Contraceptive use and unfulfilled preferences among women ages 15-49 years in the United States, 2022-2023.

Objective: To update estimates of, and examine the intersection between, method-specific contraceptive use and unfulfilled contraceptive preferences for US women ages 15-49 years since multiple events (e.g., 2019 Title X Final Rule, COVID-19 pandemic) disrupted reproductive health access in the United States. We situate findings within the changing health policy climate and broader evidence base. Design: This secondary analysis uses the recently available 2022-2023 National Survey of Family Growth, a cross-sectional population-based household survey of US women ages 15-49. We conducted multivariable logistic regression analyses to identify associations between individual's characteristics, method-specific contraceptive use, and unfulfilled contraceptive preferences. Subjects: The full sample of female respondents ages 15-49 (n = 5,586) and subsamples: all contraceptive users including permanent female method users (n = 3,163), contraceptive users and single-method users-both excluding those using only permanent female methods to address data constraints (n = 2,564 and n = 1,861 respectively), and contraceptive nonusers (n = 1,451). Exposure: None. Main Outcome Measures: Current contraceptive use, method-specific use accounting for multiple methods, and unfulfilled contraceptive preferences because of cost. Results: In 2022-2023, 57% of women (42.8 million) reported currently using contraception for any reason. The most common methods were oral contraceptive pill (23%), condom (21%), female permanent methods (20%), withdrawal (19%), and intrauterine device (16%). One-quarter (22%) of users reported multiple methods. Thirteen percent of users preferred a different method, and 31% of nonusers preferred to start a method, if cost were not a worry. Higher levels of unfulfilled contraceptive preferences among users were associated with identifying as a sexual minority (adjusted odds ratio [aOR] = 1.63; confidence interval [CI]: 1.17-2.27) and among nonusers younger than age 40 (aOR = 1.58-2.26; CI: 1.02-4.85) or not married or cohabiting (aOR = 2.49; CI: 1.68-3.69). Among single-method users, 23% using coital-dependent methods, 11% using short-acting methods, and 7% using long-acting methods, reported unfulfilled contraceptive preferences. Conclusion: Most US women used their preferred contraceptive method; however, barriers remain. Although trend analyses were not feasible because of changes in survey design, unfulfilled preferences were lower compared with other population-level studies; the extent to which this represents true shifts or shifts in data quality remains unclear. Healthcare systems grounded in sexual and reproductive equity and that reduce costs are needed to increase access to preferred methods.