‘Shifting pregnancy desires’ altered some contraceptive use patterns after pandemic

Key takeaways:

• Condom use declined after the COVID-19 pandemic, whereas other contraceptive use patterns remained stable.
• Fertility preferences for Hispanic and women aged 41 years and older changed the most.

Sexually active women in the U.S. made moderate changes to their contraceptive use due to the COVID-19 pandemic, according to national survey estimates published in Contraception.

“The COVID-19 crisis and its unprecedented economic and social upheaval led to shifting pregnancy desires; early in the pandemic, one-third of women indicated that they wanted to delay or reduce their childbearing because of the pandemic. Yet the pandemic also led to changing health care access that constrained reproductive health care provisions, making it harder for people to access contraception and make these critical life choices,” William G. Axinn, MD, professor of sociology and research professor at the Institute for Social Research at the University of Michigan Ann Arbor, and colleagues wrote. “The fertility preferences of younger women and women of color changed most, suggesting that these groups might also have experienced the greatest shifts in penile-vaginal intercourse and contraceptive use. However, no national assessment has examined how contraceptive use in the U.S. changed during the pandemic.”

Axinn and colleagues analyzed data from 1,357 responses from reproductive-aged women who participated in the American Family Health Study, the first nationally representative web survey of fertility in the U.S. from 2020 to 2022. Researchers evaluated 26,274 person-months of sex and contraceptive data from before and after the COVID-19 pandemic began to assess changes in contraceptive use after the pandemic.

Researchers observed a significant decline in condom use from 9.9% before the pandemic began to 7.4% after. Other contraceptive use patterns were stable among women who had penile-vaginal intercourse at least 1 month before and after the pandemic began with 78% of women using contraception. The estimated 10% of women not using contraception before the pandemic continued their nonuse after, according to the researchers.

An estimated 46% of women used prescription contraceptive methods before and after the pandemic began; whereas 8% of women stopped using prescription methods after the pandemic began and 6% initiated contraceptive use.

Researchers noted no pandemic-related changes in contraception initiation but did observe significant pandemic-related reductions in the rate of contraceptive use cessation for subgroups of women.

After the pandemic, Hispanic women lowered their odds of stopping contraceptive use by 71%.Compared with other age groups, women aged 41 years or older lowered their odds of stopping contraceptive use by 78%.

“These national findings contradict some early studies predicting larger differences by race and ethnicity,” the researchers wrote. “Instead, we find Hispanic (and to a lesser extent non-Hispanic Black) females avoided stopping contraception after the pandemic began, to rates similar to those of non-Hispanic white females. We estimate these changes in contraceptive use patterns net of any changes in sexual activity. Instead, less stopping of contraception might reflect shifts in the direction or strength of the desire to prevent pregnancy.”

The researchers noted that more research is needed on the reasons for subgroup differences in contraceptive use responses and their fertility consequences.