Reproductive health service use among adolescent and young adult women in the United States has declined: An analysis of data from the National Survey of Family Growth, 2002 to 2008

Purpose: To examine trends in reproductive health service use among young women in the United States from 2002 to 2008.

Methods: Using data from two waves of the National Survey of Family Growth, we investigated reproductive health service utilization among women ages 15-24 years (2002 n=2157; 2006-2008 n=2264). Descriptive and uni-variate statistics and multivariate regression models were employed to describe trends in use of reproductive health services and compare service use across women's demographic, social, and reproductive characteristics. Analyses focused on questions regarding specific reproductive health services used ever and within the previous year.

Results: Over half the total sample (n=4421) reported lifetime (58%) and recent (55%) reproductive health service use, including exam (47%), contraceptive (48%) and less commonly counseling (37%) services. Lifetime and recent service use decreased by 15% from 2002 to 2008 (p<0.001), including exam (8%, p=0.03) and contraceptive (6%, p=0.02) services, but not counseling services (p=0.17). In multivariate models, by 2008, women were 58% less likely to use services than in 2002 (OR 0.42, CI 0.28-0.63, p<0.001). Service use also varied by age, race/ethnicity, socioeconomic status (education, poverty level, employment/insurance situation, birthplace, mother's education), relationship situation (marital/cohabitation status, intercourse initiation, number of partners), gynecological/reproductive history, and religious participation.

Conclusions: Reproductive health service use among young women has declined over the past decade, reflecting socioeconomic and political barriers to family planning care in the United States. Public health and policy strategies are needed to eliminate disparities in family planning service in order to improve reproductive health outcomes.