Evolution of Contraceptive Use in France From 2012 To 2022

Background: In late 2012 in France, heightened public and media attention was drawn to the increased risk of thromboembolism associated with combined oral contraceptive (COC) use, triggering a national pill crisis. Existing guidelines were reinforced to use levonorgestrel-based COC, associated with the lowest arteriovenous risk. Reimbursement of third-generation COC (gestoden or desogestrel-based) by national insurance was ended, and rapid decrease in COC use was documented. As COC has historically been the leading contraceptive method in France, a significant fall in COC use suggests meaningful changes in a country with high contraceptive coverage.

Objectives: To describe the evolution of contraceptive use in France from 2012 to 2022 and according to age.

Methods: We conducted a population-based study of all women aged 15-49 years living in France at two time points: January 2012 and January 2022. Information on age and contraception use was collected from the French National Health Data System (SNDS, includes health claims for 99% of individuals living in France) and from sales data for non-reimbursed oral contraceptives. Women with a current pregnancy or a prior hysterectomy were excluded. Prevalence of utilization was computed at both time points for each age group.

Results: In real-world data, overall contraceptive use remained stable over the period, concerning 47 to 46% of women aged 15-49 years. Use of COC dropped from 54% to 35% of women using contraception. The decrease was observed in all age groups and most sharply in women aged 20-29 years (78% to 56% of users) and 30-39 years (48% to 28% of users). Among COC users, the share of levonorgestrel-based COC users rose from 49% in 2012 to 84% in 2022, with third and fourth generations falling from 50% to 16%. The decrease in COC use was coupled with a sharp increase in progestogen-only oral contraceptive, from 10% to 19% of contraceptive users, with the steepest increase in the oldest age group(11% to 24% of users aged 40-49 years). Use of copper intra-uterine device (Cu-IUD) increased overall (12% to 21% of users) and most dramatically in women aged 20-39 years (4% to 15% of users) and 30-39 years (15% to 30% of users). LNG-IUS remained stable over the period (17% to 15% of users), with the share of lower-dose devices increasing in women < 30 years. Injectable contraception remained minimal ( <0.05% of users) and use of implant was stable (5% to 6% of users).

Conclusions: Contraceptive use has known large-scale changes in France in the last ten years. Increase of progestogen-only oral contraceptive utilization suggests a change in prescribers’ practices following renewed recommendations, while the rise in Cu-IUD seems to echo women’s demand for effective and hormone-free contraceptive options.