Nearly one out of five women used two or more methods of contraception the last time they had sexual intercourse, researchers found.1

Specifically, 18% of women ages 15 to 44 years who had used some form of contraception at last intercourse said they used two or more methods. Condoms and another method were the most commonly used method among dual users (58%). But women also reported using the withdrawal method, or a long-acting reversible contraceptive (LARC) and another method that did not include condoms or withdrawal.1

The researchers also found a nearly linear relationship between dual use with condom and age. Younger people were using condoms at a much higher rate than older people, says Megan L. Kavanaugh, DrPH, MPH, principal research scientist at the Guttmacher Institute.

“These data help us understand there is more to dual use than we thought about in the past,” Kavanaugh says. “When people are combining methods, they’re combining condoms with hormonal methods. Clinicians should recognize that people’s contraceptive strategies are more complicated than we thought about in the past. Clinicians should orient their counseling sessions to acknowledge the complexity of these strategies so individuals can choose the best method or methods for their own life circumstance.”

The researchers drew on national data on reproductive health metrics in the United States, reviewing women’s answers to questions in the National Surveys of Family Growth. They looked at two periods: 2006-2010 and 2013-2017.

They presented data from the years 2008 and 2015. Samples were 6,601 women in 2008 and 5,562 in 2015. Data came from women who had had penile-vaginal intercourse in the three months prior to the interview and who reported some form of contraceptive use at last sex. When the researchers compared the earlier group to the later group, they found that the percentage of people using dual contraceptives had increased from 14% to 18%.

Overall, contraceptive use has remained steady in the United States. The increase in people reporting using dual contraceptive methods could be the result of how contraceptive strategies are measured and how some methods have become more acceptable in recent years. “Some contraceptive methods are becoming more widely accepted as viable,” Kavanaugh says.

For example, the withdrawal method has received more talk and literature in recent years. Also, people may have reported it less in previous decades.

“Ten to 15 years ago, people may have practiced withdrawal, but they didn’t report it as a contraceptive method or behavior, and now it’s a bit more widely adopted as a contraceptive method,” Kavanaugh says.

Also, single-method contraceptive surveillance reports may not mention the withdrawal method because they report only the most effective method that people use. This would mean a couple that uses both birth control pills and the withdrawal method would be listed only as using the withdrawal method. “In this study, we’re reporting all the methods people use,” Kavanaugh says.

Previous research showed that people felt more confident or better able to meet their goal of pregnancy prevention when they layered their contraceptive methods.2 “It was, ‘I just wanted to make sure I was fully protected, and combining withdrawal and a hormonal method makes me feel extra protected,’” she explains.

The study’s findings also suggest that reproductive health providers should ask patients about dual contraceptive use because it will provide them with better information as they make recommendations.

“Whenever contraceptive methods are being discussed, whether in a clinical encounter or health education setting, we want to do a better job of recommending contraceptive use,” Kavanaugh says.

This means clinicians should acknowledge that contraceptive use is more complex than a single method.

“When people are preventing pregnancy, it’s not just using one method; there may be several methods or one method combined with another method,” she says. “To have an encounter that’s fully informed, providers should understand how patients are protecting themselves against pregnancy. The best [patient-provider] encounter is where everyone is on the same page to achieve the patient’s goals.”

REFERENCES

  1. Kavanaugh ML, Pliskin E, Jerman J. Use of concurrent methods of contraception in the United States, 2008 to 2015. Contracept X 2021;3:100060. doi: 10.1016/j.conx.2021.100060. [Online ahead of print].
  2. Frohwirth L, Blades N, Moore AM, et al. The complexity of multiple contraceptive method use and the anxiety that informs it: Implications for theory and practice. Arch Sex Behav 2016;5:2123-2135.