Abstract
BackgroundPostpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients.MethodsWe surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery.ResultsThere were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period.ConclusionThe majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.
Highlights
Postpartum women are at risk for unintended pregnancy
Increasing patient access to long-acting reversible contraception (LARC) is one method which may aid in reducing the unintended pregnancy rate further
There was a significant relationship between offering immediate postpartum LARC and practice type with the majority of providers working at a university-based practice (p < 0.001)
Summary
Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. In recent years in the United States, there has been a decline in the unintended pregnancy rate from 51 to 45% [1]. Immediate postpartum LARC placement, or LARC placement prior to hospital discharge, may help decrease the unintended pregnancy rate. Only about a third of women who desire postpartum LARC will obtain it by 8– 12 weeks postpartum, if they do not obtain it before hospital discharge [4,5,6] This has been demonstrated with regards to both intrauterine devices and contraceptive implants. Are these women at risk for unintended pregnancy but they are at risk for short
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