Long-acting Reversible Contraception Users Research Articles

Factors associated with long-acting reversible contraceptives usage among sexually active adolescent girls and young women in Zimbabwe.

Despite the benefits of long-acting reversible contraceptives (LARCs), they are not being utilized in Zimbabwe as much as the short-acting reversible contraceptives (SARCs). The aim of the study was to explore factors associated with LARC usage among Zimbabwean adolescent girls and young women, using data from the 2015 Zimbabwe Demographic and Health Survey. Cross tabulations and chi-square tests were used initially to describe associations. Odd ratios were then used to measure the strength of association between LARCs usage and the independent variables using stepwise multinomial logistic regression. From the 2132 sexually active females included in the study 9.1% were LARCs users and 42% were SARCs users at the time of the survey. Secondary and primary education had increased odds of not using any method (OR: 5.032, 95% CI: 2.136-11.8512 and OR: 5.799, 95% CI: 2.327-14.453 respectively) compared to tertiary education. Women with no living children had increased odds of not using any method (OR 66.543, 95% CI: 25.784-171.7381). Being not married was associated with decreased odds of SARCs usage (OR 0.399, 95% CI: 0.285-0.558). Desire for no more children was associated with reduced odds of SARCs usage (OR: 0.448, 95% CI: 0.304-0.66). Being a member of the Apostolic Faith church was associated with increased odds of not using any method (OR 1.423517, 95% CI: 1.018-1.990309). In conclusion, acquiring a tertiary education, having children, a desire to cease bearing children altogether, being unmarried and belonging to the highest wealth class were generally associated with an increased likelihood of using LARCs. Being a member of the Apostolic Faith church was associated with a decreased likelihood of LARCs usage. Findings from the study are relevant in the Zimbabwean context and highlights the relevant factors essential to focus on, when carrying out interventions aimed at increasing LARCs uptake in the country.

Is use of Long-Acting Reversible Contraceptives (LARC) associated with reduced well-woman visits and STI testing? Evidence from female Medicaid clients aged 15–24 in Delaware

ObjectiveContraceptive method type matters to sexually transmitted infection (STI) prevention, but contraceptive counseling often emphasizes method efficacy and the benefits of “forgettable” methods, including long-acting reversible contraceptives (LARCs). We aimed to explore associations between prescription method type and annual STI testing and investigated whether these associations relate to annual well-woman visits. MethodsWe constructed a panel of 20,949 young women (<25) enrolled in Delaware's Medicaid program from 2012 through 2019. Conditional logit regressions measured associations between contraceptive method type and annual testing for gonorrhea, chlamydia, or syphilis. We stratified contraceptive methods into LARC, short-acting reversible methods (SARC; pills, patch, ring, and injectable), or no prescription method. We estimated three models examining STI testing in year of method initiation, in years afterwards, and attendance to a well-woman visit as a potential mediator of these associations. ResultsSTI testing rates did not differ between LARC versus SARC users in the year of method initiation. In the two years after method initiation, LARC versus SARC users were less likely to be tested (OR = 0.73 to OR = 0.87) and less likely to have a well-woman visit (OR = 0.65 to OR = 0.79). In models controlling for attendance to well-woman visits, the decreased likelihood of STI testing in years after initiating LARC versus SARC is largely eliminated, indicating that well-woman visits mediate the relationship between method type and STI testing. ConclusionsLARC use relates to reduced STI testing in years after method initiation due to reduced attendance to well-women visits. These findings can inform clinical practice and STI prevention.

The dynamics of Long-Acting Reversible Contraception (LARC) choices in rural Jambi: Socio-economic perspectives

High population growth without concurrent improvements in human quality poses significant challenges in promoting equitable welfare across various life aspects. Thus, population control is crucial for achieving sustainable development goals. This study emphasizes the role of Long-Acting Reversible Contraception (LARC) in managing fertility rates and investigates three main components of population growth: fertility, mortality, and migration. The objectives are threefold: 1) Analyze the profile of fertile-age couples using LARC in rural Jambi; 2) Investigate the socio-economic factors influencing the choice between LARC and non-LARC methods among these couples; 3) Explore the relationship between the couples' characteristics and their choice of LARC. Data were collected from a survey of 200 fertile-age couples participating in a family planning program across four villages in Jambi. The analysis utilized descriptive statistics, binary logistic regression, and multinomial logistic regression. Findings indicate that LARC usage among fertile-age couples in rural Jambi is low, at approximately 28% of total contraceptive users, with implants being the most common LARC type. In contrast, non-LARC methods are more prevalent, accounting for 72% of usage, dominated by three-month injectables, followed by pills and male condoms. Significant factors influencing the choice between LARC and non-LARC include the husband's education, the woman's employment status, the number of living children, the disparity between actual and ideal family size, desire for more children, knowledge about contraceptive options, and family income. Furthermore, characteristics significantly related to the choice of LARC methods such as tubal ligation, implants, and IUDs include the woman's age, number of living children, the gap between the ideal and actual number of children, desire for more children, woman's employment status, knowledge about contraceptive devices, and family income.

Unintended pregnancy and contraception use among African women living with HIV: Baseline analysis of the multi-country US PEPFAR PROMOTE cohort.

About 90% of unintended pregnancies are attributed to non-use of effective contraception-tubal ligation, or reversible effective contraception (REC) including injectables, oral pills, intra-uterine contraceptive device (IUCD), and implant. We assessed the prevalence of unintended pregnancy and factors associated with using RECs, and Long-Acting-Reversible-Contraceptives (LARCs)-implants and IUCDs, among women living with HIV (WLHIV) receiving antiretroviral therapy (ART). We conducted cross-sectional analyses of the US-PEPFAR PROMOTE study WLHIV on ART at enrollment. Separate outcome (REC and LARC) modified-Poisson regression models were used to estimate prevalence risk ratio (PRR) and corresponding 95% confidence interval (CI). Of 1,987 enrolled WLHIV, 990 (49.8%) reported their last/current pregnancy was unintended; 1,027/1,254 (81.9%) non-pregnant women with a potential to become pregnant reported current use of effective contraception including 215/1,254 (17.1%) LARC users. Compared to Zimbabwe, REC rates were similar in South Africa, aPRR = 0.97 (95% CI: 0.90-1.04), p = 0.355, lower in Malawi, aPRR = 0.84 (95% CI: 0.78-0.91), p<0.001, and Uganda, 0.82 (95% CI: 0.73-0.91), p<0.001. Additionally, REC use was independently associated with education attained, primary versus higher education, aPRR = 1.10 (95% CI: 1.02-1.18), p = 0.013; marriage/stable union, aPRR = 1.10 (95% CI: 1.01-1.21), p = 0.039; no desire for another child, PRR = 1.10 (95% CI: 1.02-1.16), p = 0.016; infrequent sex (none in the last 3 months), aPRR = 1.24 (95% CI: 1.15-1.33), p<0001; and controlled HIV load (≤ 1000 copies/ml), PRR = 1.10 (95% CI: 1.02-1.19), p = 0.014. LARC use was independently associated with country (Zimbabwe ref: South Africa, PRR = 0.39 (95% CI: 0.26-0.57), p<0.001; Uganda, PRR = 0.65 (95% CI: 0.42-1.01), p = 0.054; and Malawi, aPRR = 0.87 (95% CI: 0.64-1.19), p = 0.386; HIV load (≤ 1000 copies/ml copies/ml), aPRR=1.73 (95% CI: 1.26-2.37), p<0.001; and formal/self-employment, aPRR = 1.37 (95% CI: 1.02-1.91), p = 0.027. Unintended pregnancy was common while use of effective contraception methods particularly LARCs was low among these African WLHIV. HIV viral load, education, sexual-activity, fertility desires, and economic independence are pertinent individual-level factors integral to the multi-level barriers to utilization of effective contraception among African WLHIV. National programs should prioritize strategies for effective integration of HIV and reproductive health care in the respective African countries.

Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016-2021.

To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0-20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1-17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8-31.6% in patients aged 12-14 years) and decreased in a dose-response relationship by age to 8.4% (95% CI 7.4-9.4%) among patients aged 45-49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.

Foreign bodies inside us - Trends and knowledge regarding long-acting reversible contraceptives (LARCs) use, factors influencing of contraceptives choice-making process, and the dual-method use among Polish college-aged women

Introduction: The choice-making process of the contraceptive method seems complex and influenced by many factors. Long-acting reversible contraceptives require mechanical interference with the woman's body. For some, it will be an insurmountable barrier whilst for others a chance to enjoy a successful sex life without fear of pregnancy. Recognizing the factors influencing their use will allow us to identify target groups, increase awareness, and spread knowledge about them.&#x0D; Purpose: This study aimed to assess contraceptive use trends and knowledge, focusing on long-acting reversible contraceptives (LARCs) and vaginal rings, also to identify predictors associated with their use and analyze the decision-making process for dual-method use (hormonal plus barrier method) among female college students in Poland.&#x0D; Materials and methods: A self-administered questionnaire including 44 questions in the form of a web-based survey distributed among peers in social media platforms and forums.&#x0D; Results: In the survey a total of 700 female students aged 19±25 took part. All the questions about LARC and vaginal rings were answered correctly by only 19 participants (2.71%). The most knowledgeable were medical students (p&lt;0.0001). Out of 55 LARC and vaginal ring users (7.86%), 47 female students (76.4%,) stated the improvement of their life. Of the methods interfering with the body, the study group most frequently chose the vaginal ring (38.1%) and least frequently the hormone injection (0.1%). &#x0D; Conclusions: Participants’ knowledge of LARC methods and vaginal rings is insufficient and its main influencing factors are faculty type and frequency of intercourse. LARC and vaginal disc are not the first contraception choice. Fear of pregnancy is the most common factor for dual method use.

Adolescent Long-Acting Reversible Contraceptive Use, Same-Day Insertions, and Pregnancies Following a Quality Initiative

ObjectiveTo compare long-acting reversible contraceptive (LARC) use, pregnancy rate, and same-day LARC insertion among adolescents before and after a Kaiser Permanente Northern California quality initiative. MethodsA 2016 Kaiser Permanente Northern California initiative aimed to increase adolescent LARC access. Interventions included patient education resources, electronic protocols, and insertion training for pediatric, family medicine, and gynecology providers. This study examined a retrospective cohort of adolescents aged 15–18 years who used contraception before (2014–2015, n = 30,094) and after (2017-2018, n = 28,710) implementation. Contraceptive types included LARC (intrauterine device or implant), injectable, and contraceptive pill, patch, or ring. We reviewed a random sample of LARC users (n = 726) to identify same-day insertions. Multivariable analysis examined the effects of year of provision, age, race, ethnicity, LARC type, and counseling clinic. ResultsPreintervention, 12.1% of adolescents used LARC, 13.6% used injectable, and 74.3% used pill, patch, or ring. Postintervention, the proportions were 23.0%, 11.6%, and 65.4%, respectively, with the odds of LARC provision of 2.57 (95% confidence interval (CI) 2.44–2.72). The pregnancy rate decreased from 2.2% to 1.4% (p < .0001). Higher rates of pregnancy were observed with injectable contraception and in Black and Hispanic adolescents. Same-day LARC insertion rate was 25.1% without significant variation post intervention (OR 1.44, 95% confidence interval 0.93–2.23). Contraceptive counseling in gynecology clinics increased the odds of same-day provision, while non-Hispanic Black race lowered odds. DiscussionA multifaceted quality intervention was associated with a 90% increase in LARC use and a 36% decrease in teenage pregnancy rate. Future directions may include promoting same-day insertions, targeting interventions in pediatric clinics, and focusing on racial equity.

Long-acting reversible contraception and condom use: A cohort study of female adolescents and young adults in New York City

ObjectivesThis study aimed to determine whether condom use varied between adolescents and young women using long-acting reversible contraception (LARC) vs non-LARC hormonal methods and assess if the initiation of LARC was associated with lower condom use. Study designThis study used data from a large longitudinal study of sexually active females aged 13–25 years. Questionnaires assessed contraception, condom use, sexual history, and partner characteristics at the baseline visit and every 6 months. Log-binomial regression analyses examined associations between hormonal contraceptive methods and condom use, and the moderating effects of age and number of sexual partners. Exploratory analyses compared condom use based on partner characteristics. ResultsOf 1512 participants, 1116 reported LARC or non-LARC hormonal method use during any study visit. Among baseline and new LARC users, 75.7% and 84.7% reported intrauterine device (IUD) use, respectively. Condom use at baseline among hormonal non-LARC users (37.5%) was significantly higher (p < 0.01) than LARC users (23.5%). Condom use among LARC vs non-LARC users was moderated by age in that LARC was associated with lower condom use among participants aged 13–18 years, but not those aged 19–25 years. Number of sexual partners was not a significant moderator. Among participants with increased sexually transmitted infection (STI) risk based on partner characteristics, LARC users had lower condom use compared to non-LARC users. ConclusionsCondom discontinuation was common following initiation of LARC and hormonal non-LARC methods. However, condom use was lower in LARC users at baseline, among younger adolescents, and if partners had risk factors for STIs. ImplicationsCondom discontinuation following initiation of highly effective contraception increases the risk of STI. Young women using LARC may be at greater risk than non-LARC users given lower condom use despite having partners with risk factors for STIs. Condom use counseling for STI protection is critical for adolescents.

Is long‐acting reversible contraceptive method use associated with HIV testing frequency in KwaZulu‐Natal, South Africa and Lusaka, Zambia? Findings from the CUBE study

ObjectivesTo assess differences in HIV testing at 6-months intervals over 24 months among intramuscular depot medroxyprogesterone acetate (DMPA-IM) injectable, levonorgestrel implant, or copper intrauterine devices (IUD) users in KwaZulu-Natal, South Africa, and Lusaka, Zambia. Testing at recommended intervals has not been previously assessed in long-acting reversible contraceptive (LARC) users (implant and IUD users) compared to those using effective but shorter-acting methods (such as DMPA-IM) in sub-Saharan Africa. Study designAs part of the longitudinal contraceptive use beyond ECHO (CUBE) study, we measured HIV testing over 24 months. Participants were considered continuous users of DMPA-IM, levonorgestrel implant, or copper IUD if they used the same method across all months of their study participation, or not continuous users of their baseline CUBE method if they switched or discontinued their method. We used multivariable logistic regression models with generalized estimating equations and robust standard errors, stratified by country, to assess differences in HIV testing. ResultsAmong the 498 participants, HIV testing rates were higher in Zambia for all methods compared to South Africa. In bivariate analyses, continuous implant or IUD users (the LARC users) were significantly less likely to report having received HIV testing at the 6-months and 24-months surveys, compared to continuous DMPA-IM users. In adjusted longitudinal models, continuous IUD users (adjusted odds ratio: 0.42, 95% CI: 0.24, 0.74), continuous implant users (adjusted odds ratio: 0.23, 95% CI: 0.12, 0.42) in South Africa had significantly lower odds of HIV testing compared to continuous DMPA-IM users. There were no significant differences in Zambia in the adjusted models. ConclusionLARC use may reduce opportunities for HIV testing and users should be counseled on regular HIV testing and the option of HIV self-testing. ImplicationsDue to infrequent clinical contacts which may lead to lower rates of HIV testing at recommended intervals, LARC users should be provided opportunities to test for HIV at home or when seeking other health services.

Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study

Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. This trial is registered as ISRCTN14733020. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.

Contraception Use and Pregnancy Outcomes for Alabama Medicaid Enrollees: A Baseline Analysis Using 2012-2017 Data.

Access to the full range of contraceptive methods, including long-acting reversible contraception (LARC), is key for preventing unintended pregnancies and improving health outcomes. In 2019, Alabama Medicaid started paying for LARC devices for postpartum women. In anticipation of evaluating the impact of this programmatic change, we conducted a baseline study exploring contraception use and pregnancy-end outcomes for enrollees before the change. A retrospective cohort of women enrolled in Alabama Medicaid from 2012 to 2017 was examined. Outcomes include pregnancy-end events for all enrollees, teen pregnancy-end events, and short-interval (SI) pregnancy-end events. Pregnancy events in year t are matched to contraception in year t - 1. Contraception is categorized as "no evidence," short-acting contraception (SAC), LARC, and sterilization. Bivariate and multivariate models were estimated. Our final sample included 135,807 unique women who contributed 258,959 person-years. There was no evidence of contraception for 55.4% and evidence of SAC, LARC, and sterilization for 36.4%, 6.2%, and 2.0%, respectively. Relative risks for pregnancy-end events for SAC and LARC users were 0.63 (95% confidence interval [CI] 0.61-0.0.65) and 0.56 (95% CI 0.52-0.0.59), respectively, compared with women with no evidence of contraceptive use. For teen pregnancy-end events, relative risks for SAC and LARC users were 0.65 (95% CI 0.61-0.67) and 0.58 (95% CI 0.51-0.66), respectively. For SI pregnancy-end events, relative risks for SAC and LARC users were 0.71 (95% CI 0.68-0.76) and 0.40 (95% CI 0.34-0.46), respectively. LARC and SAC are associated with lower likelihood of pregnancy-end events compared with no evidence of contraception, and on average, LARC is associated with lower relative risk than SAC, especially for SI pregnancy-end events.

The acceptability of asking women to delay removal of a long-acting reversible contraceptive to take part in a preconception weight loss programme: a mixed methods study using qualitative and routine data (Plan-it)

BackgroundHaving a body mass index (BMI) which is classified as overweight (BMI ≥ 25) or obese (BMI ≥ 30) increases the risk of complications during pregnancy and labour. Weight-management interventions which target excess gestational weight gain during pregnancy have had limited success. Women who use long-acting reversible contraception (LARC) are in contact with services as part of their preparation for conception, creating a potential opportunity to offer a preconception weight-loss intervention.The aims of this mixed methods study were to assess the acceptability and practicability of a weight-loss intervention which asked people to delay LARC removal in order to lose weight before conceiving.MethodsRoutine UK NHS data were analysed to identify pathways from LARC removal to pregnancy. Qualitative surveys and advisory group discussions with service providers and LARC users with experience of being overweight were conducted and analysed thematically.ResultsThree hundred fifteen thousand seven hundred fifty-five UK women aged 16–48 years between 2009–2018 had at least one LARC-related event (e.g. insertion, removal) and 1.7% of those events were recorded as related to planning a pregnancy. BMI was included in 62% of women’s records, with 54% of those BMI being classified as overweight or obese. Online surveys were completed by 100 healthcare practitioners and 243 LARC users. Stakeholders identified facilitators and barriers associated with the proposed intervention including sensitivities of discussing weight, service-user past experiences, practitioner skills, the setting and ethical implications of the proposed intervention.ConclusionsAlthough women and service providers recognised potential benefits, a preconception weight-loss intervention asking people to delay LARC removal posed many barriers, due mainly to the acceptability of such an intervention to women and healthcare practitioners. Weight-loss interventions that target the general population, together with a focus on improving public knowledge of preconception health, may be more acceptable than interventions which solely focus on LARC users. Many of the barriers identified, including communication, understanding and beliefs about weight and risk, appointment systems and the limitations of routine datasets also have relevance for any preconception weight-loss intervention. Work to improve routine datasets and reducing communication barriers to discussing weight are priorities.Trial registrationISRCTN14733020 registered 10.05.2019.

Factors associated with long-acting reversible contraception usage: Results from the National Survey of Family Growth.

The authors aimed to identify factors associated with long-acting reversible contraception (LARC) usage. The current cross-sectional study used data from the National Survey of Family Growth from 2011 to 2019. Respondents aged 15 to 44 years were included. Those with previous sterilization, infertility, or pregnant were excluded. The outcome evaluated was use of a LARC. Of 61 543 814 women, 44 287 911 (72.0%) met inclusion criteria. The rate of LARC use was 13.4%. Factors associated with an increased likelihood of LARC usage were married/living with a partner (adjusted relative risk [aRR], 1.18 [95% CI, 1.02-1.37]), perceived good health (aRR, 1.44 [95% CI, 1.13-1.84]), year of survey 2017 to 2019 (aRR, 1.53, [95% CI, 1.28-1.83]), one or two past pregnancies (aRR, 1.62 [95% CI, 1.24-2.12]) or three or more past pregnancies (aRR, 1.67 [95% CI, 1.22-2.28]), age at first live birth <20 years (aRR, 1.58 [95% CI, 1.20-2.08]) or 20 to 24 years (aRR, 1.45 [95% CI, 1.13-1.87]), age at onset of sexual activity 13-19 years (aRR, 1.50 [95% CI, 1.26-1.78]), and a 0- to 5-month period of nonintercourse in the past year (aRR, 1.63 [95% CI, 1.40-1.90]). Factors associated with decreased LARC usage were age ≥ 35 years (aRR, 0.74 [95% CI, 0.65-0.85]), being non-Hispanic Black (aRR, 0.75 [95% CI, 0.62-0.89]) or non-Hispanic other (aRR, 0.72 [95% CI, 0.59-0.88]), intending to have children (aRR, 0.65 [95% CI, 0.57-0.74]), and never being sexually active (aRR, 0.10 [95% CI, 0.06-0.16]). Using a nationally representative sample of women in the United States, the authors identified modifiable factors associated with LARC use. Results may be used to plan interventional trials to increase LARC usage.

Are LARC Users Less Likely to Use Condoms? An Analysis of U.S. Women Initiating LARC in 2008-2018.

Public health professionals have raised concern that increased use of long-acting reversible contraceptives (LARC) could raise women's risk for sexually transmitted infections (STIs), because LARC's superior pregnancy protection may decrease women's motivation to use a barrier method for supplemental pregnancy prevention. This study uses population-based data to examine whether condom use is lower, particularly among young women who are at increased STI risk, after initiating LARC versus moderately effective methods. With the 2011-2019 data files of the National Survey of Family Growth, we examine the percent of sexually active months with condom use in the year after LARC or moderately effective method initiation for a nationally representative sample of 2,018 women aged 15-44years. Multinomial logistic models regressed condom use on method type and age group, as well as their interaction, while adjusting for key confounders. The unadjusted likelihood of any condom use is substantially lower among women who initiated LARC versus moderately effective methods (12% vs. 37%), and this difference is greater among younger versus older women. After accounting for differences in women's reproductive and sociodemographic profiles, however, a statistically significant difference in condom use by method initiated remains only for those aged 20-34years. Crude estimates suggest that condom use is lower after initiating LARC versus moderately effective methods, especially among young women. After accounting for the confounding effects of LARC users' distinct profiles-particularly in terms of parity and teenage childbearing-the difference is decreased overall and no longer significant for adolescent women. Overall results indicate a need for new STI prevention strategies and policies that emphasize the importance of dual prevention for LARC users at risk of STIs.

Factors associated with discontinuation among long-acting reversible contraceptive users: a multisite prospective cohort study in urban public health facilities in Ethiopia

ObjectiveThe study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC)...

Satisfaction, Resignation, and Dissatisfaction with Long-Acting Reversible Contraception among Low-Income Postpartum Texans.

Prior longitudinal studies of long-acting reversible contraception (LARC) satisfaction and continuation guaranteed their participants access to LARC removal. Under real-world conditions, LARC users who wish to discontinue may experience barriers to LARC removal. A prospective cohort study recruited 1,700 postpartum Texans without private insurance from 8 hospitals in 6 cities. Our analysis included the 418 respondents who initiated LARC in the 24months after childbirth. A content analysis of open-ended survey responses identified three categories of LARC users: satisfied, resigned, and dissatisfied. Satisfied LARC users were using their method of choice. Resigned users were using LARC as an alternative method when their preferred method was inaccessible. Dissatisfied users were unhappy with LARC. Multinomial logistic regression models identified risk factors for resignation and dissatisfaction. Cox proportional hazards models assessed differences in LARC discontinuation by satisfaction and sociodemographic characteristics. Participants completed 1,505 surveys while using LARC. LARC users were satisfied in 83.46% of survey responses, resigned in 5.25%, and dissatisfied in 11.30%. Resignation was more likely if respondents were uninsured or wanted sterilization at the time of childbirth. The risk of dissatisfaction increased with time using LARC and was higher among uninsured respondents. U.S.-born Hispanic LARC users were more likely than foreign-born Hispanic LARC users to be dissatisfied and less likely to discontinue when dissatisfied. Dissatisfaction-but not resignation-predicted discontinuation. Cost, lack of insurance, and difficulty obtaining an appointment were frequent barriers to LARC removal. Most postpartum LARC users were satisfied, but users who wished to discontinue frequently encountered barriers.

“I just had to pay the money and be supportive”: A qualitative exploration of the male-partner role in contraceptive decision-making in Salt Lake City, Utah family planning clinics

ObjectivesPeers and intimate partners can influence contraceptive decision-making and use. We aimed to explore the male-partner role in contraceptive decision-making, and describe ideal male-partner roles and how they relate to contraceptive use, specifically uptake of long-acting reversible contraception (LARC). Study designWe used a phenomenological approach to explore cis-hetero partner involvement in contraceptive decision-making and conducted semi-structured in-depth interviews with 30 cisgender women and 30 cisgender men in heterosexual relationships who presented to Salt Lake City family planning clinics. Participants, stratified by sex assigned at birth and current contraceptive method (LARC vs non-LARC), described the male-partner's role in the most recent contraceptive decision and discussed how ideal-partner involvement could look in contraceptive decision-making. We iteratively developed a codebook and identified dominant themes using a constant content and comparative analysis. ResultsWe did not identify thematic differences by LARC vs non-LARC users. Participants universally considered that contraceptive responsibility falls on women. At the time of the interviews, both men and women indicated a strong desire to prevent pregnancy, and felt that men's actual contributions to decision-making were limited. Themes around gendered-differences of contraceptive knowledge, responsibility and risk, and sexual priorities emerged, as well as inadequate knowledge and contraception options for men. In analyzing discussion around ideal partner support, participants suggested emotional, financial, and logistical support options and placed high importance on interpersonal communication. ConclusionsThe decision to use a method of LARC did not influence sentiments around male-partner involvement or stated desire for partner involvement. Limited contraceptive knowledge and male options restrict the contraceptive decision-making role and contraceptive engagement for men, although participants suggested other supportive options. ImplicationsThis work suggests the desire of both men and women for men to participate in contraceptive decision-making, but their role remains limited. Future interventions focused on comprehensive contraceptive education and modeling of communication strategies for men are tangible steps to support men in this role.

Low Use of Long-Acting Reversible Contraceptives in Tanzania: Evidence from the Tanzania Demographic and Health Survey.

We aimed to determine the prevalence and factors associated with the use of long-acting reversible contraceptives (LARCs) among women of reproductive age in Tanzania. We analyzed the Tanzania Demographic and Health Survey (DHS) data from 2015 to 2016. The study included 8189 women aged 15–49 years. The relationship between various factors and LARC use was determined through various analyses. Among women with a partner/husband, 7.27% used LARCs, 21.07% were grand multiparous, and 20.56% did not desire more children. Women aged 36–49 years (adjusted odds ratio (AOR)-2.10, 95% confidence interval (CI): 1.11–3.96), who completed secondary education (AOR-1.64, 95% CI: 1.05–2.55), who did not desire more children (AOR-2.28, 95% CI: 1.53–3.41), with a partner with primary level education (AOR-2.02, 95% CI: 1.34–3.02), or living in richer households (AOR-1.60, 95% CI: 1.12–2.27) were more likely to use LARCs. Further, women with a partner who wanted more children were less likely to use LARCs (AOR-0.69, 95% CI: 0.54–0.90). Tanzania has a low LARC usage rate. Women’s age, wife and partner’s education status, couple’s desire for more children, and household wealth index influenced the use of LARCs, highlighting the need to reach more couples of lower socioeconomic status to improve LARC utilization.

How Much Do Side Effects Contribute to Discontinuation? A Longitudinal Study of IUD and Implant Users in Senegal.

IntroductionIn Senegal, discontinuation due to sides effects of long-acting, reversible contraceptives (LARCs) is relatively low; 5% of new implant acceptors and 11% of new IUD acceptors stop using in their first year because of health or side effect concerns. This study investigated factors associated with LARC discontinuation in the first 12 months of use in Senegal and explored how LARC users cope with side effects.MethodsThis mixed-method study involved quantitative interviews at five time points with LARC acceptors recruited from three service channels between February 2018 and March 2019. Qualitative interviews were conducted in August 2018 with a subset of those who experienced side effects. Logistic regression models identified factors associated with discontinuation due to side effects and discontinuation for any reason. Twelve-month discontinuation rates due to side effects were also estimated using a cumulative incidence function (CIF) approach to account for time to discontinuation.ResultsIn logistic models, method choice (IUD or implant) [OR = 3.15 (95% CI: 1.91–5.22)] and parity [OR = 0.81 (95% CI: 0.7–0.94)] were associated with discontinuation due to side effects; IUD users and women with fewer children were more likely to discontinue. Results for all-cause discontinuation were similar: method choice [OR = 2.39 (95% CI: 1.6–3.58)] and parity [OR = 0.86 (95% CI: 0.77–0.96)] were significant predictors. The 12-month side effect CIF discontinuation rate was 11.2% (95% CI: 7.9–15.0%) for IUDs and 4.9% (95% CI: 3.5–6.6%) for implants. Side effect experiences varied, but most women considered menstrual changes the least acceptable. No statistically significant differences across services channels were observed.ConclusionsIn this study in Senegal, the choice between implants and IUDs had a significant impact on continuation, and women with more children continued LARC methods longer, despite side effects.

Reasons for Intent to Discontinue and Remove Long-Acting Reversible Contraceptives: National Survey of Family Growth 2017-2019.

Background: Long-acting reversible contraceptives (LARCs) are highly effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARC effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among U.S. women 15-49 years of age from 2017 to 2019. Methods: The National Survey of Family Growth 2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results: Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10 years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include side effects (29.6%), LARC expiration (26.8%), LARC complications (19.3%), and decided to get pregnant (15.9%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), other reasons (13.4%), discouragement by provider (5.8%), and provider's inability to remove (4.9%). Conclusions: Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered is needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. To respect the reproductive autonomy of LARC users' method for pregnancy prevention, these barriers must be overcome.