Background: Long-acting reversible contraceptives (LARCs), such as the intrauterine device (IUD), have received increased attention for their contraceptive effectiveness and reversibility. Although demographers have long acknowledged the importance of parity and childbearing intentions for contraceptive choice, we know little about how contraceptive use varies across the reproductive life course. Objective: Guided by the expectation that contraceptive method characteristics (e.g., reversibility, effectiveness) contribute to method choice ‒ and that the salience of method characteristics vary by reproductive life stage and education ‒ we investigate variability in IUD use patterns. Methods: We use 2008–2010 and 2011–2013 National Survey of Family Growth data to compare women’s IUD-use patterns across educational groups and at three reproductive life stages: before a first birth occurs (“starters”), between births (“spacers”), and after planned childbearing ends altogether (“limiters”). Results: IUD use is more common among spacers than among starters or limiters. Moreover, IUD use is associated with educational advantage among starters and limiters, but not among spacers. Educational differences in IUD use among starters and limiters persist when demographic background characteristics are controlled. Conclusions: Our understanding of variability in IUD use changes considerably when viewing educational gradients through the lens of the reproductive life course. Contribution: We shed new light on variability in IUD use across the reproductive life course. To best support women’s contraceptive preferences, it is important to consider the ways in which structural determinants (e.g., education, reproductive health policies and programs) shape women’s contraceptive choices at various stages of the reproductive life course.

中文翻译：

---

重新考虑美国宫内节育器的使用（不平等）：仔细研究整个生殖生活过程

背景：长效可逆性避孕药（LARC），例如宫内节育器（IUD），因其避孕效果和可逆性而受到越来越多的关注。尽管人口统计学家早就意识到避孕和选择生育的重要性，但我们对避孕方法在整个生育过程中的使用情况却知之甚少。目的：期望避孕方法的特性（例如，可逆性，有效性）对方法的选择有所帮助‒且方法特性的显着性因生殖生命阶段和教育程度而异‒我们调查了宫内节育器使用方式的变异性。方法：我们使用2008-2010年和2011-2013年全国家庭成长调查数据来比较各个教育组和三个生殖生命阶段妇女的宫内节育器使用方式：第一次生育之前（“初学者”），两次生育之间（“垫片”） ，并在计划生育完全结束后（“限制者”）。结果：间隔器中使用宫内节育器比起子或限制器中更普遍。此外，宫内节育器的使用与起步者和限制者之间的教育优势有关，但与间隔物之间​​没有关系。当控制人口统计学背景特征时，起始者和限制者之间宫内节育器使用的教育差异仍然存在。结论：当我们从生殖生活过程的角度观察教育梯度时，我们对宫内节育器使用变化的理解发生了很大变化。贡献：我们揭示了整个生育过程中宫内节育器使用的可变性。为了最好地支持妇女的避孕偏好，重要的是要考虑在生殖生活过程的各个阶段，结构性决定因素（例如教育，生殖健康政策和方案）如何影响妇女的避孕选择。