Volume 43 - Article 35 | Pages 1049–1066  

Reconsidering (in)equality in the use of IUDs in the United States: A closer look across the reproductive life course

By Megan Sweeney, Mieke Eeckhaut, Jessica D. Gipson


Background: Long-acting reversible contraceptives (LARCs), such as the intrauterine device (IUD), have received increased attention for their contraceptive effectiveness and reversibility. Although demographers have long acknowledged the importance of parity and childbearing intentions for contraceptive choice, we know little about how contraceptive use varies across the reproductive life course.

Objective: Guided by the expectation that contraceptive method characteristics (e.g., reversibility, effectiveness) contribute to method choice ‒ and that the salience of method characteristics vary by reproductive life stage and education ‒ we investigate variability in IUD use patterns.

Methods: We use 2008–2010 and 2011–2013 National Survey of Family Growth data to compare women’s IUD-use patterns across educational groups and at three reproductive life stages: before a first birth occurs (“starters”), between births (“spacers”), and after planned childbearing ends altogether (“limiters”).

Results: IUD use is more common among spacers than among starters or limiters. Moreover, IUD use is associated with educational advantage among starters and limiters, but not among spacers. Educational differences in IUD use among starters and limiters persist when demographic background characteristics are controlled.

Conclusions: Our understanding of variability in IUD use changes considerably when viewing educational gradients through the lens of the reproductive life course.

Contribution: We shed new light on variability in IUD use across the reproductive life course. To best support women’s contraceptive preferences, it is important to consider the ways in which structural determinants (e.g., education, reproductive health policies and programs) shape women’s contraceptive choices at various stages of the reproductive life course.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

Female sterilization in the life course: Understanding trends and differentials in early sterilization
Volume 47 - Article 18

The reproductive context of cohabitation in comparative perspective: Contraceptive use in the United States, Spain, and France
Volume 32 - Article 5

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