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Long-acting, reversible contraception (LARC)

Unintended pregnancies represent nearly half of all pregnancies in the United States.[1] Teen birth rates in the United States have declined, but still rank highest among developed countries.[2]  Nationally long-acting, reversible contraception (LARC) usage remains relatively low.[3]

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:

  1. Provide counseling on all contraceptive options including implants and intrauterine devices (IUDs)
  2. Educate and encourage patients to consider LARC options
  3. Advocate for insurance coverage and appropriate payment and reimbursement for every type of contraceptive method
  4. Adopt best practices for LARC insertion
  5. 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 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.

[1] Guttmacher Institute (2019). Unintended Pregnancy in the United States. https://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html

[2] Centers for Disease Control and Prevention (2021). Health Care Providers and Teen Pregnancy Prevention. https://www.cdc .gov/teenpregnancy/health-care-providers/index.htm

[3] Daniels K, Abma JC. Current contraceptive status among women aged 15–49: United States, 2017–2019. NCHS Data Brief, no 388. Hyattsville, MD: National Center for Health Statistics. 2020.

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

Health history

Sexual history

  • 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

Patient education

  • 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

Parent/guardian education

  • 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

Providers

Center for Disease Control and Prevention (2022). Contraceptive Effectiveness. https://www.cdc.gov/reproductivehealth/contraception/index.htm#Contraceptive-Effectiveness

Centers for Disease Control and Prevention (2020). United States Medical Eligibility Criteria (US MEC) for Contraceptive Use. https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

Center for Disease Control and Prevention (2022). Contraception.
https://www.cdc.gov/reproductivehealth/contraception/index.htm

Center for Disease Control and Prevention, Reproductive Health: Teen Pregnancy (November 2021). About Teen Pregnancy https://www.cdc.gov/teenpregnancy/about/social-determinants-disparities-teen-pregnancy.htm
http://www.cdc.gov/vitalsigns/pdf/2015-04-vitalsigns.pdf

Center for Disease Control and Prevention, Reproductive Health: Teen Pregnancy (August 2021). Social Determinants and Eliminating Disparities in Teen Pregnancy.  https://www.cdc.gov/teenpregnancy/about/social-determinants-disparities-teen-pregnancy.htm
http://www.cdc.gov/vitalsigns/pdf/2015-04-vitalsigns.pdf

Institute for Women’s Policy Research and Ascend at the Aspen Institute. 2019. “Parents in College: By the Numbers.” Facts Sheet, IWPR #C481. Washington DC: The Institute for Women’s Policy Research and Ascend at the Aspen Institute. (accessed June 14, 2022).

National Vital Statistics Reports (2021). Births: Final Data for 2019. Volume 70, Number 2. https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf

National Vital Statistics System (NVSS) via CDC WONDER (2022). Arkansas Teen Birth Rate. https://www.cdc.gov/nchs/pressroom/states/arkansas/ar.htm

The American College of Obstetricians and Gynecologists (ACOG). (2017. Reaffirmed 2021). 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 (ACOG). (20212). Long-Acting Reversible Contraception (LARC) Activities & Initiatives. https://www.acog.org/programs/long-acting-reversible-contraception-larc?utm_source=redirect&utm_medium=web&utm_campaign=otn

World Health Organization (November 2020). Family planning/Contraception.
http://www.who.int/mediacentre/factsheets/fs351/en/

Patients

The American College of Obstetricians and Gynecologists (November 2021). Long-Acting Reversible Contraception (LARC): IUD and Implant. FAQ 184.
https://www.acog.org/patient-resources/faqs/contraception/long-acting-reversible-contraception-intrauterine-device-and-implant

US Department of Health and Human Services, Office of Population Affairs (September 2021). Understanding Fertility: The Basics (Fertility Awareness-Based Methods (FABM) of Family Planning).
https://opa.hhs.gov/reproductive-health/understanding-fertility-basics

US Department of Health and Human Services, Office on Women’s Health (2021). Preventing Pregnancy (Birth Control Methods).
https://opa.hhs.gov/reproductive-health/preventing-pregnancy

Reviewed and Revised June 2022