Do you know which birth control is right for you?
An analysis of 620,000 women reveals the most common types of birth control, and surprising data about what moms choose
I’m 5 days away from my 30th birthday, which means that every day for the past 12 years I’ve taken a birth control pill. That’s 4,380 pills.
From time to time, I’ve questioned my choice of birth control, especially since pills can be inconvenient. Here’s what that looked like: obsessively Googling scary-sounding effects of NuvaRing, even though my friend says it works well for her. A rushed conversation with my doctor about getting an intrauterine device (IUD) at my annual physical. She recommended it—told me she had one herself, like many doctors—but said if pills worked for me, there was no reason to switch.
Here’s what my research didn’t look like: having a clear understanding of what types of birth control other women my age use. Seeing the popularity of birth control methods and brands, and using that knowledge to have an informed conversation with my doctor.
Naturally, when the Amino team thought of topics to cover in honor of National Women’s Health Week, birth control was top of mind. It’s still hotly debated, even though recent studies confirm that access to birth control is steadily increasing (which has partly contributed to the plunging teen birth rates).
Today, we’re diving into Amino’s massive insurance claims database to shed light on the types of birth control American women use, looking at 620,000 women who had private insurance and went to the doctor to receive birth control from January 2014 to December 2015.
Birth control is a personal choice—but do you know all your options?
Before writing this blog post, I surveyed 60 women about their birth control methods. While the types of birth control they use varied, many of their responses shared a lack of certainty:
“I used to use the pill, but I was terrible at taking it everyday. I would have switched sooner to the implant, but no doctor I talked to took the time to go over the different options with me.”
“I'm considering trying a new pill that works better with my system, but not sure where to start.”
“I've been thinking about switching to the IUD for some time, but haven't taken the plunge just yet.”
Birth control is an extremely personal topic. Hopefully, this report can help you understand your options and inspire a conversation with your doctor about what birth control is right for you.
Most women that I’ve talked to said their first experience with birth control was a condom, the pill, or a patch. But over the years those options have expanded to include implants, shots, vaginal rings, and IUDs—with preferences changing as women get older.
The “typical age range” you see in our chart above doesn’t mean that you shouldn’t consider a specific method of birth control if you fall outside the age range we found in our data. In fact, the American Academy of Pediatrics chose the IUD as the most effective method for teenage girls in 2014—so IUDs will likely continue to increase in popularity with younger women over time. (Right now, our data shows that women who chose shots, pills, the patch, or implants over IUDs tend to be younger in age.)
It’s worth noting that our data only shows what doctors prescribe in an office visit. Obviously condoms (and now even birth control pills in some states!) don’t require a doctor’s prescription. But we did see quite a few patient-doctor interactions in our database that involved dispensing these common forms of birth control as part of routine family planning health discussions, which allowed us to see the typical age ranges of women involved.
What your age says about your birth control method
Many of the women I surveyed for the purpose of this post are choosing long-acting reversible birth contraception (LARCs), which include IUDs and implants. As it turns out, this trend has been confirmed by Guttmacher Institute, a leading sexual and reproductive health research organization. Their research shows that the percent of women on birth control who used LARCs increased from 8.5% in 2009 to 11.6% in 2012.
Why are women choosing LARCs over other methods? Guttmacher Institute’s senior research scientist Megan Kavanaugh listed a few reasons during a recent phone interview: “They last between 3 to 12 years, are proven to be some of the most effective forms of birth control, and generally become something you don’t have to worry about once inserted. Plus, these once-expensive forms of birth control are now getting cheaper under the Affordable Care Act.”
Here’s a summary of what we found about LARCs:
- Younger women choose Nexplanon implant and Skyla IUD. Perhaps this is because both Nexplanon and Skyla last for only 3 years, a few years less than Mirena (5 years) and Paragard (10 years). Skyla also has a smaller IUD design, which might make it more popular among younger women and teens. Megan Kavanaugh wasn’t surprised to see this finding in our data. “This confirms what we’re seeing in our national data and hearing anecdotally,” she said. “Talking to adolescents and young adults, we’ve heard from some that since the implant is further away from reproductive organs, it is less likely to impact future fertility and therefore it’s a more attractive option.”
- Older women choose Mirena and Paragard. We might be seeing IUDs skew older because there has been a pervasive belief among medical practitioners that only women who have had children should get an IUD. But that idea has proven to be outdated, and this excellent article in Lifehacker explains that doctors are “slowly getting the memo” that women without children can (and should) get IUDs. Interestingly, Mirena still says on their website that it’s only recommended for women who have already had kids, while Paragard (the copper IUD) and Skyla are recommended for women with or without children.
- More women choose Mirena than the three other LARCs combined. This might be because it’s second oldest LARC on the market (Paragard began marketing to women in 1988, Mirena was introduced in 2000, Nexplanon came out in 2006, and Skyla was released in 2013).
Are moms choosing IUDs?
Okay, so we know that lots of older women are getting IUDs, and that Mirena is the top brand. We also know that historically, doctors have only been recommending IUDs to new moms (although that’s changing).
Why are IUDs so great for moms? According to Bedsider.org, IUDs are “low-maintenance, effective, safe for new moms, and totally fine to use while breastfeeding.”
We found that over the past two years, 1 in 5 women who got an IUD got it after having a baby—either on the same day as delivery or as part of their postpartum visit, typically 6 weeks after delivery. However, the number of moms who choose to get a postpartum IUD actually vary by state across America.
Looking at 2.4 million women who gave birth to a child from 2014 to 2015, we found that on average only 3.8% of those women chose to get a postpartum IUD within 150 days after delivery.
I was surprised to see that my home state of California had lower-than-average rates for postpartum IUDs—and also surprised to see states like New Mexico and North Carolina have higher-than-average rates. The states with the highest percentage of postpartum IUDs include Maine, Vermont, Idaho, Oregon, Wyoming, and South Dakota.
Why are we seeing such variation? The differences could be due to a lot of factors, including the fact that general accessibility of IUDs varies state-to-state. A recent article on Vox explains how a group called Upstream USA is educating clinics about IUDs. They’ve run pilot programs in Colorado and Missouri, and recently signed a partnership with the state of Delaware (which you’ll notice has one of the lowest percentage of women getting postpartum IUDs).
Other factors that could account for the geographic variations include the average age of the mothers in those states, as well as differences in income, race, religion, and culture. For example, according to one study, Hispanic women were less likely to have heard of IUDs than white women. Unfortunately, we aren’t able to account for these factors in our analysis.
When women choose to get a postpartum IUD, when are they getting it? We saw an initial spike in our data on the same day as delivery—either after vaginal birth or c-section. However, according to one study, “IUD insertion immediately postpartum is not common. Many providers are unaware IUD insertion post-pregnancy is safe and effective. Less than half of OB-GYNs interviewed in a 2013 study (46%) said an IUD could be inserted immediately after birth.” This trend might be changing as more doctors adopt the practice.
The largest group of women got their postpartum IUD 42 days after delivery, which falls exactly on the 6-week postpartum check-up.
What you can learn from all this birth control data
It can be overwhelming to look at data and make a decision, but doing this study made me realize that there are types of birth control I might not have considered before. I’m planning on showing this study to my OB-GYN to chat about what might be best for me as I get older.
For younger women who are still years away from wanting to get pregnant (and don’t want the annoyance of keeping up with daily or monthly birth control), implants or an IUD might be a good option. Both last for a number years, and seem much more effective than other methods. Some women might prefer an implant over an IUD, if they like the idea of a long-acting method residing under the skin of their arm rather than in their uterus.
As you get older, you might want to consider switching to an IUD if you don't already have one—especially after you have a baby (and hey, it means you’ll be using the same birth control method as female astronauts).
P.S. A little disclaimer: Amino isn’t here to give medical advice about what type of birth control is right for you. We aim to help you get the information you need to talk to your doctor and make decisions with confidence.
Where are these numbers coming from? We looked at 620,000 women who had private insurance and received select forms of contraception from a doctor between January 2014 and December 2015. We also looked at 2.4 million women who had a baby in the same timeframe (via c-section or vaginal delivery).
We used the following Healthcare Common Procedure Coding System (HCPCS) codes to determine the specific types of contraceptives administered in our data:
We used the Current Procedural Terminology (CPT) code 58300 (“insertion of intrauterine device”) to determine IUD insertion procedures.
To determine postpartum IUD usage, we looked at every instance in our dataset where a woman received an IUD within 150 days after delivery. We excluded deliveries that occurred in the last 42 days of 2015 to account for any postpartum IUD that may have yet to be observed in our dataset. For women who had more than one child within the two-year span of our analysis (~1% of the population), we only considered the most recent delivery.
From there, we calculated the proportion of deliveries that included a postpartum IUD by dividing the number of women who received a postpartum IUD by the total number of deliveries in our data set. We ran this calculation for each state in the U.S.
Data analysis, chart design, and methodology by Sohan Murthy
Blog post updated on August 4, 2016 with a few minor corrections.