Utilization Of Long-acting Reversible Contraception Research Articles

Placement of Levonorgestrel Intrauterine Device at the Time of Cesarean Delivery and the Effect on Breastfeeding Duration.

Objectives: Studies have shown that immediate postpartum initiation of long-acting reversible contraception (LARC) methods leads to increased utilization of LARC and prevention of unintended pregnancies. It is unclear if immediate postpartum levonorgestrel-releasing intrauterine device (LNG-IUD) insertion has an effect on breastfeeding success. Study Design: This study was a secondary analysis of a randomized trial that compared intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean IUD placement with women who planned for interval IUD placement at 6 or more weeks postpartum. This parallel, 1:1, nonblinded randomized trial was conducted between March 2012 and June 2014 at the University of North Carolina Women's Hospital. We recruited pregnant women aged 18-45 years who were undergoing a cesarean delivery and desired an IUD for contraception postpartum. Results: We received breastfeeding information from 63 women who desired to use a LNG-IUD. A proportion analysis demonstrated that there was no difference in the proportion of women breastfeeding at any of the three time points, 6, 12, and 24 weeks, following placement. This remained true after adjusting for age, parity, and ethnicity. Conclusion: This study adds to the existing body of evidence that shows that most women are able to successfully breastfeed after immediate postpartum LNG-IUD placement. Women should be encouraged to breastfeed, and the desire to breastfeed should not preclude the initiation of a postplacental IUD. This study provides reassurance that immediate postpartum LNG-IUD placement does not adversely affect breastfeeding; however, more high-quality data are needed on the impact of hormonal IUDs on breastfeeding outcomes.

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.

Barriers to implementation of long-acting reversible contraception: A systematic review.

Long-acting reversible contraception (LARC) is one of the most effective forms of contraception available. The utilization of LARC remains low despite being recommended by major health organizations such as Centers for Disease Control and Prevention, American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, American Academy of Family Physicians, and the National Committee for Quality Assurance. Health care professionals play an essential role in the potential increased use of LARC. This review aims to highlight key barriers to the utilization of LARC and discuss interventions to address this issue. A systematic review of 14 peer-reviewed articles focused on LARC utilization rates that help identify barriers to the utilization of LARC in current education and practice. Articles were evaluated for strength of research design using the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal tool. Three categories affecting LARC utilization emerged: deficits in provider education/competency, lack of hands-on training, and barriers to practice. The importance of including LARC training and education in the advanced practice nursing curriculum and providing opportunities for continuing education with LARC is demonstrated.

Improving Knowledge About, Access to, and Utilization of Long-Acting Reversible Contraception Among Adolescents and Young Adults

Improving Knowledge About, Access to, and Utilization of Long-Acting Reversible Contraception Among Adolescents and Young Adults

Promoting Teen Contraceptive Use by Intervention With Their Mothers

The purpose of this pilot study was to test a community outreach model designed to help mothers in a rural, medically underserved area navigate their teen daughters to health department services for long-acting reversible contraception (LARC) or alternative contraception. The pilot study used a single-group, post-test only design. Mothers of teen daughters (N=142) received a 1-hour, one-to-one intervention session (in outreach settings) from Community Liaisons. Mothers received training on how to communicate with their daughters about LARC and other contraceptive methods. Data were collected from June through October 2014, and analyzed in September 2015. The authors re-contacted 104 of 142 mothers enrolled in the study, achieving a 73.2% retention rate. Of these, 12.5% had daughters receiving LARC. An additional 11.0% had daughters with health department-verified initiation of birth control pills. Only one correlate-whether a mother believed her daughter was having sex-was associated with receiving either LARC or birth control pills. Among those indicating they knew their daughters were having sex, 31.7% of the daughters received LARC/birth control pills. By contrast, among mothers not indicating they knew their daughters were having sex, only 2.9% had daughters receiving LARC or birth control pills. Findings suggest that an outreach-based program delivered directly to mothers of teen daughters may be a highly effective method for enhancing service utilization of LARC and the initiation of birth control pill use in a rural, medically underserved area.

Pediatric Provider Education and Utilization of Long-Acting Reversible Contraception in a Community Health System in Massachusetts

Pediatric Provider Education and Utilization of Long-Acting Reversible Contraception in a Community Health System in Massachusetts

Utilization of reversible long acting family planning methods among married 15-49 years women in Areka town, Southern Ethiopia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Utilization of family planning can improve the means of people in poverty. Long-acting reversible contraceptive (LARC) methods in particular can considerably reduce the level of unwanted pregnancy as well as maternal mortality and morbidity more in developing countries. Thus, study was conducted with the aim of assessing the level of LARC utilization and associated factors among married women (15-49) in Areka town, Southern Ethiopia.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Community based cross-sectional study was conducted in a total of 357 women within the study area. Population proportion to size was used to assign sample to kebele and participates were selected by systematic random sampling technique from randomly selected kebeles. Data collection was conducted by trained data collectors, using structured and pretested questionnaire. Finally, data entered, cleaned, and analysed in SPSS 16.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The utilization of LARC was 106(29.7%) of study participants. Particularly, LARCs utilization were 81(22.7%) for implants and 25(7.0%), Intrauterine contraceptive device (IUCD). Statistically, LARC utilization was (AOR=2.47 at 95%CI (1.24-4.90)) times likely among 26-36 aged mothers compared to 15-24 age groups. Government employed mothers were (AOR=2.59 at 95%CI (1.39-4.79)) times probable to use LARC compared to merchants. Hence, maternal education and occupation were the independent predictors of LARC utilization as the principal findings of this study.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Enormous extent of unmet need exist in utilization of LARC within the study area. Mothers’ age and occupation were significantly associated with its utilization. Therefore, health promotion activities on the benefits of LARC need to be undertaken to increase awareness and usage of these contraceptives.

The Relationship Between Insurance Coverage and Utilization of Long-Acting Reversible Contraception in an Appalachian Population

The Relationship Between Insurance Coverage and Utilization of Long-Acting Reversible Contraception in an Appalachian Population

PIH44 Contraceptive Utilization in Women Who Had an Abortion: A Canadian Cohort-Study

Unintended pregnancies constitute a global problem associated with substantial health care costs. In Canada, approximately 22% of all pregnancies will lead to an abortion, with a higher rate (52%) in women under 20. As leading causes of unintended pregnancies are closely related to the contraceptive method chosen, the objective of this study was to analyze utilization of contraceptives in women who had an abortion. A retrospective cohort study was conducted using a random sample from the Régie de l'assurance-maladie du Québec (RAMQ) prescriptions and medical services databases. Inclusion criteria were: women who had an abortion at less than 14 weeks between January 1, 2008 and December 31, 2009 and who were continuously enrolled 12 months pre- and post-abortion. Claims for contraceptives were analyzed in the year preceding and following the abortion. Of the 7397 women included for analysis, 67.8% were between 15 and 29 years old. Approximately 30.2% filled at least one prescription for a contraceptive in the year preceding the abortion; 82.9% of claims were oral contraceptives. In the year after abortion, the usage of contraceptives increased to 54.3%. Utilization of a long-acting reversible contraception (LARC) increased after abortion. Levonorgestrel intrauterine system (IUS) was inserted on the day of the abortion in 7.5% of women. Within one month of abortion, 47% of women claimed for oral contraceptives, 27% for Levonorgestrel IUS, 12% for transdermal patches, 8% for vaginal rings and 6% for depo-medroxyprogesterone acetate. The data showed that the utilization of contraception increased after an abortion. A valuable benefit of LARCs is that their effectiveness does not rely on continuous user compliance, which could help explain the increased utilization of these methods after an abortion. However, the utilization of LARCs remains low which may indicate an unmet need for a greater variety of LARC options.

Long-acting reversible contraception method use among Title X providers and non-Title X providers in California

BackgroundPublicly funded family planning services play an important role in reducing unintended pregnancy by providing access to effective contraception. We assessed whether California family planning providers receiving federal Title X funds are more likely to offer on-site long-acting reversible contraception (LARC) methods than those who do not receive these funds. Study DesignUsing 2009 administrative data, we examined on-site utilization of LARC by clinic type (Title X public, non-Title X public, or private) and constructed beta-binomial logistic regression models. ResultsThe odds of on-site LARC services in non-Title X public and private providers were decreased by 35% [Odds Ratio (OR)=0.65, 95% confidence interval (CI) 0.54–0.79] and 61% [OR=0.39, 95% CI 0.32–0.47], respectively, compared to those of Title X providers after controlling for clinic size, urban/rural location, and proportion of teen, African–American, and Latina clients. ConclusionsOn-site utilization of LARC is a potential quality indicator for family planning programs. Title X resources are associated with increased use of LARC.