Are births more likely to be intended following use of long-acting reversible contraceptives? An analysis of U.S. births in 2003-15.

A major shift in the U.S. contraceptive method mix has been the recent growth in the use of long-acting reversible contraceptives (LARCs)-intrauterine devices and implants. Quantitative research into LARC's impacts until now has focused on evaluating their efficacy in reducing unintended pregnancies. The next question, of whether births after discontinuing LARC use are then more likely to result from an intended pregnancy, has received almost no attention. We analyzed data from 2,984 women who reported a live birth in the 3-4 years prior to survey interview for the 2006-2015 cycles of the National Survey of Family Growth. We compared the proportion of births intended by last contraceptive method used. To capture contraceptive failure versus stopping contraceptive use to become pregnant, we estimated logistic regressions alternately not controlling for, and controlling for, use of contraception in the month of conception. We found that four in five births following LARC use were reported to result from an intended pregnancy, compared to only three in five births following use of a moderately-effective or less-effective method. After controlling for use of contraception in the month of conception and for sociodemographic characteristics, women whose last-used method was a LARC had twice the odds of reporting that the pregnancy was intended relative to women whose last-used method was either a moderately-effective method or a less-effective method. We conclude that U.S. women's LARC use has the potential to increase the fraction of subsequent births from intended pregnancies, and in doing so promote their reproductive autonomy.