William D. Mosher

Trends in contraceptive use in the United States: 1982-1995.

CONTEXT Trends in contraceptive use have implications for shifts in pregnancy rates and birthrates and can inform clinical practice of changes in needs for contraceptive methods and services. METHODS Information on current contraceptive use was collected from a representative sample of women of reproductive age in the 1995 National Survey of Family Growth (NSFG). This information is compared with similar data from 1982 and 1988 to examine trends in use, both overall and in social and demographic subgroups. RESULTS The proportion of U.S. women using a contraceptive method rose from 56% in 1982 to 60% in 1988 and 64% in 1995. As in 1982 and 1988, female sterilization, the pill and the male condom were the most widely used methods in 1995. Between 1988 and 1995, the proportion of users relying on the pill decreased from 31% to 27%, while condom use rose from 15% to 20%. The largest decreases in pill use and the largest increases in condom use occurred among never-married women and among black women younger than 25. Reliance on the IUD dropped sharply among Hispanic women, while use of the diaphragm fell among college-educated white women. CONCLUSIONS The decline in pill and diaphragm use and the increase in reliance on condoms suggest that concerns about HIV and other sexually transmitted diseases are changing patterns of method use among unmarried women.

Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States: Data From the 2006-2008 National Survey of Family Growth

OBJECTIVE This report presents national estimates of several measures of sexual behavior, sexual attraction, and sexual identity among males and females aged 15-44 years in the United States, based on the 2006-2008 National Survey of Family Growth (NSFG). These data are relevant to demographic and public health concerns, including fertility and sexually transmitted infections among teenagers and adults. Data from the 2006-2008 NSFG are compared with data from the 2002 NSFG and other national surveys. METHODS Data for 2006-2008 were collected through in-person interviews with a national sample of 13,495 males and females in the household population of the United States. The measures presented in this report were collected using audio computer-assisted self interviewing (ACASI), in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The overall response rate for the 2006-2008 NSFG was 75%. RESULTS Sexual behaviors among males and females aged 15-44 based on the 2006-2008 NSFG were generally similar to those reported based on the 2002 NSFG. Among adults aged 25-44, about 98% of women and 97% of men ever had vaginal intercourse, 89% of women and 90% of men ever had oral sex with an opposite-sex partner, and 36% of women and 44% of men ever had anal sex with an opposite-sex partner. Twice as many women aged 25-44 (12%) reported any same-sex contact in their lifetimes compared with men (5.8%). Among teenagers aged 15-19, 7% of females and 9% of males have had oral sex with an opposite-sex partner, but no vaginal intercourse. Sexual attraction and identity correlates closely but not completely with reports of sexual behavior. Sexual behaviors, attraction, and identity vary by age, marital or cohabiting status, education, and race and Hispanic origin.

Religion and fertility in the United States: New patterns

In the United States, the baby boom-era pattern of high Catholic and low Protestant fertility has ended. Among non-Hispanic whites in the 1980s, Catholic total fertility rates (TFRs) were about one-quarter of a child lower than Protestant rates (1.64 vs. 1.91). Most of the Protestant-Catholic difference is related to later and less frequent marriage among Catholics. Future research on the demography of religious groups should focus on explaining the delayed marriage pattern of Catholics, the high fertility of Mormons and frequently attending Protestants, and the very low fertility of those with no religious affiliation.

Contraceptive practice in the United States, 1982-1988.

Use of oral contraceptives by married women declined markedly between 1973 and 1982, but analysis of data from the 1988 National Survey of Family Growth shows that this decline stopped between 1982 and 1988. Reliance on female sterilization continued to increase, however, and it remained the leading method among currently married and formerly married women. Among women of all marital statuses, IUD use dropped by two-thirds between 1982 and 1988, from 2.2 million to 0.7 million women. As the proportion of less-educated, low-income, black and Hispanic contraceptive users choosing the IUD decreased, the proportion relying on female sterilization increased. Among college-educated white women, use of female sterilization did not increase; instead, pill use rose in this group. Condom use increased most sharply among teenagers and rose among never-married white and black women, but the pill was still the leading method by far in these groups, regardless of race. Among never-married black women, reliance on sterilization increased significantly between 1982 and 1988, with female sterilization becoming the second leading method. Use of the diaphragm declined sharply over the same period among never-married white women and among those who intended to have more children, as did use of periodic abstinence (rhythm and natural family planning) and foam.

Patterns of contraceptive use in the United States: the importance of religious factors.

Previous research has shown that the major religious communities in the US have all shifted their expected family size downward but significant differences in contraceptive use styles continue to characterize Catholics, Protestants, Jews, and those of no religious affiliation. This paper examines data from Cycle IV of the National Survey of Family Growth (1988) to extend the time period covered by previous research by comparing the emerging contraceptive use patterns and fertility expectations among women in the late 1980s with earlier cohorts from previous national studies, beginning in the 1960s. The categories of religious affiliation are extended to include specific religious denominations (fundamentalist Protestants, Baptists, and other denominations, as well as Mormons) and include measures of religiosity--church attendance, the extent of receiving communion among Catholics, and attendance at church-related schools. These data are examined for blacks, Hispanics, and non-Hispanic whites. The analysis suggests how religious affiliation and religiosity continue to be important factors in the contraceptive paths to low fertility under general conditions of controlled fertility and in the context of secularization.

Vaginal douching among women of reproductive age in the United States: 1988.

BACKGROUND Vaginal douching has been associated with pelvic inflammatory disease (PID) in several epidemiologic studies. METHODS To determine the extent to which douching is practiced and to describe the population subgroups in which it is most prevalent, we analyzed data from the 1988 National Survey of Family Growth, which is based on a nationally representative sample of 8450 United States women between the ages of 15 and 44 years. RESULTS Thirty-seven percent of the sample reported douching; 18% douched at least once a week. The variable most strongly and consistently associated with douching was race: two thirds of Black women, but only one third of White women, reported douching. The practice was least frequent among 15- to 19-year-olds (31%) and most frequent among 20- to 24-year-olds (41%). Douching was more common among women who lived in poverty (50%) than among those who did not (28%). Seventy percent of Black women living in poverty reported douching. Women with less than a high school education were almost four times more likely to report douching as those with 16 or more years of schooling (56% vs 16%). Women with only 1 partner and those with 10 or more partners were less likely to douche than others. Sixteen percent of women who reported douching, compared with 10% of those who did not, also reported a history of PID. CONCLUSIONS Douching may be a modifiable risk factor for PID, it should be a high priority for future etiologic research.

Contraceptive use in the United States, 1973–1988☆

The percentage of couples using sterilization as a contraceptive method increased greatly between 1973 and 1982 and increased more until 1988. The percentages of couples on the pill decreased sharply between 1973 and 1982. The decrease did not continue between 1982 and 1988. Use of the condom did not significantly change among married couples but increased sharply among never-married women. These findings come from the National Surveys of Family Growth conducted by the National Center for Health Statistics. Cycle IV of this survey was done between January and August of 1988. 8450 women 15-44 were interviewed. Cycle III was done 1982; Cycle I in 1973. In 1988 60% of the women were using contraception. 24% were using sterilization; 37% were using other methods. The number of contraceptors increased by 4.8 million between 1982 and 1988 (16%). Contraceptive use varies by the womans age. The leading method in the youngest age group was the pill in 1982 and 1988 followed by the condom. In the oldest age group female sterilization was the leading method followed by male sterilization and the condom. The proportion of never-married women who never had intercourse dropped from 38% in 1982 to 32% in 1988. Among currently married couples surgical sterilization more than doubled from 1973 to 1988. Most of this was female sterilization. The proportion of couples using other methods declined. The increase in the percent using the condom was statistically significant. There was no significant change in the % using the pill among formerly married women between 1982 and 1988. IUD use decreased from 6% in 1982 to 2% in 1988. Black women were less likely than Whites to be using contraception. But among those Blacks who did use a method they were significantly more likely than Whites to use the 2 most effective female methods--sterilization and the pill. The largest increase in use of female sterilization occurred among the formerly married; from 398% to 51% in 1988. (authors modified)

Understanding U.S. fertility: continuity and change in the National Survey of Family Growth, 1988-1995.

About 50 studies based on the 1988 National Survey of Family Growth (NSFG) and a telephone reinterview conducted with the same women two years later provide continuing information about the fertility and health of American women. Among the findings of these studies are that black women have almost twice as many pregnancies as do white women (5.1 vs. 2.8), with nearly all of the difference being unintended pregnancies. Unwanted births increased between 1982 and 1988, particularly among less-educated, poor and minority women. This increase in the proportion of unwanted births may have prompted the increase in female sterilization among these groups. Concern with the AIDS epidemic led to increases in condom use between 1982 and 1990, especially among the partners of teenagers and college-educated women. Rates of teenage pregnancy were fairly stable during the period 1980-1988, as increases in the proportion of teenagers having intercourse were offset by increases in condom use. Rates of infertility did not change significantly in the 1980s, but because of delayed childbearing and the aging of the baby-boom cohort, the number of older childless women increased substantially. The 1995 NSFG was redesigned in a number of ways in order to answer a new generation of questions about fertility and womens health in the United States.

Reproductive impairments in the united states, 1965–1982

The first national estimates of current fecundity status of women of all marital statuses indicate that, in 1982, about 5.1 million women were unable to have a future birth but would have liked to. About 2.7 million had difficulty bearing children, and the other 2.4 million were surgically sterile for noncontraceptive reasons. Since 1965, infertility was unchanged overall and in most age groups, but increased among wives aged 20–24. This paper explores a number of methodological and substantive questions related to reproductive impairments, such as the frequency of intercourse, the duration of infertility, and the possible causes of trends.

Contraceptive use at first premarital intercourse: United States, 1965-1988

The proportion of U.S. women who used a contraceptive method at their first premarital intercourse rose from 47 percent in 1975-1979 to 65 percent in 1983-1988. Overall, and among non-Hispanic white women, this change resulted entirely from an increase in the use of condoms by their partners. The proportion of whites who used a condom at first premarital intercourse, for example, increased from 24 percent to 45 percent. Among blacks, condom use at first intercourse increased from 24 percent to 32 percent during that period, and pill use rose from 15 percent to 23 percent. Among all women, the method most often used at first intercourse during every period in the study was the condom, followed by the pill and withdrawal. The proportion of women using a method at first premarital intercourse varies strikingly according to individual characteristics. Among the various demographic subgroups, the proportion who use a method varies from 32 percent of Hispanic women to 68 percent of Jewish women. Whites are more likely to use a method than are blacks, and fundamentalist Prostestants are less likely to use a method than are other Protestants or Catholics. The proportion using a method is higher among women whose mothers completed high school than among those whose mothers did not. In addition, the proportion rises with age at first intercourse. Multiple logistic regression showed that the independent effects of Hispanic origin, Jewish or fundamentalist Protestant religious affiliation and the education of a womans mother are large and significant.(ABSTRACT TRUNCATED AT 250 WORDS)