Long-acting Reversible Contraception Research Articles

Etonogestrel Subdermal Implant in Adolescents: Everything We Should Know to Conduct Proper Counseling, a Narrative Review

Background/Objectives: Comprehensive sexual education and access to contraceptives play a vital role in alleviating the economic, health, and social challenges associated with unplanned pregnancies in adolescents. According to the World Health Organization (WHO), adolescence refers to the transitional stage from childhood to adulthood, encompassing individuals aged 10 to 19. This period is critical for reproductive decision making, making it essential to closely observe patterns of sexual activity and contraceptive use among young people. Despite advancements, many adolescents still encounter significant barriers to accessing and effectively utilizing contraceptive methods. Methods: A bibliographic search was performed across three major biomedical databases: PubMed, Embase, and CINAHL. The research question was developed utilizing the PIO (Population, Intervention, Outcome) framework to guide the investigation. Results: Long-acting reversible contraceptives (LARCs), including the etonogestrel (ENG) implant, have been recognized for their ability to significantly reduce maternal and neonatal mortality and morbidity as well as decrease the incidence of unsafe abortions. Conclusions: Access to adequate counseling and effective contraceptive services can profoundly impact young people’s lives, preventing unplanned pregnancies and promoting optimal sexual and reproductive health.

Geographic distribution and demographic factors associated with use of a long-acting reversible contraceptive (LARC) in Ethiopia.

Increasing access to and utilization of long-acting reversible contraceptives (LARC) can prevent unintended pregnancies and reduce unmet need for family planning in Ethiopia However, LARC uptake lags behind less effective contraceptive methods. This study aimed to analyze the geographical distribution and demographic factors associated to LARC uptake. The 2019 Performance Monitoring For Action Ethiopia (PMA Ethiopia) survey data was used. Spatial autocorrelation was examined using Global Moran's I and Local Indicators of Spatial Association (LISA). Bivariate Moran's I and bivariate LISA (BiLISA), Spatial lag, and spatial error regression analyses were performed to assess the spatial correlation and association between LARC uptake and demographic factors. LARC uptake was 8% among the study population, with Afar and Somali regions having the lowest uptake. There was a statistically significant positive spatial autocorrelation for LARC uptake (Moran's I= 0.308, p<0.001). Additionally, an inverse correlation was observed between LARC uptake and the percentage of Muslims, rural population, no formal education, and low wealth quantile. The spatial lag model indicated that zones with higher Muslim populations and those with higher percentages of population with no formal education had lower LARC uptake. To expand access to LARC, the Ethiopian government, policymakers, and non-governmental organizations might implement programs targeting low-uptake areas (Afar and Somali regions). Muslim religious leaders could play an important role in promoting acceptance of LARC among their members. Tailored health education programs should be developed for Muslim populations and those with no formal education to enhance awareness and acceptance of LARC.

An Acceptability and Feasibility Study of a Nurse-Led Model of Contraception and Abortion Care in Rural General Practice.

To assess the acceptability and perceived feasibility of integrating a co-designed nurse-led model of contraception and medication abortion care within rural and regional general practices. Qualitative exploratory design utilising Sidani and Braden's indicators of acceptability and feasibility. We conducted semi-structured interviews with 12 practice nurses, 8 general practitioners and 3 practice managers who currently or previously worked in rural, regional or remote general practice. Participants were recruited purposively through social media, partner organisation newsletters and snowballing. During the interview, participants were presented with an overview of the co-designed model of care and asked specific questions to gain feedback on its acceptability and perceived feasibility. Data were analysed in NVivo using template analysis and iterative categorisation. Findings were mapped according to Sidani and Braden's indicators of acceptability and feasibility. Three overarching themes were identified: nurses are acceptable providers, factors influencing the feasibility of the model and factors supporting greater feasibility of the model. Participants found the nurse-led model acceptable, describing nurses as suitable and sometimes preferred providers of long-acting reversible contraception and abortion care in rural and regional settings. They also perceived the model as feasible, citing similarities to existing care processes such as infant immunisations and chronic disease management, contributing to its feasibility. However, contextual factors such as the need to adapt the model to each clinic and patient's unique needs, foster strong general practitioner-practice nurse professional relationships and ensure that staff have shared values and adequate training for contraception and abortion provision were described as critical for feasibility. Overall, participants found the nurse-led model of care to be acceptable and feasible for implementation in rural and regional general practices. This perception carries important implications for policy and practice, highlighting the need for supportive policies to enhance the effectiveness of such models across Australian general practice. Our findings emphasise the need for initiatives aimed at addressing inadequate funding for nurse-led care, improving documentation of this care, enhancing understanding among general practitioners and nurses regarding the scope of practice for practice nurses, and overcoming training barriers specific to rural areas. These measures are essential for enabling nurse-led models of contraception and medication abortion to function effectively in practice. This paper is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines. Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

Acceptability of digital health intervention during pregnancy to inform women about postpartum contraception (DIGICAP): a pilot randomised controlled study

BackgroundPregnancy within a year of childbirth has negative impacts on women and their children’s health. We developed a digital health intervention (DHI) to empower women in contraceptive choices postpartum. Our...

Self-reported contraceptive method use at conception among patients presenting for abortion in England: a cross-sectional analysis comparing 2018 and 2023

BackgroundRecent media attention has been given to an apparent shift away from hormonal methods of contraception. While an increase in fertility awareness-based or ‘natural’ family planning methods is reported in...

Knowledge, attitude and acceptability for long-acting reversible contraceptive (LARC) methods among women attending contraception counselling sessions: A cross-sectional study

ABSTRACT Aims: To study the knowledge, attitude, and acceptability of Long-acting Reversible Contraceptive (LARC) methods among women attending contraception counselling sessions. Settings and Design: A cross-sectional study conducted in the family planning clinic of a tertiary care hospital. Methods and Material: Women aged 18–45 years attending contraception counselling sessions were included. Baseline knowledge about LARC methods was assessed. They were given information about LARC methods. Acceptability was assessed on a scale of 0–10. Results: Among four LARC methods, awareness about copper intrauterine devices (CuIUD), DMPA injection, subdermal implant and Mirena was 95%, 55.50%, 27% and 3%, respectively. Around 4% were unaware of the LARC method. Of total, 76.50% women procured the LARC methods information from health care workers, whereas 40% attained from friends, family members, neighbors, or colleagues. After counseling, the majority (58%) were willing for subdermal implant. About 27.50% and 13.50% were willing for copper IUD insertion and injection DMPA, respectively. None was willing for Mirena. Acceptability of various LARC methods was scaled on an acceptability score from 0 to 10. For Cu IUD, implanon and DMPA, the acceptability score was 10 in 50%, 40.17% and 25%, respectively. Conclusions: There are still gaps of knowledge about benefits and safety of available LARC methods. To improve wide coverage and more acceptability of LARC methods, involvement of health care workers and addition of subdermal implants to contraceptive counseling should be considered.

Long-Acting Reversible Contraception (LARC) and Early Childbearing Revisited: Births and Birth Intendedness After LARC Removal in a State Medicaid Population (2012-2020).

Objectives. To analyze births and birth intendedness after long-acting reversible contraception (LARC) removal among Medicaid-insured women. Methods. We linked all Delaware women with a Medicaid-covered LARC removal in 2012 to 2020 (n = 8047) to birth records and to Pregnancy Risk Assessment Monitoring System (PRAMS) pregnancy intendedness survey responses (n = 241). Results. Births within 3 years of a Medicaid-covered LARC removal were much more likely to be to women in their 20s compared with all Medicaid births (63.5% vs 53.4%; P < .001). The intended proportion for births within 3 years of Medicaid-covered LARC removal (65.2%) was higher than for all Medicaid-covered births (58.8%; P = .08) and was consistently above 60% across all age groups younger than 30 years. Conclusions. A state Medicaid-insured population's use of highly effective reversible contraception was associated with births being concentrated among women in their 20s and with consistently high fractions of intended births across younger ages at birth. Public Health Implications. Programs and policies may consider LARC access for its potential to increase low-income women's reproductive autonomy by enhancing their ability to achieve births at the age of their choosing. (Am J Public Health. 2025;115(1):95-102. https://doi.org/10.2105/AJPH.2024.307844).

Long-acting reversible and permanent contraceptives utilization and its associated factors among married women who desire no more children in Ethiopia: A multilevel analysis.

This study aimed to investigate long-acting reversible and permanent contraceptives (LARPCs) utilization and its associated factors among married women who desire no more children in Ethiopia. Secondary datasets from the 2016 Ethiopian Demographic and Health Survey was used for the study. A total weighted sample of 3,756 married or in union reproductive age women who desire no more children were included in the analysis. Data was cleaned, weighted, and analyzed using STATA Version 14 software. A multi-level logistic regression analysis was conducted to consider the hierarchal nature of the demographic and health survey data. In a multivariable multilevel logistic regression model, an adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) and p value <0.05 was used to declare the significant associated factors of LARPCs utilization. The overall utilization of LARPCs among married women who desire no more children was 12% [95%CI: 10.99, 13.07]. In the multivariable multilevel analysis; being female household heads [AOR = 0.60; 95%CI: 0.40, 0.92], husband primary level of education [AOR = 1.57; 95%CI: 1.18, 2.07], employed women [AO R = 1.34; 95%CI: 1.04, 1.74], women from middle wealth index [AOR = 1.45; 95%CI: 1.02, 2.07], women who visited health facility in the last 12 months [AOR = 0.69; 95%CI: 0.54, 0.88], women residing in small peripherals [AOR = 0.20, 95%CI: 0.05, 0.82], and women from communities with low poverty [AOR = 2.25, 95%CI: 1.26, 3.99] were significantly associated with LARPCs utilization. In Ethiopia, LARPCs utilization among married women who desire no more children was very low. Both individual and community-level factors were significantly associated with LARPCs utilization. Thus, individual and community-level interventions that encourage husband education, maternal occupation, and giving special attention for women who live in small peripheral areas and female-headed households are better.

Changes in Contraceptive Method Use, Access, and Experiences of Care During a Statewide Contraceptive Initiative.

To examine changes in contraceptive use, access, and care experiences during a statewide contraceptive access initiative, Delaware Contraceptive Access Now. We used responses from the Delaware/Maryland Survey of Women at the early wave (11/2016-3/2017) and late wave (2/2021-10/2021). Our cross-sectional sample included 6,467 respondents at risk of unintended pregnancy. We used logistic regression to examine changes in contraceptive outcomes, controlling for age, race/ethnicity, income, education, marital status, and employment. Using interaction terms between state and survey wave, we compared population-level changes in outcomes in Delaware to changes in Maryland, which did not implement a similar contraceptive initiative. The change in long-acting reversible contraceptive (LARC) use in Delaware compared to Maryland was estimated as a 2.8 percentage point increase, but was not statistically significant (95% CI: -2.8, 8.3). Knowing where to get free LARC increased by 6.2 percentage points (95% CI: 0.4, 12.1; p<0.05) in Delaware compared to Maryland. Both Delaware and Maryland indicated substantial within-state decreases in reporting their doctor asked about plans for pregnancy (Delaware: -8.9 percentage points; Maryland: -15.1 percentage points), but the decrease in Delaware was significantly smaller: 5.6 percentage points (95% CI: -0.9, 12.1; p<0.1). Delaware also had a net decrease of 4.7 percentage points (95% CI: -9.9, 0.5; p<0.1), compared to Maryland, among those very or somewhat satisfied with their current method. We observed a mixed picture of changes in contraceptive use, access, and care experiences during the program. Our findings will be useful to Delaware program administrators and others, including the federal government, as they adopt similar reforms.

National assessment on the frequency of pain medication prescribed for intrauterine device insertion procedures within the Veterans Affairs Health Care System.

The intrauterine device (IUD) is a highly effective form of long-acting reversible contraception, widely recognized for its convenience and efficacy. Despite its benefits, many patients report moderate to severe pain during and after their IUD insertion procedure. Furthermore, reports suggest significant variability in pain control medications, including no adequate pain medication. The aim of this evaluation was to assess the pharmaceutical pain medication types, proportions, and trends related to IUD insertion procedures within the Veterans Health Administration (VHA). IUD insertion procedures documented in the VA electronic health record were assessed from 1/1/2018 to 10/13/2023. Descriptive statistics described patient and facility characteristics while annual trends were assessed using linear regression. Out of the 28,717 procedures captured, only 11.4% had any form of prescribed pain medication identified. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) were the most frequently prescribed pain medication category (8.3%), with ibuprofen being the most common pain medication overall (6.1%). Over the assessment period, there was an average annual increase of 0.52% (p = 0.038) of procedures with prescribed pain medication, increasing from 10.3% in 2018 to 13.3% in 2023. Although IUD insertion procedures have been seeing an increase in prescribed pain medication, the overall proportion remains disproportionality low relative to the pain experienced. Additionally, when pain interventions were initiated, they disproportionally utilized medication that have been shown to be ineffective. The intent of the work is that the information will help guide data driven pain medication strategies for patients undergoing IUD insertion procedures within the VHA.

Non-daily contraception: Reinforcing the choice of users and addressing unmet needs of reproductive health.

Despite great societal efforts promoting female autonomy, Sweden still faces unmet contraceptive needs, with abortion rates being the highest in the Nordic countries. In this commentary, we discuss using non-daily contraception options to combat these unmet needs. Non-daily methods include transdermal (i.e., patch), ring, injectables, and long-acting reversible contraception (LARC). Numerous studies have revealed that users prefer non-daily methods, and studies implementing structured counseling have revealed an increase in non-daily methods. Relative to LARC, the patch and the ring are non-daily parenteral methods that offer the possibility for self-management. Ultimately, client-centered counseling and shared decision-making are crucial for increasing awareness of all methods and enhancing method utilization and adherence. Finally, dispelling myths surrounding reversible hormonal contraception is essential for empowering women to make informed choices and improving overall reproductive health outcomes.

Knowledge of contraceptive methods among deaf women: a qualitative study

Objective To analyse the understanding of deaf women regarding contraceptive methods. Method We conducted a qualitative descriptive study in two referral centres for sexual and reproductive health (SRH) in São Paulo, Brazil, trough years 2020–2022. Twenty-eight deaf women who use Brazilian Sign Language (LIBRAS) were interviewed face-to-face and remotely via videocall using a semi-structured questionnaire containing sociodemographic and clinical data and questions about understanding and knowledge of contraceptive methods. We performed a content analysis through transcription, interpretation, and validation of the LIBRAS translation with the assistance of NVivo software. Results Communication barrier (28/28) was the primary factor associated with low knowledge about contraceptive methods. Regarding barrier methods, 20 (71%) participants reported be familiar with condoms, 13 (46%) with diaphragms, 20 (71%) about oral contraceptives, and 17 (60%) about injectable methods. Concerning long-acting reversible contraceptives (LARCs), 16 (57%) were aware about intrauterine devices and 7 (25%) with subdermal implants. Fifteen (53%) of participants were aware about female and male permanent contraception. Unplanned pregnancy rate was 59% and use of fertility awareness methods was reported by 6 (21%), barrier methods 5 (17%), short-acting methods 6 (21%), LARC 2 (7%) and permanent contraception among 4 (14%). Conclusion In our sample of deaf women, condoms and oral contraceptives were identified more often and were more in use. All interviewed deaf women cited communication as a barrier to accessing information about contraceptive methods, highlighting the low knowledge and use of LARC.

Telehealth use and receipt of recommended services within one-year postpartum.

In obstetrics, telehealth is widely used in the provision of prenatal and postpartum care. The objective was to compare the utilization of commonly recommended services after delivery among individuals receiving telehealth versus in-person postpartum care. We performed a retrospective cohort study of individuals receiving postpartum care at a single institution between 1 July 2020 and 30 June 2023. The primary exposure was the exclusive use of telehealth versus an in-person visit for postpartum care. Two primary outcomes were assessed between 0 and 365 days after the delivery: 1) long-acting reversible contraceptive (LARC) method use and 2) pap smear screening. Secondary outcomes occurring between 0 and 365 days after delivery included: clinic-based weight assessment, clinic-based blood pressure assessment, any prescription contraception use, primary care visit, and pregnancy within 1 year. Among the 9953 individuals, 9058 (91.0%) had a postpartum visit. 1811 (19.9%) utilized telehealth exclusively, which peaked during the COVID-19 pandemic. Exclusive telehealth users were less likely to have a pap smear (21.6 vs. 40.1%, p < 0.001) or use LARCs (8.6 vs. 19.4%, p < 0.001) than those receiving in-person care. In the adjusted analysis, the odds ratio for receiving a pap smear was 0.38 (95% confidence interval [CI] 0.32-0.47) and for using a LARC was 0.38 (95% CI 0.31-0.47) when comparing telehealth to in-person care. Reduced odds of all secondary outcomes were seen in the exclusive telehealth use compared to the in-person cohort, with the exception of subsequent pregnancy within 1 year, which was not significantly different. Acknowledging that telehealth now has become an important means for patients to access medical care, these findings should prompt clinicians to consider when an in-person postpartum visit should be offered or recommended over telehealth, especially when a patient may not have a preference or reported barriers to accessing an in-person visit.

Exploring the Feasibility of a Bracketing Approach Utilizing Modeling for Development of Long-Acting Injectables for Regulatory Approval-A Case Study Using Levonorgestrel.

The development of long-acting products of a characterized drug substance is of great interest. It is possible to support the development of these products with available clinical data by matching the exposure to a predefined bracket of a minimal concentration for efficacy and a maximal concentration for safety. This bracketing approach would cut down on the time and cost of new long-acting contraceptive products progressing to market. The current study describes the assessment of the data available to support a bracketing approach to conclude comparable levels of efficacy and safety for a postulated novel long-acting reversible contraceptive (LARC) product of levonorgestrel. Literature evidence of levonorgestrel efficacy, as quantified by the Pearl Index, was utilized and modeled by incorporating three LARC products for the estimation of a minimal concentration required for efficacy. Further literature was reviewed to quantify the maximal concentration required to ensure product safety. Additionally, a review of the regulatory precedence for the approach was conducted using European and UK databases. There was a reasonable definition of the minimal concentrations for efficacy where the target concentrations of levonorgestrel were in the range of 200-400 pg/mL. Maximum concentrations for safety were less well defined. Although regulatory guidance supports the bracketing approach, there is little precedence for licensing new products based on pharmacokinetic data only, despite much reduced clinical and non-clinical packages being evidenced. Understanding of the exposure response is not currently considered sufficient to support a bracketing approach for a new levonorgestrel product. If additional safety data are established, current regulations may allow for a reduced application package. Additional work is needed to support the approach, and this could utilize the wealth of information in real-world datasets combined with systems models.

Contraceptive Coercion in Pre-Abortion Counseling: A Conversation Analysis

We explored how contraception is addressed in pre-abortion counseling, with a focus on the conversational strategies used by healthcare providers. We recorded 28 pre-abortion counseling sessions at three South African public hospitals and analyzed them using conversation analysis. In discussions about past contraceptive use, patients were often positioned as irresponsible and required to account for assumed inadequate contraceptive practices. This framing laid the groundwork for the coercive provision of post-abortion contraception, particularly long-acting reversible contraceptives (LARCs). Short-term users and younger patients were singled out, receiving repeated warnings about daily adherence or parental enforcement. Providers’ efforts to prevent the perceived “mistake” of abortion led to the use of coercive conversational tactics.

Intentions, Barriers and Attitudes towards Improving Postpartum Long-acting Reversible Contraceptive Usage among Pregnant Women in Urban Ghana

Aims: Long-acting reversible contraceptives (LARCs) are the most effective reversible methods of contraception with a failure rate of less than 1%. Despite their safety and effectiveness, LARCs are underutilized. This study investigated postpartum LARC use intentions and suggestions to improve postpartum LARC usage among pregnant women seeking antenatal care services in a Ghanaian Urban municipality. Study Design: A facility-based cross-sectional design. Place and Duration of Study: The study was conducted at the antenatal care unit of the Ashanti Regional Hospital in the Kumasi Metropolis of Ghana among 298 pregnant women from August to September, 2018. Methodology: A systematic sampling technique was conducted. A 55-item questionnaire containing socio-demographic, reproductive, intention and attitude, barriers and contraceptive knowledge characteristics was used to gather responses. A multivariable logistic regression analysis was done using (IBM-SPSS version 22.0) to determine predictors of the women’s intention and attitude towards postpartum LARC use. Results: Out of 298 pregnant women included for analysis, 33.9% had postpartum intentions to use LARCs. “I like implant for myself” (AOR=9.00, 95% CI: 4.75-17.05), “I like IUD for myself” (AOR=7.38, 95% CI: 2.93-18.58) and previous use of LARC (AOR=7.03, 95% CI: 2.41-20.52) were predictors of postpartum intentions to use LARC. Intensive education and “worried about the side effects” were the main recommendations and barriers to postpartum LARC usage respectively. Conclusion: Postpartum intention to use LARC was minimal. I like implant for myself”, “I like IUD for myself” and previous use of LARC were associated with intentions to use LARC postpartum. Intensive education and “worried about the side effects” were the main recommendations and barriers to postpartum LARC usage respectively. Attitudinal change towards LARC use through intensive education, easy accessibility of LARC and religious body involvement is key to increase postpartum LARC usage in Ghana and clearing its myths and misconceptions could advance modern contraceptive usage.

Integrating a Postpartum Contraception Intervention in the Maternal and Child Health Care System of China

The interpregnancy intervals are suboptimal worldwide, and women lack access to high-quality postpartum contraceptive services in China. To evaluate the effectiveness of integrating postpartum contraceptive interventions into the existing maternal and child health care (MCH) system. This cluster randomized trial randomly allocated 13 communities in Minhang District in Shanghai, China, to the intervention or the control group. Data were collected between September 2020 and February 2023. Eligible participants included women who registered their pregnancy in community health centers and were followed up to 1 year post partum. Data analysis was conducted from April 2023 to May 2024. Participants in the intervention group received postpartum contraception consultations, online educational videos, a 45-minute class, health prescriptions, and educational pamphlets at 5 stages in alignment with the MCH system of China. The control group received routine MCH services. The primary outcome was incidence of unintended pregnancy within 1 year after childbirth. The secondary outcomes included knowledge level of postpartum contraception, utilization rate of reliable long-acting reversible contraception (LARC), and incidence of induced abortion. A total of 1279 participants (698 in intervention from 7 clusters and 581 in control from 6 clusters) were recruited, and 995 (521 older than 30 years [40.7%]; 539 intervention [54.2%] and 456 control [45.8%]) completed the trial. The incidence of unintended pregnancy, LARC utilization, and induced abortion within 1 year after childbirth was 1.5% (8 participants), 3.2% (17 participants), and 0.6% (3 participants), respectively, in the intervention group, and 3.9% (18 participants), 1.1% (5 participants), and 2.0% (9 participants), respectively, in the control group. Participants in the intervention group were significantly less likely to experience unintended pregnancy (adjusted odds ratio [aOR], 0.33; 95% CI, 0.16-0.70), had a higher rate of LARC utilization (aOR, 2.47; 95% CI, 1.02-5.98), and a lower rate of induced abortion due to unintended pregnancy (aOR, 0.30; 95% CI, 0.09-0.99). The postpartum contraception knowledge level in the intervention group was substantially higher than the control group (β = 24.20; 95% CI, 20.92-27.47). This cluster randomized clinical trial demonstrated the designed postpartum contraceptive interventions were effective in reducing unintended pregnancy and induced abortion and increasing postpartum contraception knowledge and LARC utilization among women at 1-year post partum. Chictr.org.cn Identifier: ChiCTR2000034603.

Healthcare provider communication and current contraceptive use among transgender men and gender-diverse people: Results from an online, cross-sectional survey in the United States.

To explore whether discussing contraceptive use with a healthcare provider is associated with current contraceptive use among transgender men and gender-diverse (TMGD) individuals. In 2019, we conducted a cross-sectional survey among transgender men and gender-diverse adults in the United States who were assigned female or intersex at birth. We measured whether respondents had ever discussed contraception with a healthcare provider as well as current use of contraception, reasons for use, and barriers to use. We described frequencies and ranges for key variables and implemented a series of nested logistic regression models to evaluate the association between ever having spoken to a provider about contraception and current use of contraception for any reason, overall and by method type. Among 1694 respondents, about half (48%) were currently using a method of contraception for any reason, most commonly barrier methods (17%) and long-acting-reversible-contraception (LARC) (17%). Compared to those who never had a conversation about contraception with a provider, respondents who spoke with a provider were more likely to be currently using contraception - particularly among those who self-initiated the conversation (aOR: 3.8, 95% CI: 2.5-5.6). Having discussed contraception with a healthcare provider was most strongly associated with current LARC use. Having had a conversation with a provider about contraception use was positively associated with current contraception use among a large, national sample of transgender men and gender-diverse people. Facilitating patient participation in contraception counseling for transgender and gender-diverse patients should be emphasized in provider training. Given formidable barriers to healthcare faced by TMGD people, training providers on how to initiate affirming and relevant conversations with TMGD patients about contraceptive needs and preferences is essential, as are efforts to educate and empower TMGD individuals to advocate for the information they need in these interactions.

Patient and OBGYN Perspectives on Considering Long-Acting Reversible Contraception for Postpartum Patients Who Desire Permanent Contraception

Objective(s)We sought to understand patients’ and obstetrician-gynecologists’ priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient’s initial contraceptive preference. Study DesignWe interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (n=67) from four U.S. institutions to explore patient and OBGYN perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software. ResultsOur analysis revealed a mismatch between patient and OBGYN priorities when considering permanent contraception versus LARC. Many OBGYNs in our study described a preference for LARC methods over permanent contraception and often prioritized factors such as reversibility and menstrual suppression. However, many patients sought permanent contraception for reasons that were not adequately addressed by LARC methods such as method permanence, desire to avoid menstrual suppression, cancer prevention, prior negative experiences with LARC, and a preference to avoid a foreign body. Conclusion(s)These results suggest that priorities in selecting a preferred contraceptive method may sometimes not be aligned between patients and clinicians and that LARC methods may not always be an acceptable alternative for patients who desire permanent contraception. The findings from this study highlight the importance of eliciting and centering a patient’s goals and desires for pursuing permanent contraception during contraceptive counseling. Clinicians should be aware of the various perspectives and values patients have on these methods and include them in patient-centered share decision-making.

The role of pediatric subspecialists in adolescent contraceptive care: knowledge, attitudes, and barriers.

Adolescents and young adults (AYA) with chronic medical conditions (CMC) have similar sexual behaviors to their healthy peers but are less likely to use contraception. Provision of CMC-specific sexual and reproductive health (SRH) care within pediatric subspecialty clinics may improve access for this population, although system and provider level barriers exist. The purpose of this cross-sectional study was to assess the attitudes, practices, and knowledge of SRH among providers in a variety of pediatric subspecialities. Listservs were used to recruit pediatric subspecialists caring for pregnancy capable AYA (12-24 years-old) who use teratogenic medications or have CMC that pose significant pregnancy health risk, as defined by the World Health Organization. Participants completed an online survey about their contraceptive attitudes and practices and rated their knowledge and comfort discussing contraception. A total of 510 pediatric subspecialists participated. Although 92% said addressing SRH is important for pediatric subspecialists, most believed their role included SRH discussion(78.1%) and referral(82.2%) rather than provision(12.1%). Only 4.3% felt totally comfortable with contraceptive counseling. Identified facilitators included time(64.2%), referral resources(67.5%), and training in contraceptive options(62.9%). Most participants would recommend long-acting reversible contraception if medically appropriate, but few reported confidence in their knowledge and ability to counsel about them. SRH is an important part of comprehensive care for youth with CMC. Discomfort and lack of knowledge decrease a provider's ability to confidently provide SRH care in subspecialty clinics. Expanding collaborations between subspecialty and SRH providers may increase access to quality SRH tailored to these young people's unique medical needs.