Postpartum LARC: Best Practices, Policy and Public Health Implications

Abstract

To review current literature highlighting effective strategies and policies in implementation of postpartum long-acting reversible contraception (LARC) as well as outcomes of postpartum LARC use. The use of postpartum LARC is highly desired by patients, effective at reducing rates of unintended and short interval pregnancies, and has demonstrated significant health care savings. Despite these positive outcomes associated with postpartum LARC use, availability of immediate postpartum LARC is limited in the majority of US hospitals. Barriers to the provision of postpartum LARC include lack of physician education and comfort in placing postpartum LARC, lack of effective reimbursement structures, lack of streamlined protocols for identifying women who are candidates for postpartum LARC, and lack of structural support for the provision of LARC. Providers can eliminate barriers to postpartum LARC access once patients are discharged from the hospital by enhancing efforts to identify patients who are at high risk of no follow-up and by eliminating two-step protocols for LARC insertion. A step-wise strategical approach involving planning, implementation, and sustainability is effective for initiating postpartum LARC programs in hospitals. Enhancing physician education, collaborating among hospital-wide stakeholders, and reforming reimbursement strategies are all key components of successful implementation plans. Future research should continue to demonstrate cost effectiveness of postpartum LARC, and efforts to disseminate this information to other hospitals should be enhanced. Research should also target postpartum LARC insertion techniques to overcome variability of expulsion rate data and elucidate superior postpartum insertion techniques. Lastly, research should target identification strategies for women who desire postpartum LARC; for example, protocol development for streamlining access to patient’s contraceptive preferences from antenatal care to labor and delivery care, or a modified labor and delivery intake form.