Long-acting Reversible Contraception Research Articles

Long-Acting Reversible Contraception Use after Non-Receipt of Postpartum Permanent Contraception: A Retrospective Analysis.

Objective: To evaluate long-acting reversible contraception (LARC) use versus permanent contraception (PC) use at hospital discharge through 1 year postpartum after an unfulfilled immediate postpartum PC request. Study Design: We present a secondary analysis of a retrospective cohort study of patients across four study sites between 2018 and 2019 with PC as their documented inpatient postpartum contraceptive plan. We abstracted demographic and clinical characteristics, contraceptive plans and time to contraceptive fulfillment, reasons for non-fulfillment, and pregnancy incidence up to 1 year postpartum from medical records. Results: Of 3,013 patients initially desiring PC, 1,759 patients (58.4%) received PC and 136 patients (4.5%) received LARC on discharge; with an additional 217 patients receiving PC and an additional 176 patients receiving LARC in the 1 year postpartum. Participants who received inpatient LARC were more likely to be younger, to be unmarried, to have Medicaid insurance, and to have delivered vaginally compared with participants who received inpatient PC. Of the 304 patients who received LARC rather than PC during the year postpartum, 49 (16.1%) expressed an interest in LARC prenatally. Reasons for non-fulfillment of PC were varied at different time points postpartum, with 50.3% stating they did not receive PC by 1 year postpartum because they had changed their mind. Conclusions: Ten percent of patients with an unmet postpartum PC request use LARC methods instead at 1 year postpartum. Patients who do use LARC are unlikely to bridge to receipt of PC. Institutions should prioritize fulfillment of desired postpartum PC prior to hospital discharge.

Discontinuation of long-acting reversible contraception: a retrospective Dutch study in general practice

Background In the Netherlands, the use of long-acting reversible contraception (LARC) methods increases. Studies show high premature discontinuation rates of LARCs, but comprehensive insights into the Dutch situation remain limited. Aim The aim of this study is to determine (1) the rate and reasons of discontinuation of different types of LARC in the first 2.5 years of use and (2) what patient characteristics are associated with premature discontinuation. Design and setting Retrospective cohort study utilising data from a Dutch primary care research network. Methods We included all women who received a LARC between 2017 and 2019 with a 2.5-year follow-up period. We performed a descriptive analysis, Kaplan Meier and logistic regression analysis to answer the research questions. Results We included 642 women. In total, 166 women (25.9%) discontinued their LARC within 2.5 years. Discontinuation rates were 22% for levonorgestrel intra-uterine systems (LNG-IUS) 52 mg, 25% for LNG-IUS 19.5 mg, 39% for copper IUDs and 47% for subdermal implants. Common reasons for discontinuation were: alterations in bleeding pattern (68%), abdominal pain (32%), headache or mood fluctuation (24%) and a preference for natural contraceptive methods (23%). Factors associated with discontinuation for reasons other than pregnancy wish were: age between 30 and 34 years old (OR 5.1, 95% CI [1.26–20.48]) and a history of sexual, physical and/or psychological abuse (OR 3.16, 95% CI [1.60–6.23]). A high educational level (OR 0.33, 95% CI [0.12–0.89]) was associated with a lower risk of discontinuation. Conclusion The discontinuation rates of LARCs are high. Better counselling might prevent premature discontinuation.

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. Published online ahead of print October 10, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307844).

Barriers and enablers to utilisation of postpartum long-acting reversible contraception in Eastern Uganda: a qualitative study

IntroductionIn Uganda, although most women wish to delay or prevent future pregnancies, uptake of postpartum family planning (PPFP) is low. We explored behavioural factors influencing the utilisation of postpartum long-acting reversible contraceptives (LARCs) in Eastern Uganda.MethodsWe conducted a qualitative study in two districts of Eastern Uganda. We conducted 20 in-depth interviews and three focus group discussions with postpartum women, male partners, midwives, and village health team members. We analysed transcripts using framework analysis, based on the COM-B framework.ResultsThe use of immediate postpartum LARC was affected by the capabilities of women in terms of their knowledge and misconceptions. Limited capabilities of health workers to provide counselling and insert IUDs, as well as shortages of implants, reduced the physical opportunites for women to access PPFP. Social opportunities for women were limited because men wanted to be involved in the decision but rarely had time to accompany their partners to health facilities, and health workers often appeared too stressed. Men also feared that PPFP would enable their partners to be unfaithful. Motivation to take up immediate postpartum LARC included the desire to space births, preference for contraceptive implants over intra uterine devices (IUD) at the 6-week postpartum period, resumption of sex and menses, partner support, and perceived effectiveness of postpartum contraception. Participants thought that uptake of immediate postpartum LARC could be improved by health education and outreach visits, male involvement and couples’ counselling in antenatal clinic appointments, and enabling switching between family planning methods (in case of side-effects) .ConclusionLow uptake of PPFP was caused by inadequate knowledge and misconceptions about LARC by women and their partners, insufficient numbers of midwives trained to provide PPFP, stock-outs of PPFP methods, and few social opportunities for couples to be counselled together. These factors could be addressed by scaling up effective, low cost and innovative ways to provide health education (such as films), involving men in decision-making, as well as training more midwives to provide PPFP services, and ensuring that they have sufficient time and supplies.

Sex differences in use of potentially teratogenic disease modifying treatments for multiple sclerosis and degree of hormonal contraception overlap in women between 2007–2021: An Australian population-based study

BackgroundDisease modifying treatments (DMTs) for multiple sclerosis (MS) have varying levels of teratogenic potential, but whether this influences DMT prescribing patterns by sex or concurrent use of hormonal contraception in women is unknown. This study aimed to examine patterns in dispensing of DMTs in women and men with MS, and hormonal long-acting reversible contraceptive (LARC) overlap at DMT initiation among women. MethodsPopulation cohort study using 10% random sample of the Australian Pharmaceutical Benefits Scheme dispensing data (2007–2021). DMT dispensing data were evaluated separately for women and men aged 18–49 years. Hormonal LARC overlap was determined by receipt of contraceptive dispensing where the expected duration of efficacy overlapped with the DMT dispensing date. ResultsDMTs with teratogenic potential (cladribine, sphingosine-1-phosphates and teriflunomide) were less likely to be commenced in women than men aged 18–39 (OR 0.70, 0.51–0.96), but not in those aged 40–49 (OR 0.93, 0.60–1.43). Hormonal LARC overlap was higher among those commenced DMTs with teratogenic potential compared with interferons (aOR 2.52, 1.14, 5.55). ConclusionSex and age differences in DMT utilisation were observed based on teratogenic potential. Hormonal LARC overlap appears higher in those receiving potentially teratogenic DMTs, but overall rates remain low.

A Quality Improvement Approach to Increasing Access to long-Acting Reversible Contraceptives in a Federally Qualified Health Center.

Long-acting reversible contraceptives (LARCs) are the most effective forms of contraception available and therefore play a critical role in supporting patients to exercise bodily autonomy and achieve reproductive goals. A comprehensive set of quality improvement (QI) interventions were implemented between March and June 2019 to improve LARC access at a federally qualified health center (FQHC) in (US State). An evaluation study was conducted to assess the impact of the QI initiative considering the number of LARCS delivered as a proxy for access. The Wilcoxon-rank test was applied to test for significance, given a non-parametric sample of LARCs delivered by 13 providers (matched to themselves) pre- and post-intervention. Reimbursement for LARC procedures pre- and post-intervention was also examined to determine economic impact and sustainability of incorporating a new device, the Liletta™, in the floor stock. There was a statistically significant increase in LARC delivery between July 2019-March 2020 compared to July 2018-March 2019. Approximately $1,000 per month increased reimbursement for LARC services occurred post-intervention. The evaluation study concluded success of the QI intervention, with need for further study needed to determine equitable delivery of contraceptive services between different subpopulations and by insurance status. The study provides a blueprint for QI initiatives to improve access to LARCs while also increasing revenue for LARC services in an FQHC setting.

Longitudinal trends in uptake of hormonal long-acting reversible contraception devices throughout the COVID-19 pandemic: an Australian population-based study

BackgroundLittle is known about the degree to which the COVID-19 pandemic, and associated restrictions and disruptions to health services, impacted the accessibility of hormonal long-acting reversible contraception (LARC) devices within...

Effect of Levonorgestrel Implant on Lactation and Infant Growth: A Review

Background: Family Planning is a way to regulate the number of children born and the spacing of pregnancies through information, education, and the use of contraceptives. Postpartum contraception is important to obtain an optimal interpregnancy interval. Postpartum contraception should be initiated early; one of which is Long-Acting Reversible Contraception (LARC). Levonorgestrel can be used to prevent pregnancy because it interferes with ovulation, implantation, and fertilization. Objectives: This study aimed to assess the efficacy and effects of using levonorgestrel implants on breastfeeding and infant growth. Methods: Primary data were in the form of research papers obtained from ScienceDirect, PubMed, and Google Scholar published from the period 2010-2018. The keywords for the searches included: “levonorgestrel”, “levonorgestrel (LNG)-releasing implant”, “levonorgestrel on lactogenesis”, “levonorgestrel on infant growth”, and “levonorgestrel on breastfeeding”, which were used alone or in combination. Results: The 20 selected articles were reviewed based on five identified phrases. Levonorgestrel subdermal implants were shown to be a good choice for women who wanted effective contraception. When used by breastfeeding mothers, levonorgestrel subdermal implants affected neither infant growth (0-1 year of age) nor lactation duration. Conclusions: Levonorgestrel subdermal implants can be effective long-term contraception. These implants are safe for breastfeeding mothers and do not affect infant growth.

A systematic review on clinical practice guidelines for managing pregnancy following metabolic-bariatric surgery.

The ongoing pandemic of obesity is associated with an increase of weight loss surgeries in women of reproductive age. This study was conducted to review clinical practice guidelines (CPGs) for managing pregnancy following metabolic-bariatric surgery. We conducted a comprehensive literature search of all CPGs that covered the management of pregnancy following metabolic-bariatric surgery, 2010 through 2022, and that were published in English. Two authors independently scored the quality and usefulness of CPGs using the Appraisal of Guidelines for Research and Evaluation II tool (AGREE II). From a total of 20 CPGs, consistent recommendations included the following: 1) contraception with long-acting reversible contraceptives before surgery until the optimal time of pregnancy; 2) nutritional care by a dietitian; 3) considering gastrointestinal discomforts during pregnancy as a potential surgical complication; and 4) modified screening for gestational diabetes instead of glucose tolerance tests preventing post-bariatric hypoglycemia. There was a lack of uniformity concerning surgery-to-conception interval and dose of supplements, as well as research gaps regarding the surgical type, mental health, delivery type, breastfeeding, neonatal care, and weight retention. All recommendations for managing pregnancy after metabolic-bariatric surgery were deemed clinically useful. Although consistent recommendations should be implemented, inconsistencies should be the focus of research.

Contraception for women over 40: A comprehensive guide.

Women in their 40s experience significant reproductive health changes, requiring personalised contraception to avoid unintended high-risk pregnancies and adapt to changing health conditions. This article examines optimal contraceptive choices for women in their 40s, considering effectiveness, ease of use, non-contraceptive benefits, side effects, contraindications and re-evaluation or discontinuation timings. Contraceptive choices for women in their 40s vary depending on their family planning status, underlying health conditions and risk factors. Long-acting reversible contraceptives, permanent sterilisation and progestogen-only methods (excluding depot medroxyprogesterone acetate) are preferred options for women who have completed their families. Hormonal contraceptives can help manage menstrual disorders and bone health issues while providing endometrial protection during menopause. Regular contraceptive reviews should be conducted, and options adapted asneeded.

Intrauterine device use in adolescence: a narrative review.

Contraceptive use in adolescence remains a challenging issue. Adolescents are at high risk of unintended pregnancies and sexual transmitted infections. During the past few decades intrauterine devices are recommended from global health organization, including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists and World Health Organization as a method of contraception for adolescents. Intrauterine devices are part of the long-acting reversible contraceptives (LARCs) and include the copper bearing device (CU-IUD) and the levonorgestrel intrauterine system (LNG-IUS). IUDs are a safe and effective contraceptive method for adolescents with a failure rate less than 1%. Their use is not limited only in contraception. LNG-IUS 52 mg is approved for treating heavy menstrual bleeding and protection from endometrial hyperplasia in women receiving hormone replacement therapy. It can also be an effective tool in the management of dysmenorrhea, while CU-IUD can provide emergency contraception. Nevertheless, IUDs remain underutilized in this group of population. Adolescents' lack of proper education about contraception and sexual behavior creates myths and misconceptions about the possible side effects and the suitability of IUDs in this age group. Furthermore, health care providers remain skeptical and hesitate to suggest IUDs to adolescents. Other barriers including high cost, concern about confidentiality and difficulties in access contribute to its limited use. It is of high importance to eliminate barriers and offer more accessible contraceptive services to adolescents.

Contraception options during pubertal transition: Risks, benefits and considerations.

The age of puberty and sexual maturation has been decreasing, highlighting the importance of providing appropriate contraception to girls and adolescents. However, challenges remain, including legal implications and understanding the effects of hormonal methods on pubertal development. This article aims to equip general practitioners with theknowledge of options, as well as their use and limitations, in young people seeking contraception. No one-size-fits-all approach exists for adolescent contraception. Long-acting reversible contraceptives offer superior contraceptive efficacy, with subdermal implants being the most acceptable regarding the insertion procedure. Condoms should be recommended for protection against sexually transmissible infections. Bone health and mood disorders should be considered when prescribing hormonal contraceptives. Despite the lack of robust evidence regarding harm caused by contraception in adolescents, preventing unintended pregnancies should take precedence, with theoretical risks guiding tailored options for individuals.

Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization

ObjectiveTo understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with healthcare barriers and high short-interval birth rates. MethodsWe conducted a retrospective cohort study of electronic delivery records between March 2018-June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using chi-square or Fisher’s exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables. ResultsAnalysis included 10,472 delivery encounters; 2,459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (n=2,523, 24.1%), 1,224 (48.5%) selected arm implants and 1,299 selected IUDs. Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (aOR=0.84, 95% CI: 0.72-0.98, aOR=0.68, CI 95%: 0.48-0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31-1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35-1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC. ConclusionLARC utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated. Funding SourceOrganon IIS #60719 Implications StatementUnderstanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.

Examining the impact of an online educational video on the contraceptive knowledge, awareness and choices of young women living in rural and remote Australia

ObjectiveTo assess whether an online educational video, tailored to young women living in rural and remote areas, increases their contraceptive knowledge, preference for and uptake of long-acting reversible contraception (LARC). Study DesignA single group pre-post survey design, in which participants completed the pre-video survey (S1), watched the 13-min video, then completed a survey immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression. ResultsA total of 153 participants watched the video and completed S1 and S2; 56 % of these completed S3. Prevideo (S1) 33 % of participants were unaware of LARC methods. Only 3 % rated their knowledge about every method as high. Knowledge improved immediately post video (S2) for all methods (aOR 12.5, 95 % CI 5.2 to 29.8) and LARC methods (aOR 7.9, 95 % CI 4.3 to 11.8). Overall method preference for LARC increased from 23.5 % (n = 36) at S1 to 48 % (n = 74) at S2. Likelihood of using a LARC increased at S2 (aOR 2.1, 95 % CI 1.5 to 2.9). The overall proportion of participants using a LARC increased from 18 % at S1 to 21 % at S3, however, this increase was not significant (p = 0.3). ConclusionOur findings underscore the effectiveness of tailored online educational videos in enhancing contraceptive knowledge and preference for LARCs amongst young women living in rural and remote areas. However preference did not translate into uptake, suggesting that structural and other barriers may be prominent. ImplicationsThis study emphasises the need for a multifaceted approach to facilitating young womens’ access to effective methods of contraception, including LARC. Efforts to promote knowledge should be coordinated with place-based initiatives and policies that directly address the structural barriers to accessing critical sexual and reproductive health services unique to women in rural and remote areas.

Effects of structured contraceptive counseling in young women: Secondary analyses of a cluster randomized controlledtrial (the LOWE trial).

Unwanted pregnancy constitutes a huge health issue. Long-acting reversible contraception (LARC) are the most effective methods for preventing unwanted pregnancy, especially among young women. This study evaluates the intervention effect of structured contraceptive counseling on the choice, initiation, and use of LARC in young women. This is a secondary analysis of women aged 18-25, enrolled in a multicenter cluster randomized controlled trial performed in abortion, youth, and maternal health clinics across the Stockholm County in Sweden. Clinics were randomized (1:1) to provide structured contraceptive counseling (intervention) or standard counseling (control). Surveys were administered at the clinic visit and follow-ups at 3, 6, and 12 months. Primary outcome focused on the choice of LARC among women 18-25 years of age. Secondary outcomes included initiation, and use of LARC at 3 and 12 months, satisfaction with the counseling received and information on extended use of combined hormonal contraceptives. The study was registered at Clinicaltrials.gov (NCT03269357). From September 2017 to May 2019, 770 women aged 18-25 years from 28 clinics/clusters were recruited. There was a significant intervention effect on LARC choice (aOR 5.96, 95% CI 3.25-10.94), initiation (aOR 4.43, 95% CI 2.32-8.46), and use at 12 months (aOR 2.21, 95% CI 1.31-3.73). The odds of LARC choice at pre-booked visits were higher and more women received information about extended-use regimen for short-acting reversible contraception in the intervention group compared to the control group. The intervention package was well received, but with higher satisfaction at pre-booked compared to drop-in visits. Our study demonstrates that comprehensive structured contraceptive counseling significantly increases LARC choice, initiation and use, with high satisfaction among young participants, especially at pre-booked visits. The results highlight an approach that merits implementation to increase quality of care in contraceptive services, to enhance reproductive health for adolescents and young adults.

Association between Abortion and Acceptance of Post abortion Contraception

Post-abortion contraceptive uptake is essential in reproductive health, as it helps to identify women’s contraceptive needs, reduce unintended pregnancies and prevent subsequent abortions. Integrating abortion services with family planning counselling at all levels of health facilities can enhance contraceptive acceptance. This study aimed to evaluate the acceptance of various family planning methods following different abortion services over one year period, at a family planning center, Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital. This study analyzed the women who participated in contraceptive counselling and accepted different types of contraceptives following different methods of first and second trimester abortions services. The study included women who received post-abortion contraceptive counselling and services, excluding those with termination beyond the second trimester or those seeking only postpartum contraceptive counselling or post-abortion care. It aimed to analyze the association between different methods of abortion and contraception acceptance post-abortion. Among 100 women who had spontaneous and induced abortions, 89% received post-abortion counselling and 75% accepted various types of contraception immediately after abortion. About one third of women were aged 25–29 years (30%), 99% were married, 40% were graduates and 48% were housewives. Abortion methods included medical abortion (62%), manual vacuum aspiration (MVA) (35%) and dilatation and evacuation (3%). Contraceptive acceptance rates were: short-acting reversible contraception (SARC) 60%, long-acting reversible contraception (LARC) 14%, and permanent methods 1%. Among medical abortion recipients, most chose SARC (43%) followed by LARC (4%). For those undergoing MVA, 16% chose SARC, and 9% chose LARC. Condoms were the most accepted SARC method (22%). The study demonstrated that post-abortion counseling significantly increases acceptance of various contraceptive methods, with SARC being the predominant choice, especially condoms among users.

Concurrent use of hormonal long-acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013-2021: a retrospective cohort study.

To examine patterns in the dispensing of category X medications (Therapeutic Goods Administration categorisation system for prescribing medicines in pregnancy) to women aged 15-49 years in Australia during 2008-2021, and patterns of concurrent use of hormonal long-acting reversible contraception (LARC) and other hormonal contraception. Retrospective cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data. Women aged 15-49 years dispensed category X medications, Australia, 1 January 2013 - 31 December 2021. Incident and prevalent dispensing of category X medications, by medication class, age group, and year; contraceptive overlap (proportions of women dispensed hormonal LARC or other hormonal contraception that overlapped the first dispensing of category X medications), by medication class. Among 15 627 women aged 15-49 years dispensed category X medications during 2013-2021, the prevalence of dispensing increased from 4.6 in 2013 to 8.7 per 1000 women aged 15-49 years in 2021; the largest increase was for the dispensing of dermatological agents, from 3.9 to 7.9 per 1000 women aged 15-49 years. LARC overlap was inferred for 2059 women at the time of first dispensing of category X medications (13.2%); 3441 had been dispensed any type of hormonal contraception (22.1%). The proportion with LARC overlap was smallest for those dispensed dermatological agents (1806 of 14 331 women, 12.6%); for this drug class, both LARC overlap (adjusted odds ratio [aOR], 0.17; 95% confidence interval [CI], 0.14-0.20) and any hormonal contraception overlap (aOR, 0.28; 95% CI, 0.25-0.32) were less likely for those aged 15-19 years than for women aged 25-29 years. Concurrent use of highly effective hormonal contraception at the time of first dispensing of category X medications is low in Australia, raising concerns about potential fetal harms during unintended pregnancies. Awareness of the importance of hormonal contraception and its uptake by women prescribed category X medications should be increased.

General practitioners' views and experiences of postpartum contraception counselling and provision: a qualitative-descriptive study.

To explore Australian general practitioners' views and experiences of undertaking postpartum contraception counselling and provision during the 6-8-week postnatal check. Qualitative-descriptive study; semi-structured online interviews. General practitioners who provide postnatal care in Australian primary health care, recruited using purposive, convenience, and snowball methods, 16 June - 6 July 2023. Views and experiences of postpartum contraception counselling and provision. Twenty-three general practitioners from six states were interviewed; the mean interview time was 30 minutes (range, 21-47 minutes), twenty-two participants were women, and twenty-one worked in metropolitan areas. All participants provide postnatal checks and had the training and facilities needed for providing contraceptive implant insertions. Twelve participants had training in intrauterine device (IUD) insertion, and twenty-one worked in practices with facilities for IUD insertions. Three themes were constructed: views and preferences regarding postnatal contraception counselling; postpartum provision of long-acting reversible contraception (LARC); and opportunities for improving postpartum contraception care in general practice. While most participants recommended LARC methods at postnatal checks, only twelve were trained to insert IUDs. Time constraints, limited access to training, limited financial support, and the lack of guidelines for postnatal checks and contraception care were seen as impeding postpartum contraception counselling. Participants highlighted the importance of access to education and training, appropriate remuneration for general practitioners, multidisciplinary collaboration among health professionals, the inclusion of practice nurses, and raising awareness among mothers of the importance of postnatal checks and postpartum contraception care. General practitioners are well placed to facilitate discussions about contraception with women who have recently given birth. Postpartum contraception care in general practice could be improved by better access to contraception training, appropriate remuneration for contraception procedures, greater multidisciplinary collaboration, and national postnatal check and postpartum contraception guidelines.

Utilization of Immediate Postpartum Contraception and Its Association with Interpregnancy Interval: 10-Year Experience at a Single Center.

Increasing availability of immediate postpartum long-acting reversible contraception (LARC) has added contraceptive alternatives to bilateral tubal ligation (BTL) in the immediate postpartum period. The resultant access to long-term contraception has provided patients with improved control over the timing of pregnancies. Our objective is to evaluate changes in the utilization of immediate postpartum contraceptive methods over a 10-year period and its association with interpregnancy interval (IPI). Retrospective cohort study of 36,445 patients delivered at a single academic hospital center from 2012 to 2020. Deliveries <23 weeks gestation and patients who underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. The primary outcome was the utilization of postpartum BTL, intrauterine devices, contraceptive implants, and Depo-Provera over the study time period. The secondary outcomes were IPI and interdelivery interval (IDI). Outcomes were compared using appropriate tests of trend. We adjusted for significant covariates as assessed in baseline characteristics. A total of 35,281 patients were included in our study. Groups were different in baseline characteristics including age, race/ethnicity, parity, BMI, insurance status, comorbidity risk, and attendance at postpartum exam. Over the study period, there was a significant difference in utilization of Depo-Provera, LARC, intrauterine device (IUD), and implant (p < 0.001). There was a significant increase in IPI (p < 0.001) and IDI (p < 0.001). We observed a significant increase in utilization of immediate postpartum LARC over the study period which corresponded to a significant increase in IPI and IDI. Our findings emphasize the importance of the availability of immediate postpartum contraception as well as its effectiveness in improving family planning options for reproductive-aged patients. We found significantly increased IPI and IDI associated with increased utilization of long-acting reversible contraceptives immediately postpartum. Our findings emphasize the importance of providers offering these options to patients as well as being comfortable initiating immediate postpartum contraception. · Immediate postpartum LARC access has increased over the past 10 years.. · Access to more methods of contraception allows patients more options for family planning.. · Increased utilization of LARC led to increased IPI and IDI..

Selection of long acting reversible contraception methods by emergency contraception clients: A prospective observational study

ObjectivesTo describe long acting reversible contraception (LARC) initiation in emergency contraception (EC) visits. Study designEC clients age 18–35 years at four Utah family planning clinics between February 2021 and April 2023 chose between oral EC and three LARC options. ResultsOf 2106 EC clients approached, 306 (14.5%) requested LARC and 293 initiated a device: 160 (55%) an etonogestrel implant+ oral levonorgestrel (LNG), 72 (25%) a copper intrauterine device (IUD), and 61 (21%) a 52 mg levonorgestrel IUD (p < 0.001). ConclusionsIn this observational study, one in seven EC clients initiated a LARC method and more frequently selected the etonogestrel implant with oral levonorgestrel over an IUD. Clinical Trial RegistrationClinicaltrials.gov NCT04678817; registered 12/16/20.