Long-acting Reversible Contraception Utilization Research Articles

Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers

Postpartum utilization of long-acting reversible contraception (LARC) has been found to be effective at increasing inter-pregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers. (1) To quantify postpartum uptake of long-acting reversible contraception among U.S. Army active-duty female soldiers, and (2) to identify demographic and military-specific characteristics associated with utilization. This retrospective cohort study used longitudinal data on all digitally recorded health encounters for active-duty U.S. Army soldiers from 2014-2017. The servicewomen included in our analysis were aged 18-44 years with at least one delivery and a minimum of four months of total observed time post-delivery within the study period. We defined postpartum long-acting reversible contraception utilization as initiation in the delivery month or in the three calendar months following delivery, and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception utilization using multivariable logistic regression. Inclusion criteria were met by 15,843 soldiers. Of those, 3,162 (19.96%) received a method of long-acting reversible contraception in the month of, or within the three months following, delivery. Fewer than 5% of these women utilized immediate postpartum long-acting reversible contraception. Among women receiving a postpartum long-acting reversible contraceptive method, 1,803 (57.0%) received an IUD, 1,328 (42.0%) received an etonogestrel implant and 31 received both (0.98%). Soldiers of younger age, self-reported White race, and those married or previously married were more likely to initiate long-acting reversible contraception in the postpartum period. Race-stratified analyses showed that self-reported White women had the highest utilization rates overall. Compared to these women, the adjusted odds of postpartum utilization among self-reported Black and Asian/Pacific Islander women were 18% and 30% lower, respectively (both p<0.001). There was also a trend of decreasing postpartum utilization with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential utilization of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older, as well as among Black-identifying women. Among active-duty U.S. Army servicewomen, one in five utilized postpartum long-acting reversible contraception, with fewer than 5 percent of these women utilizing an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of utilization and significant differences in uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.

Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum long-acting reversible contraception services

National guidelines recommend that maternity systems provide patient-centered access to immediate postpartum long-acting reversible contraception (ie, insertion of an intrauterine device or implant during the delivery hospitalization). Hospitals face significant barriers to offering these services, and efforts to improve peripartum contraception care quality have met with mixed success. Implementation toolkits-packages of resources and strategies to facilitate the implementation of new services-are a promising approach for guiding clinical practice change. This study aimed to develop a theory-informed toolkit, evaluate the feasibility of toolkit-based implementation of immediate postpartum long-acting reversible contraception care in a single site, and refine the toolkit and implementation process for future effectiveness testing. We conducted a single-site feasibility study of the toolkit-based implementation of immediate postpartum contraception services at a large academic medical center in 2017 to 2020. Based on previous qualitative work, we developed a theory-informed implementation toolkit. A stakeholder panel selected toolkit resources to use in a multicomponent implementation intervention at the study site. These resources included tools and strategies designed to optimize implementation conditions (ie, implementation leadership, planning, and evaluation; the financial environment; engagement of key stakeholders; patient needs; compatibility with workflow; and clinician and staff knowledge, skills, and attitudes). The implementation intervention was executed from January 2018 to April 2019. Study outcomes included implementation outcomes (ie, provider perceptions of the implementation process and implementation tools [assessed via online provider survey]) and healthcare quality outcomes (ie, trends in prenatal contraceptive counseling, trends in immediate postpartum long-acting reversible contraceptive utilization [both ascertained by institutional administrative data], and the patient experience of contraceptive care [assessed via serial, cross-sectional, online patient survey items adapted from the National Quality Forum-endorsed, validated Person-Centered Contraceptive Counseling measure]). In the implementation process, among 172 of 401 eligible clinicians (43%) participating in surveys, 70% were "extremely" or "somewhat" satisfied with the implementation process overall. In the prenatal contraceptive counseling, among 4960 individuals undergoing childbirth at the study site in 2019, 1789 (36.1%) had documented prenatal counseling about postpartum contraception. Documented counseling rates increased overall throughout 2019 (Q1, 12.5%; Q4, 51.0%) but varied significantly by clinic site (Q4, range 30%-79%). Immediate postpartum long-acting reversible contraception utilization increased throughout the study period (before implementation, 5.46% of deliveries; during implementation, 8.95%; after implementation, 8.58%). In the patient experience of contraceptive care, patient survey respondents (response rate, 15%-29%) were largely White (344/425 [81%]) and highly educated (309/425 [73%] with at least a 4-year college degree), reflecting the study site population. Scores were poor across settings, with modest improvements in the hospital setting from 2018 to 2020 (prenatal visits, 67%-63%; hospitalization, 45%-58%; outpatient after delivery, 69%-65%). Based on these findings, toolkit refinements included additional resources designed to routinize prenatal contraceptive counseling and support a more patient-centered experience of contraceptive care. A toolkit-based process to implement immediate postpartum long-acting reversible contraceptive services at a single academic center was associated with high acceptability but mixed healthcare quality outcomes. Toolkit resources were added to optimize counseling rates and the patient experience of contraceptive care. Future research should formally test the effectiveness of the refined toolkit in a multisite, prospective trial.

Long-acting reversible contraception utilization and associated factors among women in extended postpartum period in southern Ethiopia

BackgroundPostpartum long-acting reversible contraceptive is important to prevent unintended and closed spaced pregnancy following the first 12 months of childbirth. Few data were available on postpartum long-acting reversible contraceptive use in Ethiopia. So, this study aimed to assess the long-acting reversible contraception use and associated factors among women who gave birth in the last 12 months.MethodsA community-based cross-sectional study was conducted from October 1st to November 2019. Systematic random sampling was applied to recruit a total of 416 study participants. Data were collected using a structured questionnaire. Data were entered using Epidata 4.6 and exported to SPSS version 25 for analysis. P-value < 0.05 with 95% confidence interval (CI) used to declare statistical significance.ResultIn this study, long acting contraceptive utilization among women in the extended postpartum period was 22.6%. Maternal age ≤ 24 years (AOR = 3.7, 95% CI: 1.5, 8.9), being married (AOR =3.5 95% CI: (1.17–10.28)), menses resumption (AOR = 4.9 95% CI: (2.92, 8.20)), sexual intercourse resumption (AOR = 7.1 95% CI: (4.03, 12.56)) and received postpartum family planning counseling (AOR = 3.2 95% (1.95, 5.28)) were the factors associated with Long-acting reversible contraception use.ConclusionThis finding showed postpartum women’s long-acting reversible contraceptive use during the extended postpartum period was low. The factors significantly associated with extended postpartum modern contraceptive use were women’s age, being married, menses resumption, sexual intercourse resumption, and got postnatal family planning counseling. Strengthening Antenatal and postnatal counseling of postpartum family planning would improve long-acting reversible contraception use.

Association of rural location and long acting reversible contraceptive use among Oregon Medicaid recipients

ObjectiveTo evaluate whether the use of long-acting, reversible contraception (LARC) is equitably accessible to Medicaid recipients in rural and urban areas. We also determined whether women's health specialists' availability was associated with the type of LARC used. Study designWe used claims data for 242,057 adult women who were continuously enrolled in Oregon Medicaid for at least one year and at risk of pregnancy from January 1, 2015, through December 31, 2017 to assess the association between LARC utilization and (1) rurality and (2) provider supply. Our primary analysis included 430,918 person-years. Regression models adjusted for patient age, whether the patient was newly eligible for Medicaid due to Medicaid expansion, and health status. We also examined differences in the caseload of implants and IUD by provider type (women's health specialist vs other). ResultsAmong all women, 11.6% had at least one claim indicating LARC use. There was no significant difference in overall LARC use by location (urban residence +0.66%, 95% CI [-0.12%, 1.43%]), although urban residents were slightly more likely to have an IUD (+0.72%, 95% CI [0.11%, 1.33%]). An increase of one women's health specialty provider per 10,000 women was associated with a 0.14 percentage point increase in the rate of IUD utilization (95% CI: 0.02, 0.26). Compared to other providers, women's health specialty providers supplied 62% of all IUDs and 43% of all implants. ConclusionAmong Oregon's Medicaid enrollees, LARC is equitably used in rural areas; however, IUD use is slightly more frequent in urban areas.

Implementation of Community‑Wide Initiatives Designed to Reduce Teen Pregnancy: Measuring Progress in a 5‑Year Project in 10 Communities.

Community-wide initiatives (CWI) to prevent teen pregnancy were implemented in 10 communities in the USA. The CWI supported the implementation of evidence-based teen pregnancy interventions (EBIs) and implementation of best practices for adolescent reproductive health care. Implementation was supported through mobilizing communities, educating stakeholders, and strategies to promote health equity. We assessed indicators of progress of the CWI for the following five project components (data collected from 2010 to 2015): community mobilization, stakeholder education, working with diverse communities, evidence-based interventions, and increasing access to clinical services and the potential contributions of training and technical assistance. Communities engaged multiple stakeholder groups to contribute to planning, community outreach and education, and partnership development and used multiple dissemination methods to share information on adolescent reproductive health needs and teen pregnancy prevention strategies. The amount of training and technical assistance from state- and community-based organizations was associated with increased numbers of youth receiving EBIs and increased provision of contraceptives. The number of health centers implementing best practices for adolescent reproductive health services increased; conducting sexual health assessments, offering hormonal contraception or IUD, and offering quick start of IUDs were associated with increases in long-acting reversible contraception utilization. These findings demonstrate that scaled prevention efforts can occur with adequate support including training and technical assistance and community awareness and engagement in the process. The findings raise important questions for understanding what factors contribute to successful community-wide implementation of EBIs and health center best practices for contraceptive access and whether these lead to reductions in teen pregnancies in highly impacted communities.

Availability of and Interest in Long-Acting Reversible Contraception (LARC) and their Effect on LARC Utilization among Latina Adolescents

Long-acting reversible contraception devices, including etonogestrel implants and levonorgestrel intrauterine devices, are highly effective contraception options for all women including adolescent and young adult nulliparous women.

Prevalence and factors associated with postpartum use of long-acting reversible contraception in Bukombe District, Geita Region, Tanzania: a community- based study

BackgroundGlobally, approximately half of all pregnancies occur before 24 months after child birth. In Sub Saharan Africa the unmet need for family planning is highest among postpartum women. There is a dearth of information regarding factors associated with postpartum use of long acting reversible contraception (LARC) in Tanzania particularly in the Lake zone. This study aimed to determine the prevalence and factors associated with postpartum use of LARC (< 24 months) in Bukombe District, Geita Region in the Lake zone, in 2018.MethodologyCommunity based analytical cross-sectional study was conducted between May and June 2018 among women with less than 24 months since delivery. Multistage sampling technique was used to recruit participants. Face to face interviews with 768 postpartum women was conducted using standardized questionnaire. Data were analyzed using Stata Version 13.0. Multivariable logistic regression model was used to determine factors associated with postpartum use of LARC.ResultsPrevalence of postpartum use of LARC was 10.4%. Urban residence (AOR = 2.94, 95% CI: 1.07–8.06), having formal employment (AOR = 4.81, 95% CI: 1.85–12.57) and receiving family planning counseling (AOR = 4.39, 95% CI: 1.89–10.20) were significantly associated with postpartum LARC use.ConclusionThe postpartum use of LARC was low in the studied population with implants being the most commonly used method. Urban residency, formal employment and receiving family planning counseling were associated with postpartum LARC use. Improving prenatal and quality of family planning counseling is warranted to increase postpartum LARC utilization in Bukombe.

Long-acting reversible contraception utilization and associated factors among women in extended postpartum period in\xa0Hossana town, southern Ethiopia: cross sectional study

BackgroundIn low and middle-income countries, 95% of postpartum women want to avoid a pregnancy for 2 years, but 70% are not using contraception. Delay in use of contraception by couples during postpartum period can result in many unwanted pregnancies. Long-acting reversible contraception (LARC) is ideal for postpartum women. Therefore this study aimed at assessing the prevalence and factors associated with LARC use among postpartum women.MethodsFacility based cross sectional study was conducted from July 23-Aug 25, 2018. Systematic random sampling technique was employed to recruit a total of 381 women in extended postpartum period visiting Child Immunization service in hosanna health institutions. Pretested structured questionnaire was used for data collection. Data was analyzed by SPSS version 20. Binary and multiple logistic regression analysis was done. The presence and strength of association was determined using AOR with its 95% CI. Variables with P value less than 0.05 were considered as statistical significant.ResultsThe prevalence of LARC use was 36.5% (95%CI (33.05–39.95)). The main reason for not using LARC was fear of side effect and false information. Previous use of LARC (AOR = 3.3, 95%CI (1.7–6.5)) and have ever discussed with health providers on LARC (AOR = 2.5, 95%CI (1.1–5.74)) were found to be significantly associated with LARC use.ConclusionsThe utilization of LARC among postpartum women was found to be higher than other studies in Ethiopia. Provision of effective contraceptive counseling during Antenatal, delivery and postnatal care services with emphasis on LARC/Postpartum Intra-Uterine Device is important.

The effect of an educational video on long-acting reversible contraception (LARC) utilization at 6-8weeks postpartum period: a randomized controlled trial.

Long-acting reversible contraception is highly effective in preventing unintended pregnancy and unsafe abortion. An educational video administered during early postpartum period might be an effective tool to improve postpartum LARC use. The objectives were to evaluate whether a postpartum educational video about LARC could increase postpartum LARC utilization at 6-8weeks postpartum and to assess why postpartum women did not receive LARC. This randomized-controlled trial was conducted at the postpartum unit of a university Hospital between August 2016 and February 2017. Postpartum women who were aged > 20years and willing to participate were recruited. Participants allocated to the study group watched the 7-min educational video on LARC methods while the control group did not. To assess LARC utilization, data were collected at 6-8weeks postpartum using telephone calls and/or medical record review to determine postpartum contraception use and reasons for not using LARC. Two-hundred and seventy participants were enrolled, and the video (135) and non-video (135) groups had similar baseline characteristics. In the video group, 57.8% (95% CI 49.0-66.2) reported using a LARC method, compared to 25.9% (95% CI 18.8-34.2) in the non-video group (p < 0.05). The reasons for not using LARC in both groups were inconvenience of access (42.0-43.8%) and uncertainty about methods (17.0-24.6%). The educational video introduced at immediate postpartum period was efficacious in increasing the utilization of LARC at 6-8weeks postpartum. Inconvenience of access was the most common reason cited for not using LARC. Clinicaltrials.in.th TCTR20171225001 "retrospectively registered".

Correlates of long-acting reversible contraception uptake among rural women in Guatemala.

ObjectiveIn many low-resource settings around the world utilization of long-acting reversible contraception (LARC) is low, in part due to access barriers. We sought to explore LARC utilization patterns as well as factors associated with LARC initiation by women seeking contraception in rural Guatemala from a program working to reduce contraception access barriers.Study designWe analyzed data from a program that provides family planning in six remote, primarily indigenous, villages in Guatemala with limited access to alternative health services. Methods are free and delivered directly within villages by culturally competent providers. We conducted a retrospective chart review of all 288 women who initiated a contraceptive method over a 16-month period and conducted a logistic regression to obtain adjusted odds ratios (OR) for predictors of LARC uptake.ResultsOverall 79.2% of women elected a LARC method. More than half of women (49.8%) switched to LARC from short-acting hormonal methods. In the univariate analysis prior use of short-acting method (p = 0.014), number of prior methods (p = 0.049), and current contraceptive use (p<0.01) were significantly associated with choosing a LARC. In the logistic regression model current use of contraception remained significant (OR 3.29, 95% CI 1.67–8.04). Report of abnormal bleeding or other side effects from prior short-acting method use did not predict LARC uptake (p = 0.82 and p = 0.079).ConclusionsMost women in this marginalized population opted for a LARC method.ImplicationsLow utilization of LARCs may be related to service delivery factors. Further research is needed to validate these conclusions prospectively and in less selected populations.

Post-Partum LARC Utilization Among Group Prenatal Care Participants in Atlanta, Georgia [4E

INTRODUCTION: CenteringPregnancy (CP) is a model of group prenatal care (PNC) that reduces preterm birth and increases patient satisfaction. Less is known about post-partum outcomes. This study was conducted to determine whether CP participants have increased utilization of long-acting reversible contraception (LARC) post-partum in comparison to those in traditional PNC. METHODS: We conducted a retrospective cohort study of 422 women who received PNC and delivered at Grady Memorial Hospital in Atlanta, Georgia between 2011 and 2015. Participants were eligible if enrolled in Medicaid and received at least three PNC visits with a Certified Nurse Midwife in either CP (n=248) or traditional PNC (n=174). Demographic and clinical data were abstracted from the electronic medical record. Unadjusted relative risk (RR) and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CI) were generated to compare CP with traditional PNC. RESULTS: One quarter of women (26%) chose LARC for post-partum contraception. CP participants were more likely to use LARC by 12 weeks post-partum in comparison to those who received traditional PNC (aIRR 1.89; p=0.01), adjusting for age, mode of delivery, number of prenatal visits and primiparity. Short inter-pregnancy interval was similar between the CP and traditional PNC groups (RR 0.95, p=0.57). CONCLUSION: Women in CP groups may be more likely to choose LARC post-partum contraception but were no less likely to have a short inter-pregnancy interval.

Does Repeat Termination of Pregnancy Affect Contraception Choice? [222

INTRODUCTION: Patients with a previous termination of pregnancy may be susceptible to unintended pregnancies. Looking at their contraception choices may illustrate whether their risk is inherit to their contraception. METHODS: This is a cross-sectional study investigating patients undergoing surgical termination of pregnancy between April 1 2009 and May 10 2013 at our institution. Patients were analyzed according to primary compared with repeat termination of pregnancy. Contraceptive choices were categorized into short-acting (ring patch oral contraceptive pills or all of these) or LARC (intrauterine device Depo or both). Categorical variables were analyzed using chi and continuous variables with Students t tests. Odds ratios (ORs) were calculated utilizing logistic regression adjusting for patient demographic and confounding variables. RESULTS: The study included 1458 patients; 684 primary and 774 repeat termination of pregnancy. Patients with prior termination of pregnancy were older (26.7 compared with 23.0 years P<.001) had higher gravity (4.9 compared with 2.3 P<.001) were more commonly black (72.7% compared with 59.4% P<.001) less commonly Hispanic (16.7% compared with 25.6% P<.001) and more likely had medical comorbidities. Gestational age (10.1 compared with 10.1 weeks P=.91) and procedure type (dilatation and curettage 82.6% compared with 85.1% P=.22) were similar. Individuals with prior termination of pregnancies were less likely to select none (OR 0.40 95% confidence interval [CI] 0.28-0.58) or barrier (0.49 95% CI 0.39-0.62) and more likely to select short acting (2.23 95% CI 1.80-2.76). After adjustment only none (0.46 95% CI 0.32-0.67) and short acting (1.88 95% CI 1.46-2.42) were significant. There were no differences in long-acting reversible contraception utilization. CONCLUSION: Increasing interventions regarding all forms of contraception with patients undergoing primary termination of pregnancy and specifically long-acting reversible contraception among patients with previous termination of pregnancies may prevent subsequent termination of pregnancies.

Increasing LARC utilization: any woman, any place, any time.

Intrauterine contraceptive devices and the progestin implant are the most effective long-acting reversible contraception (LARC) methods available for preventing unintended pregnancy. LARC devices are safe, non-user-dependent methods that have the highest rates of continuation and satisfaction of all reversible contraceptives. Use of these contraceptives remains low in the United States due to several barriers including: misperceptions among both providers and patients; cost barriers; and patient access to the devices. Increasing the opportunities for women to access LARC methods in the primary care, postabortion, and postpartum setting can be achieved by addressing the system, provider, and patient barriers that exist.

Effect of an educational script on postpartum contraceptive use: a randomized controlled trial

ObjectivesShort interpregnancy intervals are associated with adverse perinatal outcomes. Increased postpartum use of long-acting reversible contraception (LARC) could reduce short interpregnancy intervals. Therefore, the primary objective of our study was to evaluate if a postpartum educational script about LARC (LARC script) could increase postpartum LARC utilization at the 6-week postpartum visit. Study designWe completed a randomized controlled trial (1:1) of 800 postpartum women in Raleigh, North Carolina. Women were recruited from the postpartum unit and randomized to receive (intervention) or not receive (control) the LARC script prior to hospital discharge. We conducted follow-up phone interviews to assess LARC use after their 6-week postpartum visit. We used Pearson's chi-squared test to compare LARC use between arms. ResultsBetween May 2011 and January 2012, 400 women were randomized to each arm. Three hundred sixty-nine women (92.3%) in each arm were successfully contacted after their 6-week postpartum visit. LARC use was reported by 17.6% and 13.3% of women in the intervention and control arms, respectively (p=.103). ConclusionsThe LARC script did not increase LARC utilization at the 6-week postpartum visit. Future studies should evaluate interventions that address both educational and systematic barriers to postpartum LARC uptake. ImplicationsUse of a postpartum educational script focused on the intrauterine device and contraceptive implant did not increase their utilization after the 6-week postpartum visit. Future studies should evaluate interventions that address both educational and systematic barriers to postpartum contraceptive uptake.

Postpartum Use of Long-Acting Reversible Contraception in a Military Treatment Facility

To determine the rate at which long-acting reversible contraception (LARC) is desired immediately postpartum and utilized within 12 weeks of delivery at our institution. This prospective cohort study analyzed 400 consecutive postpartum patients between January 2009 and March 2009. We followed contraceptive desire prior to discharge and actual contraception utilized within 12 weeks postpartum. Patient demographics and LARC utilization was analyzed to determine characteristics predictive of use. There was complete follow-up information on 329 (82.3%) of the studied women. Thirty-three percent (132/400) desired LARC immediately postpartum, and overall LARC utilization at 12 weeks was 31% (100/329). Demographic characteristics predictive of LARC desire and utilization included age <25 years (adjusted RR=1.53, 95% CI 1.17-1.92) and African-American ethnicity (adjusted RR=1.39, 95% CI 1.03-1.78). In our institution, LARC is highly desired and utilized within 12 weeks postpartum with African-American ethnicity and age <25 years predictive of use.