, W Barfield, MD, P Marchbanks, PhD, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; CL Robbins, PhD, EIS Officer, CDC.

Editorial Note:

Despite availability and use of contraceptives, the overall unintended pregnancy rate in the United States has remained stable (3) and is one of the highest among industrialized nations (51 per 1,000 women annually) (2,3,5). In addition, the percentage of births occurring within 24 months of a previous birth increased from 11% in 1995 (5) to 21% in 2002 (4) (the most recent data available), moving away from the Healthy People 2010 target of 6% (5). Increased use of highly effective postpartum contraception is an important strategy to both prevent unintended pregnancy in the postpartum period and prevent short interpregnancy intervals (7).

This is the first population-based report to examine the prevalence of contraceptive use among postpartum women by contraceptive method effectiveness. The finding that 88% of postpartum women reported current use of some form of contraception is consistent with previous estimates of 78%--90% (7--10). Rates of using at least one method were generally uniform across reporting areas and maternal characteristics, although women with no prenatal care had the lowest rate at 76.4%. However, the findings indicate substantial variation in use of highly effective contraceptive methods by reporting area and maternal characteristics. For example, some subgroups with the lowest rates of highly effective contraceptive method use included Asian/Pacific Islanders (35.3%), women who reported that their most recent pregnancy was wanted sooner (49.9%), women aged ≥35 years (53.0%), and women who had no prenatal care (54.5%). Additional analyses and research are needed to determine reasons for the variations found in the use of highly effective methods by reporting area and maternal characteristics.

These findings point to possible missed opportunities for promoting healthy birth spacing and reducing unintended pregnancies. Women who do not receive prenatal care, for example, might benefit from more consultation about postpartum contraceptive options. This population likely does not routinely access preventive health-care services. Therefore, for these women the period after delivery and before hospital discharge might constitute an especially opportune time for health-care providers to promote the use of effective contraception postpartum and adequate birth spacing.

Although use of condoms for protection against sexually transmitted diseases was not a focus of the study, 13% of the women reported use of condoms along with a highly effective method. All women not using condoms should be counseled regarding the use of condoms for the prevention of sexually transmitted diseases, including human immunodeficiency virus infection.

The findings in this report are subject to at least four limitations. First, although population based, these findings are not nationally representative and are generalizable only to mothers with recent live births in the 13 reporting areas. Second, because PRAMS data are self-reported, prevalence rates of desirable behaviors might be overestimated and those for undesirable behaviors might be underestimated. Third, the survey did not ascertain use of some additional contraceptive methods, such as spermicides, emergency contraception, and lactational amenorrhea. Finally, because of the survey skip pattern, information was not obtained about contraceptive methods used by women who might have incorrectly reported they were not doing anything currently to keep from getting pregnant. If this occurred, particularly among respondents who had a tubal ligation or whose partners had a vasectomy, the use of highly effective contraceptive methods might have been underestimated.

Knowing the characteristics associated with low rates of effective contraceptive use during the postpartum period will better enable health-care providers to target interventions. Health-care providers should consider encouraging postpartum women to use highly effective contraceptive methods to increase the proportion of pregnancies that are intended and promote healthy birth spacing.

Acknowledgments

The findings in this report are based, in part on contributions by members of the PRAMS Working Group; the CDC PRAMS Team, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

References

  1. Zhu BP, Rolfs RT, Nangle BE, Horan JM. Effect of the interval between pregnancies on perinatal outcomes. N Engl J Med 1999;340:589--94.
  2. Institute of Medicine. Demography of unintended pregnancy. In: Brown SS, Eisenberg L, eds. The best intentions: unintended pregnancy and the well-being of children and families. Washington, DC: The National Academies Press; 1995:21--49.
  3. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006;38:90--6.
  4. Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Number of women 15--44 years of age who had at least 1 live birth and percent distribution by number of months from first birth to second birth, according to selected characteristics: United States, 2002 [Table 13]. Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. Vital Health Stat 2005;23(25).
  5. US Department of Health and Human Services. Healthy people 2010 (conference ed., in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.healthypeople.gov.
  6. Trussell J. Contraceptive failure in the United States. Contraception 2004;70:89--96.
  7. CDC. Preconception and interconception health status of women who recently gave birth to a live born infant---Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. MMWR 2007;56(No. SS-10).
  8. DePineres T, Blumenthal PD, Diener-West M. Postpartum contraception: the New Mexico Pregnancy Risk Assessment Monitoring System. Contraception 2005;72:422--5.
  9. CDC. PRAMS 2002 surveillance report. Atlanta, GA: US Department of Health and Human Services, CDC; 2006.
  10. CDC. Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000. MMWR 2003;52(No. SS-11).

* Additional information regarding PRAMS is available at http://www.cdc.gov/prams.

Additional information on sexually transmitted disease prevention and treatment available at http://www.cdc.gov/std/treatment.

TABLE 1. Percentage of postpartum (2--9 months) contraceptive use among nonpregnant, sexually active women who delivered live infants, by contraceptive effectiveness and state/area --- Pregnancy Risk Assessment Monitoring System, 12 states and New York City, 2004--2006

Highly effective*

State/Area

Sample

no.††

At least
one method
*

Any highly effective method

Permanent
method
§

Reversible
method

%

(95% CI§§)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Arkansas

5,885

92.0

(91.0--92.9)

70.5

(68.8--72.1)

20.3

(19.0--21.7)

50.2

(48.4--51.9)

Florida

3,670

87.0

(85.3--88.4)

60.6

(58.2--62.8)

16.6

(14.9--18.4)

44.0

(41.7--46.2)

Louisiana

1,502

91.7

(89.9--93.2)

72.6

(69.9--75.0)

20.3

(18.0--22.7)

52.3

(49.4--55.2)

Michigan

3,430

88.5

(87.2--89.7)

60.4

(58.5--62.3)

15.7

(14.4--17.2)

44.7

(42.8--46.7)

Mississippi

2,210

92.3

(90.7--93.5)

79.3

(77.1--81.3)

21.0

(19.0--23.2)

58.3

(55.7--60.8)

Nebraska

3,213

90.8

(89.5--91.9)

63.2

(61.2--65.0)

12.7

(11.4--14.1)

50.5

(48.4--52.5)

New York

2,528

87.1

(85.4--88.6)

55.1

(52.7--57.6)

13.8

(12.2--15.6)

41.3

(38.9--43.8)

New York City

2,780

78.5

(76.5--80.3)

43.2

(40.8--45.4)

7.2

(6.1--8.4)

36.0

(33.8--38.2)

North Carolina

2,378

90.2

(88.7--91.6)

71.6

(69.2--73.7)

16.2

(14.4--18.1)

55.4

(52.8--57.8)

Oregon

5,101

91.8

(90.5--92.9)

64.4

(62.4--66.5)

13.5

(12.1--15.1)

50.9

(48.8--53.1)

Rhode Island

3,753

89.8

(88.6--90.9)

63.9

(62.1--65.7)

14.0

(12.8--15.4)

49.9

(48.0--51.8)

South Carolina

3,619

93.4

(92.0--94.6)

73.7

(71.3--76.9)

18.0

(16.0--20.1)

55.7

(53.1--58.3)

West Virginia

3,818

88.4

(86.9--89.9)

67.3

(65.1--69.4)

20.9

(19.0--22.8)

46.4

(44.2--48.7)

Total

43,887

88.0

(87.5--88.5)

61.7

(60.9--62.4)

15.3

(14.7--15.8)

46.4

(45.6--47.2)

Moderately effective*

Less effective*

Condoms

Other methods**

No method*

State/Area

%

(95% CI)

%

(95% CI)

%

(95% CI)

Arkansas

16.6

(15.3--18.0)

4.9

(4.2--5.7)

8.0

(7.1--9.0)

Florida

21.1

(19.3--23.1)

5.3

(4.3--6.6)

13.1

(11.6--14.7)

Louisiana

15.1

(13.1--17.2)

4.1

(3.1--5.3)

8.3

(6.9--10.1)

Michigan

20.7

(19.2--22.3)

7.4

(6.4--8.5)

11.5

(10.3--12.8)

Mississippi

10.2

(8.7--11.8)

2.8

(2.1--3.8)

7.8

(6.5--9.3)

Nebraska

20.3

(18.7--21.9)

7.4

(6.4--8.5)

9.2

(8.1--10.5)

New York

22.8

(20.8--24.9)

9.2

(7.9--10.7)

12.9

(11.4--14.6)

New York City

27.0

(25.0--29.1)

8.4

(7.2--9.8)

21.5

(19.7--23.5)

North Carolina

13.7

(12.1--15.5)

5.0

(4.0--6.3)

9.8

(8.4--11.4)

Oregon

21.6

(19.9--23.4)

5.7

(4.8--6.8)

8.2

(7.1--9.5)

Rhode Island

18.5

(17.0--20.0)

7.5

(6.5--8.5)

10.2

(9.1--11.4)

South Carolina

15.5

(13.7--17.6)

4.2

(3.3--5.4)

6.6

(5.4--8.0)

West Virginia

16.5

(14.9--18.3)

4.6

(3.7--5.6)

11.6

(10.3--13.1)

Total

20.0

(19.4--20.6)

6.4

(6.0--6.8)

12.0

(11.5--12.5)

* Percentages based on weighted data. Effectiveness determined by percentage of women who experience pregnancy during first year of typical use and categorized as highly effective (<10%), moderately effective (10%--15%), and less effective (>15%). Totals might not equal 100% because of rounding.

Includes permanent and reversible methods.

§ Includes tubal ligation or vasectomy.

Includes shot, pill, patch, ring, or intrauterine device.

** Includes diaphragm, cervical cap, sponge, rhythm, or withdrawal.

†† Based on unweighted data.

§§ Confidence interval.


TABLE 2. Percentage of postpartum (2--9 months) contraceptive use among nonpregnant, sexually active women who delivered live infants, by contraceptive effectiveness and selected characteristics --- Pregnancy Risk Assessment Monitoring System, 12 states and New York City, 2004--2006

Highly effective*

Sample

At least one method*

Any highly effective method§

Permanent
method

Reversible
method**

Characteristic

No.

%*

%

(95% CI§§)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Maternal age (yrs)

<20

5,828

9.8

90.1

(88.6--91.4)

72.9

(70.8--74.9)

1.1

(0.6--1.8)

71.8

(69.7--73.9)

20--24

11,566

25.3

89.1

(88.1--90.1)

68.7

(67.2--70.1)

9.8

(8.9--10.7)

58.9

(57.4--60.4)

25--29

11,623

27.4

88.8

(87.8--89.7)

60.5

(59.0--62.0)

15.3

(14.3--16.4)

45.1

(43.7--46.6)

30--34

9,310

23.5

88.0

(86.9--89.1)

56.1

(54.4--57.7)

19.2

(17.9--20.5)

36.9

(35.3--38.5)

≥35

5,557

14.1

83.2

(81.5--84.7)

53.0

(50.9--55.2)

28.4

(26.5--30.4)

24.6

(22.8--26.5)

Race

Black

9,732

18.6

89.8

(88.7--90.8)

71.3

(69.7--72.7)

16.7

(15.5--17.9)

54.6

(53.0-56.2)

White

29,530

73.4

87.8

(87.1--88.4)

60.4

(59.4--61.3)

15.3

(14.6--16.0)

45.1

(44.2--46.0)

American Indian/Alaska Native

1,104

0.5

87.4

(79.6--92.5)

71.5

(63.0--78.7)

27.1

(19.9--35.8)

44.4

(36.3--53.0)

Asian/Pacific Islander

2,046

3.3

82.8

(79.2--85.8)

35.3

(31.3--39.5)

7.8

(5.7--10.7)

27.5

(23.9--31.3)

Other***

1,413

4.2

88.9

(86.3--91.2)

62.6

(58.8--66.2)

13.5

(11.0--16.4)

49.1

(45.2--53.0)

Hispanic

Yes

5,806

16.8

89.1

(87.7--90.4)

61.0

(58.9--63.1)

12.7

(11.3--14.2)

48.3

(46.2--50.4)

No

37,366

83.2

87.8

(87.2--88.4)

61.8

(61.0--62.7)

15.8

(15.2--16.4)

46.0

(45.2--46.9)

Maternal education (yrs)

<12

8,911

19.2

86.5

(85.1--87.7)

66.2

(64.4--68.0)

13.7

(12.4--15.0)

52.6

(50.7--54.4)

12

13,823

30.3

87.4

(86.4--88.4)

66.1

(64.7--67.4)

17.7

(16.6--18.8)

48.4

(47.0--49.8)

>12

20,768

50.5

89.1

(88.4--89.7)

57.5

(56.4--58.6)

14.4

(13.7--15.2)

43.1

(42.0--44.1)

Marital status

Married

26,189

62.7

86.7

(86.0--87.4)

56.1

(55.1--57.1)

16.7

(16.0--17.5)

39.4

(38.4--40.4)

Other

17,668

37.3

90.3

(89.5--91.1)

71.0

(69.8--72.2)

12.8

(12.0--13.7)

58.2

(56.9--59.5)

Parity

0

19,135

41.2

87.2

(86.4--88.0)

58.5

(57.3--59.7)

1.5

(1.2--1.8)

57.0

(55.8--58.2)

1--2

20,205

48.8

89.1

(88.4--89.8)

63.5

(62.4--64.6)

22.3

(21.4--23.2)

41.3

(40.2--42.4)

>2

4,351

10.0

86.4

(84.5--88.0)

66.0

(63.6--68.4)

38.1

(35.7--40.5)

27.9

(25.8--30.2)

Prepregnancy insurance coverage

Yes

23,872

58.4

87.7

(86.9--88.3)

57.8

(56.8--58.8)

14.9

(14.2--15.7)

42.9

(41.9--43.9)

No

19,895

41.6

88.6

(87.8--89.4)

67.2

(66.0--68.3)

15.8

(15.0--16.7)

51.4

(50.2--52.6)

Prepregnancy Medicaid coverage

Yes

7,804

15.7

85.3

(83.8--86.7)

67.8

(65.9--69.6)

16.3

(14.9--17.8)

51.5

(49.5--53.4)

No

35,944

84.3

88.6

(88.0--89.10)

60.6

(59.7--61.4)

15.1

(14.5--15.7)

45.5

(44.6--46.3)

Pregnancy intendedness†††

Wanted sooner

7,321

16.4

80.1

(78.5--81.6)

49.9

(47.9--51.8)

11.7

(10.5--13.0)

38.2

(36.3--40.1)

Wanted as occurred

16,874

41.7

87.2

(86.3--88.0)

57.1

(55.9--58.3)

12.9

(12.1--13.7)

44.2

(43.0--45.4)

Wanted later

14,287

31.8

91.8

(91.0--92.6)

69.4

(68.1--70.7)

13.5

(12.6--14.5)

55.9

(54.5--57.3)

Never wanted

4,779

10.0

93.2

(91.9--94.3)

75.9

(73.7--77.9)

36.3

(34.0--38.7)

39.6

(37.2--41.9)

Prenatal care entry

Early (first trimester)

33,597

78.7

88.4

(87.8--88.9)

60.5

(59.7--61.4)

15.1

(14.4--15.7)

45.5

(44.6--46.4)

Late (second or third trimester)

8,837

20.5

87.6

(86.4--88.8)

66.5

(64.8--68.2)

16.5

(15.2--17.8)

50.0

(48.3--51.8)

No prenatal care

506

0.8

76.9

(68.5--83.6)

54.5

(46.1--62.7)

7.6

(4.3--13.0)

46.9

(38.7--55.4)

See Table 2 footnotes on next page.


TABLE 2. (Continued) Percentage of postpartum (2--9 months) contraceptive use among nonpregnant, sexually active women who delivered live infants, by contraceptive effectiveness and selected characteristics --- Pregnancy Risk Assessment Monitoring System, 12 states and New York City, 2004--2006

Moderately effective*

Less effective*

Condoms

Other methods††

No method*

Characteristic

%

(95% CI)

%

(95% CI)

%

(95% CI)

Maternal age (yrs)

<20

15.0

(13.4--16.7)

2.3

(1.7--3.1)

9.9

(8.6--11.4)

20--24

16.8

(15.7--18.0)

3.7

(3.1--4.3)

10.9

(9.9--11.9)

25--29

20.8

(19.5--22.0)

7.6

(6.8--8.4)

11.2

(10.3--12.2)

30--34

23.3

(22.0--24.8)

8.6

(7.8--9.6)

12.0

(10.9--13.1)

≥35

22.1

(20.4--24.0)

8.0

(6.9--9.2)

16.8

(15.3--18.5)

Race

Black

15.2

(14.1-16.4)

3.3

(2.8-4.0)

10.2

(9.3-11.3)

White

20.4

(19.6--21.1)

7.1

(6.6--7.6)

12.2

(11.6--12.9)

American Indian/Alaska Native

13.5

(8.8--20.1)

2.4¶¶

(0.9--6.3)

12.6

(7.5--20.4)

Asian/Pacific Islander

36.4

(32.3--40.5)

11.1

(8.7--14.1)

17.2

(14.2--20.8)

Other***

22.0

(19.0-25.4)

4.4

(3.1--6.2)

11.1

(8.9--13.7)

Hispanic

Yes

22.6

(20.9--24.4)

5.5

(4.6--6.6)

10.9

(9.6--12.3)

No

19.4

(18.8--20.1)

6.6

(6.1--7.0)

12.2

(11.6--12.8)

Maternal education (yrs)

<12

16.6

(15.3--18.1)

3.6

(2.9--4.5)

13.5

(12.3--14.9)

12

16.7

(15.6--17.8)

4.7

(4.1--5.3)

12.6

(11.7--13.6)

>12

23.1

(22.2--24.1)

8.5

(7.9--9.1)

10.9

(10.3--11.7)

Marital status

Married

22.7

(21.9--23.6)

7.9

(7.3--8.4)

13.3

(12.7--14.0)

Other

15.4

(14.5--16.4)

3.9

(3.4--4.5)

9.7

(8.9--10.5)

Parity

0

22.5

(21.5--23.5)

6.3

(5.7--6.9)

12.8

(12.0--13.6)

1--2

19.0

(18.2--19.9)

6.6

(6.0--7.2)

10.9

(10.2--11.6)

>2

14.5

(12.7--16.4)

5.9

(4.7--7.3)

13.7

(12.0--15.5)

Prepregnancy insurance coverage

Yes

22.2

(21.4--23.1)

7.7

(7.1--8.2)

12.4

(11.7--13.1)

No

16.9

(16.0--17.9)

4.6

(4.0--5.1)

11.4

(10.6--12.2)

Prepregnancy Medicaid coverage

Yes

14.0

(12.8--15.4)

3.5

(2.8--4.3)

14.7

(13.4--16.2)

No

21.1

(20.4--21.8)

6.9

(6.5--7.4)

11.4

(10.9--12.0)

Pregnancy intendedness†††

Wanted sooner

21.8

(20.2--23.4)

8.5

(7.4--9.6)

19.9

(18.4--21.6)

Wanted as occurred

22.3

(21.3--23.4)

7.8

(7.1--8.5)

12.8

(12.0--13.7)

Wanted later

18.2

(17.2--19.3)

4.2

(3.7--4.8)

8.2

(7.4--9.0)

Never wanted

13.5

(11.9--15.3)

3.8

(2.9--5.0)

6.8

(5.7--8.0)

Prenatal care entry

Early (first trimester)

20.9

(20.2--21.7)

6.9

(6.4--7.4)

11.7

(11.1--12.3)

Late (second or third trimester)

16.5

(15.2--17.8)

4.7

(3.9--5.5)

12.4

(11.2--13.6)

No prenatal care

19.0

(13.7--25.7)

---§§§

---§§§

23.1

(16.4--31.5)

* Percentages based on weighted data. Effectiveness determined by percentage of women who experience pregnancy during first year of typical use and categorized as highly effective (<10%), moderately effective (10%--15%), and less effective (>15%). Totals might not equal 100% because of rounding.

Based on unweighted data, N = 43,887; subcategories might not equal sample total because of missing data on maternal characteristics.

§ Includes permanent and reversible methods.

Includes tubal ligation or vasectomy.

** Includes shot, pill, patch, ring, or intrauterine device.

†† Includes diaphragm, cervical cap, sponge, rhythm, or withdrawal.

§§ Confidence interval.

¶¶ <60 respondents; might not be reliable.

*** Excludes data from Louisiana and Mississippi, which reported no respondents in this category.

††† Pregnancy intention of recent pregnancy that ended in a live birth.

§§§ Not reported (<30 respondents).

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.


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All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

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Date last reviewed: 8/6/2009

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