Dual Contraceptive Nonuse - Youth in United States

United States

According to the American College of Obstetricians and Gynecologists (ACOG), the ideal contraceptive practice for sexually active adolescents is dual contraceptive use — both a condom to prevent sexually transmitted diseases (STDs) and a method more effective at preventing unwanted pregnancies. ACOG recommends long-acting reversible contraceptive (LARC) methods such as intrauterine devices and hormonal implants, which have higher rates of efficacy and continued use compared with short-acting options. Condoms are not ideal as a sole contraceptive due to their high typical-use failure rate compared with other contraceptives such as LARCs and hormonal methods.

Based on data from a survey of sexually active high school students, dual contraceptive use is higher among:

• Non-Hispanic white youth compared with non-Hispanic Black and Hispanic youth.
• Heterosexual youth compared with youth who identify as lesbian, gay, bisexual, questioning or another non-heterosexual identity.

Studies show that adolescents are more likely to access contraceptive services via pharmacies or general health services than youth-centered programs. Effective strategies should therefore focus on equipping these existing venues to better respond to the contraceptive needs of adolescents. Some areas to focus on include:

• Educating health care providers to respond to the diverse contraceptive needs of youth.
• Expanding free and reduced-cost services.
• Removing legislative barriers to contraception.
• Ensuring privacy and confidentiality, including and especially for minors. 

County Health Rankings & Roadmaps lists several proven approaches for improving condom use and reducing risky sexual behavior, including condom availability programs and behavioral interventions to prevent HIV and other STIs.

The Guttmacher Institute maintains a comprehensive dashboard on federal and state policies regarding contraception use in youth and related topics.

Healthy People 2030 has multiple objectives related to youth contraceptive use, including:

• Increasing the proportion of adolescents who use birth control the first time they have sex.
• Increasing the proportion of adolescent females at risk for unintended pregnancy who use effective birth control.

“ACOG Committee Opinion No. 710: Counseling Adolescents About Contraception.” 2017. Obstetrics & Gynecology 130 (2): e74–80. https://doi.org/10.1097/AOG.0000000000002234.

Center for Disease Control and Prevention. 2023. “Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021.” Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Adolescent and School Health. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf.

Chandra-Mouli, Venkatraman, and Elsie Akwara. 2020. “Improving Access to and Use of Contraception by Adolescents: What Progress Has Been Made, What Lessons Have Been Learnt, and What Are the Implications for Action?” Best Practice & Research Clinical Obstetrics & Gynaecology, Modern Methods of Contraception, 66 (July): 107–18. https://doi.org/10.1016/j.bpobgyn.2020.04.003.