Long-acting, reversible contraception (LARC)
Of the more than 6 million pregnancies per year in the United States, nearly half are unintended. Teen birth rates in the United States have declined, but still rank highest among developed countries. Nationally long-acting, reversible contraception (LARC) usage remains relatively low. Many adolescents and young women report they know little or nothing about LARC.
Unintended pregnancies are associated with an increased risk of poor health outcomes for mothers and babies, including delayed access to prenatal care, preterm birth, and negative physical and mental health effects. LARC is safe and highly effective in preventing unintended pregnancies. LARC requires minimal user intervention, work over long periods of time, and can be reversed.
Preventing and/or lowering unintended pregnancy can affect the present and future well-being of teens and families, while also contributing to the economic health of our state.
Video produced 2016
What can providers do?
These five steps are recommended by the American College of Obstetricians and Gynecologists:
- Provide counseling on all contraceptive options including implants and intrauterine devices (IUDs)
- Educate and encourage patients to consider LARC options
- Advocate for insurance coverage and appropriate payment and reimbursement for every type of contraceptive method
- Adopt best practices for LARC insertion
- Become familiar with and support local, state (including Medicaid), federal and private programs that improve affordability of all contraceptive methods
Taking a collaborative approach
Lowering unintended pregnancy rates requires a multiple-faceted approach from the community, state and local government, health care providers, school-based clinics, local health clinics, hospitals, universities and colleges. AFMC’s Arkansas Medicaid Quality improvement team works all these groups to increase awareness of LARC in our collaborative effort to reduce unintended pregnancies. Our Medicaid Quality Improvement team provides educational programs to increase the knowledge of LARC and implanting methods among primary care providers and gynecologists/obstetricians.
All women should have access to safe and effective contraceptive methods. Talk to your patients today.
 Guttmacher Institute (2019). Unintended Pregnancy in the United States. Retrieved April 9, 2020, from https://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html
 Centers for Disease Control and Prevention (2020). Health Care Providers and Teen Pregnancy Prevention. Retrieved April 10, 2020 from https://www.cdc .gov/teenpregnancy/health-care-providers/index.htm
 Abma, J. C. & Martinez, G. M. (2017). Sexual Activity and Contraceptive Use Among Teenagers in the United States, 2011-2015. Division of Vital Statistics. Retrieved on April 13, 2020 from https://www.cdc.gov/nchs/data/nhsr/nhsr104.pdf
LARC strategies for success
Improve office systems
Routinely discuss contraception
- All women of child-bearing age, including teens
- Always include LARC choices when discussing contraception
- Recognize LARC as a safe and effective choice in birth control for women of child-bearing age, including teens
- LARC is recommended as a first choice for teens by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics
- Discuss the pros and cons of all methods of birth control
- Screen for medical conditions
- Refer to Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use
- Detailed sexual history
- Sexual history questions are an important part of overall health and health history
- Some sexual history questions are more explicit than others
- All information provided is confidential.
- Seek training in LARC insertion and removal
- Provide detailed information on LARC choices to women of child-bearing age, including teens
- Encourage teens not to have sex
- Remind patients that LARC by itself does not protect against sexually transmitted infections (STIs)
- Always use a condom to help protect from HIV or other STIs
- Encourage parents/guardians to discuss sex with teens to include:
- Encouraging teens not to have sex
- Encouraging effective birth control methods, including LARC
- Encouraging teens to always use a condom to protect against STIs
- Encourage parents/guardians to visit a health care provider with the teen to discuss birth control options and how to prevent STIs
LARC web resources
Center for Disease Control and Prevention
U.S. MEC & U.S. SPR App Flier
Download the U.S. MEC & U.S. SPR app for iPhone/iPad from the iTunes App Store
Download the U.S. MEC & U.S. SPR app for Android from the Google Play Store
Center for Disease Control and Prevention (2015). Effectiveness of Family Planning Methods. http://www.cdc.gov/reproductivehealth/unintendedpregnancy/pdf/contraceptive_methods_508.pdf
Center for Disease Control and Prevention (2017). National Vital Statistics System.
Centers for Disease Control and Prevention (2020). United States Medical Eligibility Criteria (US MEC) for Contraceptive Use. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm
Center for Disease Control and Prevention, Vital Signs (April 2015). Preventing Teen Pregnancy (A key role for health care providers). http://www.cdc.gov/vitalsigns/pdf/2015-04-vitalsigns.pdf
Center for Disease Control and Prevention (2020). Reversible Methods of Birth Control. http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm
World Health Organization (February 2018). Family planning/Contraception.
The American College of Obstetricians and Gynecologists (ACOG). (2017). Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No. 186. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices
The American College of Obstetricians and Gynecologists (January 2018). Long-Acting Reversible Contraception (LARC): IUD and Implant. FAQ 184.
US Department of Health and Human Services, Office of Population Affairs (May 2019). Fertility Awareness (Natural Family Planning) The Facts.
US Department of Health and Human Services, Office on Women’s Health (2017). Birth Control Methods.
Reviewed and Revised April 2020