The Advantages of LARC Methods

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The use of long-acting reversible contraceptive (LARCs) methods is the best tool to reduce unplanned pregnancy rates, given their superior contraceptive effectiveness which is comparable to that of permanent contraception. Fortunately, LARCs have evolved since the original introduction of the plastic intrauterine device (IUD) and six-rod subdermal implant. With the introduction of the copper IUD (Cu-IUD), of the levonorgestrel intrauterine system (LNG IUS) “family” and of the new one-rod (etonogestrel; ENG) and two-rod (levonorgestrel; LNG) implants, women’s LARC options have much improved. An additional point is that LARCs have many non-contraceptive benefits. One of the advantages of LARCs compared to other contraceptives is that users do not need to be particularly self-motivated. The extended use of the 52 mg LNG IUS up to 7 years and of the etonogestrel (ENG)-releasing implant up to 5 years could increase the cost-effectiveness of these methods. However, one disadvantage of LARCs is that they require healthcare professionals (HCPs) for insertion, who need training in device insertion and removal. Counselling prospective LARC users must include anticipatory guidance about possible changes in bleeding patterns, which are the most common discontinuation reason for the Cu-IUD, the LNG IUS and the subdermal contraceptive implants. In many settings, a barrier to LARC use is the high upfront cost. However, new LNG IUS and LNG implant have been introduced with more affordable prices, and many international donor agencies and foundations provide devices at no cost, which has contributed to an increase in LARC uptake. The World Health Organization recently included the Cu-IUD, the LNG IUS and both subdermal implants on the List of Essential Medicines, which implies that these methods are cost-effective for low- and middle-income countries and relevant for public health systems.