Factors associated with long-acting reversible contraception use among women Veterans in the ECUUN study

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ObjectivesThe objective of this study is to understand patient-, provider- and system-level factors associated with long-acting reversible contraception (LARC) use among women Veterans and with receipt of LARC methods within the Veterans Affairs (VA) system. Study designWe analyzed data from a national telephone-based survey of 2302 women ages 18–44 receiving primary care in VA. Multivariable regression was used to examine adjusted associations of participant-reported patient-, provider- and facility-level factors with LARC use and within-VA receipt of LARC among women Veterans. ResultsAmong 987 women Veterans at risk of unintended pregnancy, 294 (30%) reported using LARC, 65% of whom had received their method within VA. Higher LARC use was observed among women who were multiparous vs. nulliparous [adjusted odds ratio (aOR)=1.52; 95% confidence interval (CI)=1.04–2.22] and did not desire future pregnancies (aOR=1.88; 95% CI=1.31–2.68). Although overall LARC uptake was not associated with any provider- or facility-level factors, receipt of these methods within VA was associated with receiving both general and gender-specific health care by a single provider (aOR=2.81; 95% CI=1.20–6.61) and with receiving care within a women's health clinic (aOR=2.54; 95% CI=1.17–5.50). ConclusionsWhile patient-level factors were more strongly correlated with use of LARC, provider- and system-level factors influence whether women received these methods within VA. ImplicationsThis study of patient-, provider- and system-level correlates of LARC use in VA, the country's largest integrated healthcare system, highlights that women Veterans share similar patient-level factors associated with LARC use as the general population and that continuity with providers and comprehensive women's health services can facilitate LARC access.