Original research article Obesity and contraceptive use among women 20–44 years of age in the United States: results from the 2011–15 National Survey of Family Growth (NSFG) ☆ William D. Mosher a , Hannah Lantos a,b , Anne E. Burke a,c, ⁎ a Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Johns Hopkins University, Baltimore, MD. 21205 b Child Trends, 7315 Wisconsin Ave Suite 1200W, Bethesda, MD 20814 c Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine Received 25 July 2017; revised 2 November 2017; accepted 24 November 2017 Abstract Objective: Obesity has increased dramatically in the United States in recent decades. Our objective was to explore associations of contraceptive choices of US women, aged 20–44 years, with body mass index (BMI) and relevant covariates. Study design: Data are based on interviews with a national sample of 11,300 women in the 2011–2015 National Survey of Family Growth. We analyzed women ages 20–44 at risk of unintended pregnancy. The primary dependent variable was BMI category. Covariates analyzed included age, parity, race/ethnicity, marital status, self-reported health and education. Data were analyzed via cross-tabulation and logistic regression. We determined unadjusted and adjusted odds ratios for three categories of contraceptive method: female sterilization, intrauterine device (IUD) and hormonal contraception. Results: Obese women have higher odds of female sterilization (BMI 30.0–34.9 kg/m 2 : adjusted odds ratio (aOR) = 1.96, 95% confidence interval (CI) 1.45–2.66; BMI 35.0 kg/m 2 and higher: aOR=1.56, 95% CI 1.13–2.14) compared to women with normal BMI. Odds of IUD use are significantly higher among women with BMI N35 kg/m 2 (aOR=1.64, 95% CI 1.20–2.25). Odds of hormonal contraceptive use are correspondingly reduced (aOR=0.78, 95% CI 0.62–0.98) for women in the highest BMI category. Conclusions: Contraceptive use varies by BMI category even after adjusting for usual correlates of use. Differences in contraceptive use by BMI category have implications for contraceptive counseling and provision. Implications: Findings that obese women are more likely to rely on female sterilization raise questions about how weight concerns and obesity affect contraceptive decision making. Future research could explore associations between obesity and contraceptive use in adolescent women. © 2017 Published by Elsevier Inc. Keywords: Contraception; Obesity; Female sterilization; IUD; National Survey of Family Growth 1. Introduction Obesity and unintended pregnancy have been described as “overlapping epidemics” [1]. Just under half of repro- ductive-age women seeking contraception are overweight or obese [2,3], with higher obesity prevalence among black and Hispanic women [2,4]. Obese women [those with body mass index (BMI) 30 kg/m 2 or higher] may have higher odds of unintended pregnancy [5,6]. Concern about potential health effects or decreased efficacy may impact contraceptive choices for women who are overweight or obese [7,8]. Previous studies differ in their conclusions about associations between BMI and contraceptive use, with some finding no association and others reporting differences in use by BMI category, including more sterilization among obese women [1,9,10]. Use of long-acting reversible contraceptive (LARC) methods — which are safe and effective regardless of BMI — has steadily increased since Contraception xx (2017) xxx – xxx ☆ Funding acknowledgment: Dr. Mosher is grateful for general support from the Johns Hopkins Population Center (NICHD R24HD042854). In addition, Dr. Mosher and Dr. Lantos received support from the Johns Hopkins Department of Population, Family and Reproductive Health in the summer of 2015 for the first part of this work. Dr. Burke received no financial support for this work. She receives support from Bayer for an unrelated project. ⁎ Corresponding author. E-mail address: aburke@jhmi.edu (A.E. Burke). https://doi.org/10.1016/j.contraception.2017.11.007 0010-7824/© 2017 Published by Elsevier Inc.