The Evolving Role of Permanent Contraception in the United States, 1965-2019

Sarah R. Hayford, Ohio State University
Eva Beaujouan, University of Vienna (Wittgenstein Centre for Demography and Global Human Capital)

The use of effective contraception allows people to manage reproduction and thus can drive demographic trends, particularly declines in birth rates. At the same time, demand for contraception can also be a product of the demographic regime. In particular, changes in fertility desires and timing may shift the demand for permanent vs. reversible forms of contraception. In this paper, we examine trends in permanent contraception (sterilization) in the United States and the relationship between these trends and trends in fertility. We consider levels of permanent contraception as well as distribution by age and parity. Consistent with previous research on the uptake of permanent contraception in the U.S., our preliminary results suggest that increasing sterilization rates contributed to the post-Baby Boom decline in birth rates. In contrast, recent declines in birth rates are not driven by permanent contraception; instead, sterilization rates are falling even as birth rates decline. Comparing age-standardized sterilization rates with unstandardized rates suggests that some of the recent decline in sterilization is attributable to changes in the age structure of fertility. The completed paper will refine preliminary analyses and add subgroup-specific analyses of permanent contraceptive use by age, parity, and duration since last birth.

Keywords: Family Planning and Contraception, Fertility, Quantum and tempo effects

See extended abstract.