Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynecologists

Abstract

ObjectiveTo examine obstetrician-gynecologists' practices regarding provision of long-acting reversible contraceptive (LARC) methods same-day, immediately postpartum, or to women under age 21. Study designBetween August 2016 and March 2017, the American College of Obstetricians and Gynecologists (ACOG) sent 2500 of their members an electronic survey questionnaire regarding the provision of LARC methods. ACOG mailed nonresponders paper surveys. ResultsAfter exclusions, the final sample was 1280 respondents (52.2% response rate). Although 91% of obstetrician-gynecologists reported providing IUDs, only 29% (95% CI, 26–32%) offered same-day placement. Ninety-two percent (95% CI, 90–94%) offered IUDs to eligible patients under age 21. Nineteen percent (95% CI, 16.1–21.3%) offered immediate postpartum IUD placement and 21% (95% CI, 18–23%) offered immediate postpartum implant placement. Obstetrician-gynecologists practicing in states where Medicaid reimbursed for immediate postpartum LARC devices within the global fee for delivery (versus separate reimbursement) had lower odds of offering them. ConclusionWhile most ob-gyns are offering IUDs to women under age 21, many are still not offering them same-day. A minority of ob-gyns offer either IUDs or implants immediately postpartum, and there are important geographic and practice setting disparities in this practice. ImplicationsEfforts to align LARC practices with published evidence and improve access to LARC methods for women desiring them will require a multipronged effort including continuing education of physicians, patient education and outreach, as well as advocacy to improve insurance coverage and reimbursement.