Contraceptive Use in the United States, 1973-1976

Contraceptive Use in the United States, 1973-1976Author(s): Kathleen FordSource: Family Planning Perspectives, Vol. 10, No. 5 (Sep. - Oct., 1978), pp. 264-269Published by: Guttmacher InstituteStable URL: http://www.jstor.org/stable/2134378 .

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Contraceptive Use in the United States, 1973-1976

By Kathleen Ford

Summary Data collected in the 1973 and 1976 Na- tional Survey of Family Growth (NSFG) indicate that the pill and, increasingly, surgical sterilization are the main methods used by married U.S. couples to prevent pregnancy. Although the over- whelming majority of couples exposed to the risk of unplanned pregnancy are protected by contraception, and most employ highly effective methods, socio- economic differentials persist in the proportion of women protected against unplanned conceptions. In both years, low- income women and black women were less likely to use a contraceptive method to prevent unintended pregnancy than were higher income women and white women. In 1973, black wives were as likely as white wives to be protected by the most effective methods (the pill, the IUD and surgical sterilization); but by 1976, this was no longer the case. The reason is that among black couples- especially those of low income-there has been a substantial increase in reli- ance on nonmedical and folk methods.

Between 1973 and 1976, there was a dramatic rise in the prevalence of surgical sterilization among white couples, but not among blacks. A slight decline occurred among women of both races in the use of the pill, although oral con-

Kathleen Ford is a demographic statistician with the National Center for Health Statistics.

"Data from Cycle II are preliminary.

tFecund couples here include the partially fecund or "subfecund" whose ability to bear children is im- paired, but not totally lost, due to some physical or medical problem. While most subfecund couples are probably included in the category "other nonusers," some will be using methods or seeking pregnancy.

tIn this discussion, contraceptive methods exclude surgical sterilization, regardless of contraceptive intent.

The pill and sterilization were the main methods used by U.S. married couples in 1976 to prevent pregnancy. In 1973 the poor were more likely than the more affluent, and blacks as likely as whites, to use the most effective methods. By 1976 this was no longer true, because more blacks turned to tradi- tional and folk methods and the sterilization increase was largely limited to more affluent whites.

traceptives remain the dominant method (aside from sterilization) among all couples who practice contraception.

A summary report of these data has been published by the National Center for Health Statistics (which conducted both rounds of the NSFG),' and a more detailed report is now in preparation.

The National Survey of Family Growth The data presented in this article are the most recent nationwide statistics on contraceptive utilization from Cycles I and II of the NSFG.* Data were collected by personal interviews with a multistage probability sample of women in the non- institutional population of the contermi- nous United States. Women aged 15-44 who were currently or previously married, or who were never married but had offspring living with them, were included in the sample. The interview was fo- cused on the respondents' marital and pregnancy histories, their use of contraception, and the planning status of each pregnancy, according to their inten- tions regarding number and spacing of future births, use of maternity and family planning services, and a broad range of social and economic characteristics. For Cycle I, 3,856 black women and 5,941 women of all other races were interviewed between June 1973 and Feb- ruary 1974. For Cycle II, 2,946 black women and 5,665 women of other races were interviewed between January and

September 1976. In this article, only the data obtained from women currently married at the time of the interview are presented. Estimates for low-income women, who constituted only a small part of those interviewed, are less pre- cise than are those for all married women and should be interpreted with cau- tion. In the tabulations, percentages that have a standard error that is more than 25 percent of the estimate itself are en- closed in parentheses.

User Status: 1973-1976 Table 1 shows for women of all races the proportional distribution of currently married women 15-44 years of age according to their exposure to the risk of conception, and for fecund couples,t their contraceptive status. Table 2 shows the distribution for white wives and Ta- ble 3 displays the distribution for black wives.

In 1976, 30 percent of all wives were sterile. Twenty-one percent were fecund but not using any method of contraception (seven percent, because they were pregnant or had just completed a pregnancy; 6.5 percent, because they were trying to become pregnant; and eight percent, because of other reasons). Forty-nine percent of the wives were using methods other than sterilization.

From the tables, it is possible to calcu- late the percentage of users of contraceptive methodst among those wives who,

264 Family Planning Perspectives



Table 1.- Percentage distribution of currently married women aged 15-44 by contraceptive status, according to age and poverty status: all races, United States, 1976 and 1973

Contraceptive status Ages 15-44 Agcs 15-24 1976 1973 1976 1973 Total < 150%/ -I150%/ Total <150% -150% Total < 150%1/ -150% Total < 150% -150%

Of of Of of Of Of Of of poverty poverty poverty poverty poverty poverty poverty poverty

Number (in 000s) 27,185 3,435 20,806 26,646 4,141 22,505 5,941 1,088 4,286 5,977 1,198 4,779 (Unweighted N) (6,414) (1,026) (4,510) (7,566) (1,452) (6,114) (1,413) (306) (933) (1,776) (415) (1,361)

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Sterile 30.2 27.4 30.7 23.8 26.7 23.3 4.3 (5.9) 3.9 4.3 6.0 3.9 Nonsurgical 1.9 1.0 1.8 0.9 1.5 0.8 (0.4) (0.1) (0.3) (0.2) (0.7) (0.1)

Surgical 28.3 26.4 28.9 22.9 25.2 22.5 3.9 (5.8) 3.5 4.1 5.3 3.8 Noncontraceptive 9.0 7.0 9.0 6.5 6.7 6.5 (0.4) (0.8) (0.4) (0.1) - (0.1)

Female 8.2 6.7 8.1 6.3 6.5 6.3 (0.4) (0.8) (0.4) (0.1) - (0.1) Male 0.8 (0.3) 0.9 0.2 (0.2) 0.2 - - - - - -

Contraceptive 19.3 19.3 19.9 16.4 18.5 16.0 3.5 (5.1) 3.2 4.0 5.3 3.7 Female 9.6 15.0 8.7 8.6 13.1 7.7 2.5 (4.2) (2.0) 2.5 3.4 2.3 Male 9.7 4.3 11.2 7.8 5.4 8.2 1.0 (0.8) (1.1) 1.5 (1.9) 1.4

Fecund 69.8 72.6 69.3 76.1 73.3 76.7 95.7 94.1 96.1 95.6 94.0 96.1 Noncontraceptors 21.1 24.6 19.4 22.9 25.1 22.5 31.1 31.1 29.1 30.9 32.1 30.6

Pregnant, postpartum 6.9 8.8 6.3 7.3 9.2 6.9 14.9 17.2 12.5 16.0 18.7 15.3 Seeking pregnancy 6.5 5.5 6.8 7.0 5.0 7.3 10A4 (7.5) 11.4 9.1 6.7 9.7 Other nonusers 7.7 10.3 6.2 8.7 10.8 8.3 5.9 (6.4) 5.3 5.8 6.6 5.6

Contraceptors 48.6 48.0 49.9 53.2 48.2 54.1 64.5 63.0 67.0 64.7 61.8 65.5 Pill 22.3 25.2 22.8 25.1 25.6 25.0 42.9 46.5 43.2 44.8 44.1 45.0 IUD 6.1 5.3 6.3 6.7 6.7 6.7 6.2 6.0 6.7 7.2 5.5 7.6 Diaphragm 2.9 2.4 3.0 2.4 1.4 2.6 2.5 2.8 (2.4) 1.1 (1.4) (1.0) Condom 7.2 5.1 7.7 9.4 6.0 10.0 4.9 2.9 5.9 5.7 4.9 5.9 Foam 3.0 2.5 3.0 3.5 3.0 3.6 2.9 (0.8) 3.4 2.7 (1.9) 2.9 Rhythm 3.4 2.4 3.6 2.8 2.3 2.9 2.5 (1.1) (2.9) 1.3 (0.4) 1.5 Withdrawal 2.0 1.7 2.1 1.5 1.0 1.6 1.6 (1.9) (1.6) (0.7) (1.1) (0.7) Douche 0.7 1.9 0.5 0.6 0.7 0.5 (0.3) (0.3) (0.3) (0.2) (0.5) (0.1) Other 0.9 1.5 0.8 1.3 1.4 1.3 (0.6) (0.6) (0.6) 1.0 2.0 (0.8)

Contraceptive status Ages 25-34 Ages 35-44

Number (in 000s) 12,014 1,412 9,430 11,311 1,578 9,733 9,230 935 7,090 9,358 1,365 7,992 (Unweighted N) (2,867) (417) (2,098) (3,202) (548) (2,654) (2,134) (303) (1,479) (2,588) (489) (2,099)

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Sterile 27.7 35.3 27.3 20.5 25.9 19.6 50.2 40.3 51.4 40.4 45.9 39.4 Nonsurgical 1.5 (0.4) 1.6 (0.6) (0.9) (0.6) 3.3 (3.0) 2.9 1.7 (2.9) 1.5

Surgical 26.2 34.9 25.6 19.8 24.9 19.0 46.9 37.3 48.5 38.6 42.9 37.9 Noncontraceptive 6.3 7.9 6.0 3.5 3.9 3.4 18.0 13.0 18.3 14.4 15.6 14.1

Female 5.5 7.6 5.1 3.2 3.9 3.0 16.8 12.4 16.8 14.0 15.0 13.8 Male (0.8) (0.3) (0.9) (0.3) - (0.3) 1.2 (0.5) 1.5 (0.3) (0.6) (0.3)

Contraceptive 19.8 27.0 19.6 16.4 21.0 15.6 28.9 24.4 30.2 24.3 27.3 23.7 Female 10.6 18.9 9.6 8.2 15.3 7.1 13.0 21.6 11.5 12.9 19.2 11.8 Male 9.2 8.1 10.1 8.1 5.7 8.5 15.9 (2.8) 18.7 11.4 8.1 11.9


Pregnant, postpartum 7.4 6.1 7.7 7.7 8.5 7.6 1.1 (2.9) (0.9) 1.2 (1.6) (1.11) Seeking pregnancy 8.1 6.0 8.3 9.0 4.7 9.7 2.0 (2.6) 2.0 3.2 (3.9) 3.0 Other nonusers 5.7 8.8 4.4 6.3 8.7 5.9 11.5 17.4 9.3 13.3 17.0 12.7

Contraceptors 51.2 43.8 52.4 56.5 52.1 57.2 35.2 36.8 36.3 41.9 31.5 43.7 Pill 23.3 19.9 24.4 25.7 24.1 26.0 7.9 8.4 8.3 11.8 11'.0 11.9 IUD 7.2 4.5 7.5 9.0 9.2 9.0 4.6 (5.8) 4.5 3.5 (4.8) 3.3 Diaphragm 3.1 (2.2) 3.3 2.3 (1.9) 2.4 2.9 (2.2) 3.1 3.3 (0.8) 3.8 Condom 7.5 5.5 7.6 9.7 7.1 10.1 8.3 (7.0) 9.0 11.4 (5.7) 12.3 Foam 3.2 4.2 3.0 4.4 3.2 4.6 2.9 (1.7) 2.8 2.9 (3.7) 2.7




Table 2. Percentage distribution of white* currently married women aged 15-44 by contraceptive status, according to age and poverty status: United States, 1976 and 1973


1976 1973 1976 1973

Total <150% 150% Total <150% -150% Total <150% -150% Total <150% -150% of of of of of of of of poverty poverty poverty poverty poverty poverty poverty poverty

Number (in 000s) 24,518 2,857 19,280 24,249 3,348 20,851 5,339 906 3,981 5,384 1,025 4,359 (Unweighted N) (4,764) (642) (3,612) (5,301) (745) (4,566) (1,060) (201) (755) (1,174) (223) (951)

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Sterile 31.0 28.0 31.2 24.0 27.2 23.4 4.2 (5.6) 3.9 4.3 (6.0) 3.9 Nonsurgical 1.9 (0.8) 1.8 0.8 1.2 0.8 (0.3) - (0.3) (0.2) (0.8) (0.1)

Surgical 29.1 27.2 29.4 23.1 26.0 22.7 3.9 (5.6) 3.6 4.1 (5.2) 3.8 Noncontraceptive 9.0 7.1 8.9 6.6 7.0 6.5 (0.4) (0.7) (0.3) (0.1) - (0.1)

Female 8.2 6.8 8.0 6.3 6.8 6.3 (0.4) (0.7) (0.3) (0.1) - (0.1) Male 0.8 (0.3) 0.9 0.3 (0.2) 0.3 - - - -

Contraceptive 20.1 20.0 20.5 16.5 19.0 16.1 3.5 (4.9) 3.3 4.0 (5.2) 3.7 Female 9.6 15.5 8.7 8.2 12.9 7.4 2.4 (3.9) 2.0 2.3 (2.9) 2.2 Male 10.5 4.6 11.8 8.4 6.1 8.8 (1.1) (0.9) (1.2) 1.7 (2.2) (1.5)


Pregnant, postpartum 6.8 9.2 6.3 7.4 9.6 7.0 15.0 18.5 12.4 16.1 19.1 15.4 Seeking pregnancy 6.0 5.6 6.2 6.8 5.6 7.0 9.8 (7.7) 10.5 9.1 (7.3) 9.5 Other nonusers 7.2 9.4 6.0 7.8 8.7 7.7 5.2 (4.7) 4.9 5.4 (6.4) 5.1

Contraceptors 49.0 47.7 50.2 54.0 49.0 54.8 65.8 63.5 68.2 65.1 61.2 66.0 Pill 22.5 25.2 22.9 25.1 25.6 25.0 43.9 47.7 44.2 44.5 42.4 45.0 IUD 6.1 5.1 6.3 6.6 6.4 6.7 6.3 (5.7) 6.7 7.2 (5.9) 7.5 Diaphragm 3.0 2.8 3.1 2.5 1.5 2.7 2.8 (3.4) 2.5 (1.2) (1.6) (1.1) Condom 7.4 5.5 7.8 9.9 6.5 10.5 5.1 (3.3) 6.0 6.1 (5.0) 6.3 Foam 2.9 2.4 2.9 3.5 3.4 3.5 2.9 (1.0) 3.2 2.8 (2.1) 2.9 Rhythm 3.5 1.9 3.8 2.9 2.4 3.0 2.4 - 3.1 (1.3) - 1.6 Withdrawal 2.0 1.4 2.1 1.6 1.2 1.6 (1.6) (1.7) (1.7) (0.8) (1.3) (0.7) Douche 0.5 1.7 0.4 0.5 (0.4) 0.5 (0.2) - (0.3) (0.1) (0.5) Other 0.9 1.6 0.8 1.3 1.6 1.3 (0.5) (0.7) (0.5) (1.1) (2.3) (0.8)


Number (in 000s) 10,840 1,206 8,686 10,347 1,278 9,068 8,339 74 6,613 8,518 1,094 7,424 (Unweighted N) (2,133) (276) (1,653) (2,302) (288) (2,014) (1,571) (165) (1,204) (1,825) (234) (1,591)

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Sterile 28.8 36.9 28.1 20.8 27.6 19.9 51.1 41.0 51.8 40.2 46.5 39.3 Nonsurgical 1.6 (0.3) 1.7 0.7 (1.1) (0.6) 3.3 (2.8) 2.9 1.4 (1.6) 1.3

Surgical 27.2 36.6 26.4 20.2 26.4 19.3 47.8 38.2 48.9 38.8 45.0 37.9 Noncontraceptive 6.3 (7.7) 5.9 3.4 (3.5) 3.4 18.0 14.0 18.1 14.6 17.8 14.1

Female 5.5 (7.3) 4.9 3.1 (3.5) 3.0 16.7 13.3 16.6 14.2 17.0 13.8 Male (0.9) (0.4) (1.0) (0.3) - (0.4) 1.2 (0.7) (1.5) (0.4) (0.8) (0.3)

Contraceptive 20.9 28.9 20.5 16.7 22.9 15.9 29.8 24.2 30.8 24.2 27.2 23.8 Female 10.9 20.6 9.7 8.1 16.7 6.9 12.7 21.1 11.3 11.9 17.7 11.1 Male 10.0 8.2 10.8 8.6 (6,2) 9.0 17.1 (3.1) 19.4 12.3 9.6 12.7


Pregnant, postpartum 7.3 (5.8) 7.6 7.9 8.5 7.8 1.1 (3.2) (0.9) 1.2 (1.9) 1.1 Seeking pregnancy 7.5 (5.8) 7.9 8.7 (5.2) 9.2 1.6 (2.9) (1.5) 3.1 (4.5) 2.9 Other nonusers 5.4 8.1 4.2 5.6 (6.7) 5.5 10.7 17.4 9.1 12.0 13.1 11.9

Contraceptors 51.0 43.4 52.2 56.9 52.0 57.6 35.5 35.5 36.7 43.4 33.9 44.8 PiB 23.2 18.7 24.3 25.8 24.2 26.0 7.8 (8.4) 8.1 12.0 11.6 12.0 IUD 7.1 (4.5) 7.4 8.9 (7.5) 9.1 4.6 (5.5) 4.6 3.5 (5.5) 3.2 Diaphragm 3.2 (2.6) 3.4 2.4 (2.0) 2.4 3.0 (2.4) 3.1 3.5 (0.9) 3.9 Condom 7.6 (6.2) 7.5 10.1 (7.9) 10.4 8.6 (7.2) 9.3 12.1 (6.2) 13.0 Foam 3.0 (4.6) 2.8 4.5 (3.8) 4.6 2.8 (0.7) 2.8 2.8 (4.0) 2.7 Rhythm 3.3 (2.5) 3.5 2.3 (3.2) 2.2 4.3 (3.2) 4.6 4.6 (3.6) 4.8 Withdrawal 1 .9 (1 .1 ) 1 .9 1 .4 (1.8) 1 .3 2.5 (1 .4) 2.7 2.3 (0.3) 2.6 Douche (0.3) (0.8) (0.3) (0.4) (0.6) (0.4) 1.1 (5.4) (0.7) (0.8) - (0.9) Other 1.3 (2.4) (1.0) 1 .2 (1.0) 1.2 |(0.7) (1.2) (Q.6) 1 .7 (1.7) 1.7

*Includes other races than black.




Table 3. Percentage distribution of black currently married women aged 15-44 by contraceptive status, according to age and poverty status: United States, 1976 and 1973


1976 1973 1976 1973

Total < 150% -150% Total < 150% -150% Total <150% -150% Total <150% ~150%/ of of of of of of of of poverty poverty poverty poverty poverty poverty poverty poverty

Number (in 000s) 2,144 474 1,202 2,081 684 1,397 504 150 256 547 163 384 (Unweighted N) (1,557) (366) (839) (2,197) (694) (1,503) (335) (100) (167) (592) (190) (402)

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Sterile 24.3 26.3 24.4 22.7 24.2 22.0 6.4 (9.2) (4.4) 4.9 (6.5) (4.2) Nonsurgical 2.6 (2.4) 2.3 1.9 (3.4) 1.1 (1.2) (0.6) (1.1) ---

Surgical 21.7 24.0 22.1 20.8 20.8 20.9 5.2 (8.6) (3.2) 4.9 (6.5) (4.2) Noncontraceptive 8.8 7.6 9.4 6.2 4.8 6.9 (1.1) (1.1) (1.1) (0.6) - (0.9)

Female 8.7 7.6 9.4 6.1 4.8 6.8 (1.1) (1.1) (1.1) (0.6) - (0.9) Male (0.0) - (0.1) (0.1) - (0.1) - -- ---

Contraceptive 12.9 16.4 12.7 14.6 16.0 14.0 (4.0) (7.5) (2.1) 4.3 (6.5) (3.3) Female 11.0 15.5 9.8 13.6 15.5 12.7 (3.7) (6.9) (2.1) 4.2 (6.2) (3.3) Male 1.9 (1.0) 2.9 1.0 (0.4) (1.3) (0.3) (0.5) - (0.1) (0.3) -


Pregnant, postpartum 6.9 6.8 7.6 6.8 8.3 6.1 11.3 (8.4) 13.0 14.6 17.9 13.2 Seeking pregnancy 9.7 (4.6) 11.4 7.1 2.8 9.3 14.5 (7.9) 17.1 9.2 (3.8) 11.5 Other nonusers 13.5 17.0 9.5 17.9 21.4 16.2 13.3 (17.7) 10.7 9.5 8.4 9.9

Contraceptors 45.4 45.2 47.0 45.3 43.3 46.4 54.6 56.8 54.8 61.8 63.4 61.1 Pill 22.0 20.2 25.2 26.3 26.7 26.0 35.8 32.6 36.2 48.6 57.1 45.0 IUD 6.1 7.7 5.3 7.6 7.9 7.5 5.8 (8.9) (5.9) 7.8 (3.2) 9.8 Diaphragm 1.8 (0.8) (1.9) 1.2 (0.7) (1.5) (0.2) - (0.3) (0.1) (0.3) - Condom 4.5 (3.3) 5.3 3.2 (2.8) 3.4 (3.3) (1.3) (4.5) (1.4) (1.9) (1.3) Foam 3.8 (2.7) 4.5 3.0 (1.4) (3.8) (1.8) - (3.6) (1.7) (0.3) (2.2) Rhythm 1.4 (3.2) (0.6) (0.7) (0. 1) (1.0) (3.4) (8.3) (0.8) (1.0) - (1.4) Withdrawal 1.8 (2.6) (1.9) (0.4) (0.2) (0.5) (1.9) (3.8) (0.8) (0.2) - (0.3) Douche 2.7 (3.1) (1. 1) 1.8 (2.6) (1.4) (1.0) (2.0) (0.5) (1.0) (0.6) (1.1) Other 1.2 (1.4) (1.2) 1.0 (0.8) (1.1) (1.3) - (2.2) ---


Number (in 000s) 900 154 579 819 263 556 741 170 368 715 258 456 (Unweighted N) (683) (132) (413) (869) (252) (617) (539) (134) (259) (736) (252) (484)

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Sterile 18.5 25.3 18.2 17.1 1 6.0 17.6 43.7 42.4 48.3 42.8 43.7 42.2 Nonsurgical (1.8) (1.8) (2.0) (0.3) (0.2) (0.3) 4.6 (4.4) (3.8) 5.2 8.8 (3.1)

Surgical 16.6 23.6 16.2 16.9 15.8 17.4 39.1 37.9 44.4 37.6 34.9 39.1 Noncontraceptive 6.9 11.2 6.9 4.3 (5.3) (3.9) 16.3 (10.0) 19.1 12.6 (7.4) 15.5

Female 6.9 11.2 6.9 4.3 (5.3) (3.9) 16.2 (10.0) 18.9 12.4 (7.4) 15.3 Male - - - - - - (0.1) - (0.2) (0.2) - (0.3)

Contraceptive 9.7 12.4 9.3 12.5 10.5 13.5 22.9 28.0 25.3 25.0 27.5 23.6 Female 9.3 12.0 9.0 10.7 10.3 10.9 18.1 26.2 16.4 24.1 26.7 22.7 Male (0.4) (0.6) (0.3) 1.8 (0.2) (2.6) 4.8 1.7 8.8 (0.8) (0.8) (0.9)


Pregnant, postpartum 9.6 10.6 9.7 6.6 10.0 (5.1) (0.7) (1.9) (0.3) (1.1) (0.4) (1.5) Seeking pregnancy 11.5 (5.0) 12.3 10.3 (3.2) 13.7 4.2 (1.4) (6.1) (1.9) (1.7) (2.0) Other nonusers 7.9 14.0 6.3 15.3 18.0 14.0 20.6 19.1 13.8 27.5 33.1 24.2

Contraceptors 52.5 45.0 53.4 50.6 52.7 49.6 30.7 35.2 31.5 26.8 21.0 30.0 Pill 26.1 23.7 29.5 27.1 25.4 27.9 7.7 (6.2) 10.8 8.2 8.9 7.8 IUD 7.1 (6.3) 6.3 10.7 16.9 7.8 5.0 (7.8) 3.2 4.0 (1.8) (5.2)

Diaphragm (1~~~~~~.47) (0.6 (n% 1.3)n 1.8 (1.7)- (1.9) 2.9- (1..7 (3.9)- (.4 - (2.2)




at the time of interview, were at risk of an unplanned pregnancy (i.e., not surgically or nonsurgically sterile, pregnant, postpartum or trying to become pregnant). About 86 percent of respondents at risk were using a contraceptive method both in 1973 and in 1976. Among the oldest wives in the survey, those 35-44, only 75-76 percent of those at risk were using a method in both years, compared to 90-92 percent of those in the two younger age groups. However, other fac- tors, such as lower fecundity and less frequent intercourse, undoubtedly reduced the risk of conception among the older women.

Black women and low-income women of all races (i.e., those below 150 percent of poverty*) at risk of an unplanned pregnancy were less likely to practice contraception than white women and higher income women. About 87 percent of white wives at risk were using a contraceptive method in 1973 and 1976. The proportion of black wives at risk who employed a method was 77 percent in 1976-up from 72 percent in 1973. Some 82 percent of low-income wives at risk were using a method in both years, compared to 89 percent of higher income wives in 1976 and 87 percent in 1973. Black women of low income were least likely to be contraceptors (67 percent in 1973, and 73 percent in 1976).

Sterilization Thirty percent of wives (or their hus- bands) were sterile in 1976; two percent were sterile for nonsurgical reasons. Twenty-eight percent had been surgically sterilized: Nine percent reported that the procedure had been performed for noncontraceptive reasons; 19 percent said the purpose had been at least partly contraceptive.

The largest increase in the prevalence of surgical sterilization between 1973 and 1976 (from 23 percent to 29 percent) occurred among higher income white couples. As would be expected, couples at the older ages of childbearing con- tributed most heavily to this increase. Among couples aged 15-24, the prevalence of surgical sterilization in 1976 was only about four percent; it was slightly higher (six percent) among low- income couples.

0The poverty index in 1976 centered around an an- nutial famiiily incomiie of $5,815 for a nonfarm family of fouir; thus, 150 percenit of poverty implies an aver- age aintnual family incomiie of $8,723.

4-0-

Similar pro portions of low-income and higher income women used contraception in 1976.

Among low-income white couples aged 25-34, there was a large increase in the percentage who had had a sterilizing operation-rising from 26 percent in 1973 to 37 percent in 1976. Among higher income couples, the percentage sterilized was smaller in each year: 19 percent in 1973, and 26 percent in 1976.

Prevalence of sterilization increased among low-incomne black couples in this age group (from 16 percent in 1973 to 24 percent in 1976), but failed to rise among higher income black couples (it was 17 percent in 1973, 16 percent in 1976).

Finally, in the 35-44 age group, by 1976 at least one partner had been surgically sterilized among almost half (48 percent) of the white couples. A large increase in the use of surgical sterilization occurred among higher income white couples (from 38 percent in 1973 to 49 percent in 1976). However, among low- income white couples, the percentage surgically sterilized declined-from 45 percent in 1973 to 38 percent in 1976. Among black couples, the increase was greater among those of higher income (39 percent to 44 percent) than among those of lower income (35 percent to 38 percent).

Sterilizing operations were classified as contraceptive or noncontraceptive, according to responses to a question regarding the family planning intent of the operation. The wording of this (luestion differed in the 1973&and 1976 surveys. In the 1973 survey, the (uestion read: "Was

the operation done at least partly so that you would not have any more children?" In 1976, the question was reworded to ask: "Was one reason for the operation because you had all the children you wanted?"

Sterilizing operations are performed for both medical and family planning reasons. In many cases, both motivations are present, so that there is an obvious ambiguity as to when pregnancy is contraindicated purely on medical grounds.2 Overall, the change in wording probably reduced the increase between 1973 and 1976 in the proportion of operations reported as contraceptive in intent. As a result, the percentages of couples with contraceptive and noncontraceptive sterilizations in the 1976 survey are not completely comparable with the percentages in the 1973 survey. The percenitage of sterilizations classified as contraceptive in 1976 should, therefore, be regarded as a minimum estimate. This is the main reason why sterilization for contraceptive reasons is reported here with other causes of sterility and not, as formerly, with other methods of contraception.

The proportion of sterilizing operations (for all reasons) performed on the male partner stayed at about 38 percent of all such operations among white couples over the period; among black couples, the proportion rose, but remained very small in both 1973 and 1976. Both white and black low-income couples




were less likely to use male sterilization than higher income couples.

The Pill The increase in the use of oral contracep- tives observed from 1960 through 1973 has come to a halt. Indeed, the percentage of wives using the pill declined by about three points between 1973 and 1976-falling from 25 percent to 22 percent. Nevertheless, among couples in which neither partner had been sterilized, no other method comes close to the pill in popularity. The percentage of currently married women using the pill is similar among whites and blacks.

The level and trend of pill use during 1973-1976 differed according to poverty status, age and race. Among low-income white wives under age 25, pill use increased from 42 percent to 48 percent between 1973 and 1976. However, among white women of this age group with higher incomes, pill use was similar in both years (45 percent and 44 percent, respectively). Among black wives younger than 25, pill use decreased more sharply in both income groups: from 45 percent to 36 percent among women of higher income, and from 57 to 33 percent among low-income women.

Among higher income white wives aged 25-34, pill use decreased slightly, from 26 to 24 percent, and among the low-income women, it fell from 24 percent to 19 percent. In contrast, among

Although pill use has declined slightly, it is still the most widely used contraceptive.

blacks in this age group, changes in the percent using the pill were small in both income groups. (It fell from 25 to 24 percent for low-income women and increased from 28 to 30 percent among higher income women.)

Finally, pill use among wives aged 35-44 declined by 3-4 percentage points among both higher income and low- income women.

Other Methods The pill continues to dominate contraceptive practice among U.S. couples, and there is relatively little use of all other methods (except, of course, for sterilization). Use of the condom, the most popular method after the pill, continued to decline between 1973 and 1976-from about nine to seven percent. IUD use remained about the same over the period (6-7 percent). Any increase or decrease in the use of individual methods other than the pill should be interpreted with cau- tion-especially for individual age, race and income groups-because of the small number of sample cases involved.

Race and Income Differences Previous analyses of the 1973 NSFG concluded that although black couples were less likely than white couples to practice contraception, those who did use a method were more likely to employ the pill, the IUD or sterilization.3 In- deed, about 55 percent of couples of both racial groups in 1973 had been surgically sterilized (whatever their contraceptive intent) or were using the pill or the IUD. In 1976, however, 58 percent of white couples, but only 50 percent of black couples, were using the pill or the IUD or had been surgically sterilized. Overall, then, the proportion of black couples protected by these most effective methods is now below the percentage of white couples so protected.

Expressed as a percentage of all methods other than sterilization used by currently married women, the pill and IUD accounted for about 58-59 percent of all use by white wives in both 1973 and 1976; among black contraceptors, however, use of these two methods declined from 75 percent in 1973 to 62 percent in 1976. Use of nonmedical and folk methods (condom, foam, rhythm, withdrawal and douche) by black women increased from 20 percent of method use other than sterilization in 1973 to 31 percent in 1976.

Low-income white contraceptors were

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Among reversible methods, women prefer the pill and IUD to the condom, displayed here.

more likely than higher income couples to be using the pill or the IUD in both 1973 and 1976. In 1976, 64 percent, and in 1973, 65 percent, of low-income users employed the pill or the IUD, compared to about 58 percent of higher income users in both years. Low-income black users in 1973 were more likely to be using the pill or the IUD (80 percent) than higher income black users (72 percent). However, by 1976, only 62 percent of low income black users and 65 percent of higher income black contraceptors were using these methods. An increase in use of nonmedical and folk methods occurred among both higher income and low-income black women; but the rise is particularly striking among the latter: Use of nonmedical methods by low- income black users doubled, from 16 to 33 percent, between 1973 and 1976, but rose from 22 to 29 percent among the higher income black users.

References 1. K. Ford, "Conitraceptive Utilization in the United States: 1973 anid 1976," Advance Data from Vital anrd Health Statistics, National Center for Health Statistics, DHEW (NCHS), No. 36, Aug. 18,1978.

2. C.F. Westoff anid E.F. Jones, "Contraception and Sterilization in the United States, 1965-1975," Fam- ily Planning Perspectives, 9:153, 1977.

3. K. Ford, "Contraceptive Utilization Among Cur- rently Married Women 15-44 Years of Age: United States, 1973," Monthly Vital Statistics Report, NCHS, Vol. 25, No. 7, Supplement, Oct. 4, 1976.

Volume 10, Number 5, September/October 1978 269



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Contraceptive Use in the United States, 1973-1976

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