LARC Use Research Articles

Primary Contraceptive Method use and Sexually Transmitted Infections in a Nationally Representative Sample of Young Women

Study objectiveRates of sexually transmitted infections (STIs) in the United States have increased for the sixth consecutive year. Young people ages 15-24 account for over half of all new infections despite comprising only a quarter of the sexually active population. A potential explanation for this is the increased use of long-acting reversible contraceptives, (LARCs) which could result in lower condom use and/or increased sexual risk-taking due to higher pregnancy prevention efficacy. DesignThis paper uses the National Survey of Family Growth to examine the relationship between primary contraceptive method use among young women ages 15-24 and STI treatment in the past year, as well as the extent to which this association is mediated by relationship status and frequency of condom use. ResultsFindings did not show differences in STI treatment in the past year by primary contraceptive method, indicating that LARC use among young women does not equate to increased STI risk. Findings did show that young women who had been in casual-only relationships or a mix of relationship types in the past year were more likely to have been treated for an STI than young women in serious or dating-only relationships, regardless of the primary method used. Additionally, young women who used condoms “some” of the time were more likely to have been treated for an STI compared with women who used condoms “all” or “most” of the time. This association was mediated by relationship status (P = .05). ConclusionFindings suggest that efforts to address the growing STI burden should be directed at providing comprehensive, gender-equitable sexual health education that enables young people to engage in healthy relationships and consistent condom use.

Association of the affordable care act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy

ObjectivesBefore the Affordable Care Act (ACA), 55% of individuals giving birth with Medicaid lost insurance postpartum, potentially affecting their access to postpartum contraception. We evaluate the association of the ACA Medicaid expansions with postpartum contraceptive use and pregnancy at the time of the survey. MethodsWe used 2012–2019 Pregnancy Risk Assessment Monitoring System data to estimate difference-in-difference models for the association of Medicaid expansions with the use of postpartum contraception (mean: 4 months postpartum): any contraception, long-acting reversible contraception, or LARC (contraceptive implant and intrauterine device), short-acting (contraceptive pill, patch, and ring), permanent, or non-prescription methods (condoms, rhythm method, and withdrawal), and pregnancy at the time of the survey. We examine low-income respondents overall and stratified by race and ethnicity. ResultsWe find that Medicaid expansion was associated with a 7.0 percentage point (95% CI: 3.0, 11.0) increase in postpartum LARC, a 3.1 percentage point (95% CI: -6.0, -0.2) decrease in short-acting contraception, and a 3.9 percentage point (95% CI: -6.2, -1.5) decrease in non-prescription contraceptive use overall. In stratified analyses, we find that increases in LARC use were concentrated among non-Hispanic White and Black respondents, with shifts in other postpartum contraceptives towards LARCs. Medicaid expansion was associated with a decrease in early postpartum pregnancy only among non-Hispanic Black respondents. ConclusionsMedicaid expansions led to shifts from methods with a lower upfront out-of-pocket cost for people without insurance towards methods with the higher upfront out-of-pocket cost for people without insurance. These changes suggest that Medicaid expansion improved postpartum contraceptive access. ImplicationsThese findings indicate that postpartum uninsurance was a barrier to postpartum contraceptive access prior to Medicaid expansions under the Affordable Care Act. Medicaid expansions increased access to the full range of contraceptive methods.

Factors associated with the uptake of long-acting reversible contraception among female sex workers in post-conflict Northern Uganda: a cross-sectional study

BackgroundLong-acting reversible contraception (LARC) is the most effective and reliable contraception option for female sex workers (FSWs) who desire future fertility. Unlike the other reversible contraceptive methods, LARC use requires only periodic users’ involvement at the time of application and re-application. However, only a few studies on LARC uptake among FSWs are available in Uganda. To fill this knowledge gap, we examined factors associated with the uptake of LARC among FSWs in post-conflict Northern Uganda.MethodsWe conducted a cross-sectional study among adult FSWs operating in the post-conflict Gulu district in Northern Uganda. We collected quantitative data among 280 FSWs of reproductive ages (18–49 years) who were neither pregnant nor using permanent contraception. We utilized a pretested semi-structured questionnaire to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex work-related characteristics, obstetric history, HIV status, and LARC uptake. Data were then entered into EPI INFO 7, cleaned, and analyzed using multivariable Poisson regression in STATA 14.0 to obtained adjusted prevalence ratios (PR).ResultsAmong the study participants: the mean age (SD, range) was 26.5 (5.9, 18–45) years, 48.6% reported at least one unintended pregnancy during sex work, and 37.4% had at least one induced abortion. Meanwhile, only less than two in three (58.6%) participants were using LARC. At multivariable level, factors that remained independently associated with LARC uptake included: longer duration of sex work (adjusted PR = 1.44, 95% CI: 1.03–2.02), higher parity (adjusted PR = 1.13, 95% CI: 1.02–1.26), history of unintended pregnancies during sex work (adjusted PR = 1.24 CI: 1.01–1.51), and being a brothel/lodge-based FSWs (adjusted PR = 1.28, 95% CI: 1.01–1.63).ConclusionsThe above findings revealed a gap in the uptake of LARC among FSWs in post-conflict Northern Uganda influenced by duration of sex work, parity, unintended pregnancies during sex work, and place of sex work. Interventions to improve LARC uptake should target the newly recruited FSWs with low parity and the non-brothel/lodge-based FSWs.

The public-sector family planning program impact scores in association with long-acting reversible contraceptive use among young women in 22 Sub-Saharan African countries: A pooled multi-level analysis

ObjectiveThe objective of this study was to evaluate the role of public-sector family planning program impact scores and other country-level factors on LARC use among young women aged 15 to 24. Study designWe conducted this research using a large population database covering several decades’ worth of multi-wave cross-sectional samples of the demographic health survey (DHS) and the World Bank website data. We carried out a multi-level analysis on data from 1990 to 2019 from 22 Sub-Saharan African countries, with 163,242 participants. ResultsWe found LARC use was at 3.1% of all young women under study. Sierra Leone, 2019 survey had the highest LARC use at 21,961 per 100,000. A 10% increase in public-sector family planning program impact scores was positively associated with LARC use with odds ratio of 1.44, 95% CI, 1.43−1.45). We also noted that a 1% increase in HIV prevalence was associated with a reduced odds ratio of LARC use at 0.75 (95% CI, 0.70−0.81). ConclusionsFindings from this study provide empirical evidence highlighting the importance of country-level factors in influencing LARC use among young women in sub-Saharan Africa ImplicationsFor young women in Africa, policymakers need to increase their effort on national family planning programs especially in the public sector. Broader societal level interventions to improve LARC use are required. Specific interventions must address the complexities of HIV prevention and LARC use to benefit young women living in countries with a high HIV prevalence.

The effects of offering immediate postpartum placement of IUDs and implants to pregnant patients with heart disease

ObjectiveTo evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease. Study DesignRetrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into 2 cohorts: pre-immediate postpartum LARC Program implementation (March 2015 to January 2017) and post-implementation (February 2017 to June 2019). The primary outcome was LARC (intrauterine device [IUD] or etonogestrel implant) use postpartum, defined as LARC either immediately postpartum or at the postpartum visit. Secondary outcomes included contraception intent at delivery and IUD expulsion rate of IUDs placed immediately postpartum. ResultsOf 159 included patients, 96 (60%) delivered during the post-implementation period. LARC use tripled after program implementation, 11% vs 35%, p < 0.01. Specifically, immediate postpartum IUD use increased from 1 (1.6%) to 10 (10.4%), p = 0.05, and use of immediate postpartum implant increased from 0 to 14 (14.6%), p = 0.002. Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p = 0.01. Tubal ligation rates were not different before and after program implementation: 24% and 29%, p = 0.46. Postpartum visit rates were similar between Pre and Post groups: 70% and 72%, p = 0.78, respectively. One immediate postpartum IUD expulsion occurred. ConclusionLARC use tripled in pregnant patients in an obstetric heart disease program after implementation of an immediate postpartum LARC Program. Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality. ImplicationsAccess to immediate postpartum IUDs and implants should be a public health priority for women with heart disease – as well as all people with high-risk health conditions – to reduce their disproportionate burden of maternal morbidity and mortality.

Social Network Influences on Young Women's Choice to Use Long-Acting Reversible Contraception: A Systematic Review.

Long-acting reversible contraception (LARC; including intrauterine devices and implants) is recommended as the first-line contraceptive choice by several professional organizations (eg, American College of Obstetricians and Gynecologists); however, rates of uptake are lower than those of other contraceptive methods. A young woman's social network may influence the decision to use LARC. The purpose of this review was to determine the role of health care providers (HCPs), family, peers, and sexual partner(s) on young women's decisions to initiate LARC. Several databases (PubMed, CINAHL, and PsycINFO) were searched for articles published between 2000 and 2020 that studied the social network influences of HCPs, family, peers, and sexual partner(s) on LARC initiation among women in the United States aged 18 to 25. A narrative synthesis of the included articles was conducted. Twenty-nine articles met the inclusion criteria (21 qualitative, 6 quantitative, 2 mixed methods). HCPs are an important influence on a young woman's LARC decision-making. Peers and family also have a role but were often sources of negative or inaccurate information. Gaps in the literature were identified, including a lack of data on implant users and a dearth of studies on the role of sexual partner influence; most studies were not guided by theory. HCPs are integral to LARC initiation and may be more influential than other social network members. Future research should focus on understanding how social network members interact to result in LARC initiation. Gaining insight into these influences may improve existing interventions or contribute to the development of new interventions and ultimately promote LARC use among young women.

Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries.

BackgroundLong-acting reversible contraceptives (LARCs) are associated with high efficacy rates and continuity of use. Based on the foregoing, we sought to examine the prevalence and factors associated with LARC use among sexually active women in 26 countries in sub-Saharan Africa(SSA).MethodsSecondary data from Demographic and Health Surveys conducted in 26 countries in SSA between January 2010 and December 2019 were pooled and analysed. A total of 56 067 sexually active women 15–49 y of age met the inclusion criteria. Bivariate and multivariate regression analyses were performed to examine the association between selected factors and the use of LARCs in SSA. Results were presented as crude odds ratios and adjusted odds ratios (aORs) with statistical precision at <0.05.ResultsThe prevalence of LARC use was 21.73%, ranging from 1.94% in Namibia to 54.96% in Benin. Sexually active women with secondary or higher education (aOR 1.19 [95% confidence interval {CI} 1.08 to 1.32]), those cohabiting (aOR 1.25 [95% CI 1.06 to 1.47]) and those with four or more children (aOR 2.22 [95% CI 1.78 to 2.78]) were more likely to use LARCs compared with those without education, never married and with no biological child.ConclusionsThe use of LARCs in the 26 countries in SSA was relatively low. Hence, the identified contributory factors of LARC use should be tackled with appropriate interventions. These include continuous campaigns on the efficacy of LARCs in reducing unintended pregnancy, maternal mortality and morbidity.

Role of social network in decision making for increasing uptake and continuing use of long acting reversible (LARC) methods in Pakistan

IntroductionDespite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan.MethodsIn-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts.ResultsFour key themes, supported by sub-themes relating to a temporal model, were identified to explain women’s experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method’s use.ConclusionThis study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.

Changes in Rates of Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the USA, 2012-2016.

To examine recent rates of long-acting and permanent methods (LAPM) of contraception use during delivery hospitalization and correlates of their use. A retrospective cohort study utilizing the 2012-2016 National Inpatient Sample of hospitalizations in the United States of America. The International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes were used to identify deliveries, inpatient long-acting reversible contraception (IPP LARC), and postpartum tubal ligation (PPTL). We conducted univariable and multivariable logistic regression to examine associations between demographic, clinical, hospital and geographical characteristics with likelihood of LAPM including IPP LARC and PPTL. Our sample included 3,642,328 unweighted deliveries. The rate of IPP LARC increased from 34.6 to 54.9 per 10,000 deliveries (58.7%), while the rate of PPTL utilization decreased from 719.5 to 671.8 per 10,000 deliveries (6.6%) over the study period. In multivariable analysis of LAPM utilization versus neither, cesarean delivery (aOR 7.25, 95% CI 7.08-7.43) was associated with greater utilization. Native American (aOR 4.01, 95% CI 2.91-5.53) race was associated with increased use of IPP LARC compared to a non-long-acting method of contraception. Age between 18 and 29 years (aOR 6.21, 95% CI 5.42-7.11) was associated with greater use of IPP LARC versus PPTL. Delivering in a rural hospital ((aOR 0.09, 95% CI 0.06-0.12) and cesarean delivery (aOR 0.09, 95% CI 0.06-0.12) were associated with greater use PPTL versus IPP LARC. The IPP LARC rate remains at less than 10% the PPTL rates in our study timeframe. The demonstrated variation in uptake of highly effective methods of contraception inpatient after delivery offer possible opportunities for better understanding and improvement in access.

Correlates of Long-Acting Reversible Contraceptives Use among Female Youths in Rivers State

This study explored the factors that correlate with long-acting reversible contraceptive use among female youths in Rivers state. Two specific objectives with corresponding research questions were formulated for the study. Two null hypotheses were tested at a 0.05 level of significance. A mixed-method research design was used. The study population comprised 85,197 female youths in Rivers state. A multistage sampling procedure was used to draw a sample of 1,428 female youths. A self-structured questionnaire (CLARCUQ) was used as the research instrument while data analysis was done using mean, standard deviation, linear regression and simple percentage. Some of the findings of the study revealed that LARC's service providers' attitude at a correlated rate of 2.6% while access has a correlate of 1.8%, showing low extent altogether. Based on the quantitative outcome, it was concluded that LARC use is low but essential to address health malady among female youths in Rivers state. It was therefore recommended that the ministry of education should collaborate with school administrators and women organizations to sensitize the female youths in Rivers state on reproductive health services and the healthcare service providers in Rivers state should be supported by relevant authorities to improve their education, knowledge, skill and awareness about LARC for the younger group in the society.

The Current Barriers and Management Strategy to Increase the Use of Long Acting Reversible Contraception Methods in Egypt

Background: Long acting reversible contraception methods (LARCs) are ideal pregnancy prevention options for many women compared with shorter-term methods. Aim: to assess the current barriers and management strategy to increase the use of LARCs in Egypt. Subjects and methods: A cross-sectional design was used. The study was conducted at 5 family planning units at Sharkia governorate, Egypt. A representative sample composed of 225 woman from the total (84404) between the period from January to December 2018. The tool used was A Structured interview questionnaire tool that consists of two parts; Socio-demographic characteristics and barriers of LARC to assess the barriers against use of LARC. And a strategy plan design was performed to increase the awareness and the use of LARCs. Results: The main barriers against the use of LARCs were cognitive barriers in both groups followed by requiring woman to return for check-ups and socio cultural barriers (50.7%, 15.6%, 14.6%) respectively. Conclusion: There are many barriers against the use of LARC. A strategy that promote LARCs uptake by targeting specific barriers may guide women to high uses of this methods. Recommendations: Increase women's awareness about the importance of using family planning methods especially LARCs.Key words: Long acting reversible methods, Barriers, Management strategy.

Contraceptive Use Patterns among Women of Reproductive Age in Two Southeastern States.

Unintended pregnancies remain an important public health issue. Modern contraception is an important clinical service for reducing unintended pregnancy. This study examines contraception use among a representative sample of women residing in two southeastern U.S. states. A cross-sectional statewide survey assessing women's contraceptive use and reproductive health experiences was conducted in Alabama and South Carolina. Characteristics of the study population were compared across contraceptive use categories and multivariable regression analysis was performed examining relationships between covariates of interest and contraceptive use outcomes. Approximately 3,775 women were included in the study population. Overall, 26.5% of women reported not using any contraception. Short-acting hormonal methods were the most commonly reported (26.3%), followed by permanent methods (24.4%), long-acting reversible contraception (LARC; 14.3%), and barrier/other methods (8.5%). Nonuse was more prevalent among women with some college or an associate's degree, incomes between $25,000 and $50,000, no health insurance, and longer gaps in care. LARC use among women with Medicaid as a pay source was higher than use among privately insured women and higher in South Carolina than Alabama. Both nonuse and LARC use were higher among women with no insurance. Study findings are largely consistent with previous research using similar population-based surveys. LARC use was higher among the study population relative to what is observed nationally. Factors enabling access to contraceptive services, particularly for lower income women, were associated with contraception use patterns. These findings provide important context for understanding individuals' access to resources and are important for fostering increased access to contraceptive services among women in these two states.

LARC Implant Use Does Not Exacerbate Bone Loss Associated With Hindlimb Unloading

Combined oral contraceptives (COC; ethinyl estradiol and progestin) reduce exercise-induced gains in bone mineral density (BMD), possibly by suppressing bone turnover. Long-acting reversible contraceptives (LARC; progestin-only) provide many practical advantages over COC and will likely be recommended for female astronauts on long-duration missions; however, the impact on bone health with unloading is unknown. PURPOSE: To determine if LARC use will blunt loss of bone associated with hindlimb unloading (HU) METHODS: Virgin female Sprague-Dawley rats (n=52; 4-mo-old) were singly housed and randomly assigned to placebo (PL) and LARC groups, via an implanted slow-release etonogestrel pellet (0.00ug/d vs. 0.30ug/d). A week later, animals were further randomized to weight bearing (WB) and HU groups (n=13/subgroup) for 6 weeks. Calcein injections were delivered 9 and 2 days prior to termination. Pre/post-HU, proximal tibia metaphysis (PTM) and the tibia mid-diaphysis (TD) were scanned with in vivo peripheral quantitative computed tomography. At termination tibiae were stored for mechanical testing and dynamic/static histomorphometry. Univariate and repeated measures 2-way ANOVA were used. RESULTS: Despite increasing their food intake during HU (p<0.01), HU animals lost weight and weighed less than WB animals starting on HU week 2 (p<0.01). Irrespective of pellet type, HU resulted in a loss of total and cancellous volumetric BMD (vBMD) at the PTM (p<0.01), reduced cortical thickness at the PTM and TD p<0.01), and reduced endosteal and periosteal mineralization (MS/BS, MAR, and BFR; p<0.02) at the TD compared to WB animals. Irrespective of loading group, at the PTM LARC animals lost cancellous vBMD (p<0.05), but had an increase in osteoid (organic bone matrix; p<0.04) compared to PL animals. PTM BV/TV and Tb.Th were greater in PL-WB animals compared to PL-HU animals only (p<0.04). Similarly, ultimate force was greater in PL-WB animals compared to PL-HU animals only (p<0.02). CONCLUSIONS: On balance, LARC implantation did not blunt nor worsen the bone response to unloading. LARC appear to be a viable option for premenopausal female astronauts selected for long-duration missions. This work is supported by the Translational Research Institute for Space Health through Cooperative Agreement NNX16AO69A

Postpartum Contraceptive Use Among Denver-Based Adolescents and Young Adults: Association with Subsequent Repeat Delivery.

To determine the association of postpartum contraceptive use with repeat deliveries among adolescents and youth. Retrospective, observational analysis of electronic health record data. Single, urban facility in Denver, Colorado, United States. Women aged 10-24years who gave birth between January 1, 2011 and December 31,2015. Postpartum contraceptive use and time to subsequent delivery. Among 4068 women, 1735 (43%) used postpartum contraception. In adjusted analyses, characteristics associated with contraceptive use included Hispanic ethnicity (relative risk [RR], 1.1; P=.03), incremental prenatal visits (RR, 1.01; P=.047), and attendance at postpartum care (RR, 1.60; P<.001). Long-acting reversible contraceptive (LARC) use was higher among women younger than 15years (reference: 20-24years; RR, 1.12; P<.001) and lower among women aged 18-19years (RR, 0.93; P=.009). Hispanic women had higher rates of LARC use than non-Hispanic women (RR, 1.07; P=.02). Compared with inpatient LARC placement, outpatient placement (1-4weeks and 5 or more weeks) rates were lower (RR, 0.77 and RR, 0.89, respectively; P<.001). Time to subsequent delivery was shorter in non-LARC users (median, 659days) and contraception nonusers (median, 624days) compared with LARC users (median, 790days; P<.001); non-LARC postpartum contraceptive use did not significantly alter time to repeat delivery compared with that in women who used no method (P=.24). Postpartum LARC use reduced the risk of repeat pregnancy with a significant increase in time to the next delivery. Non-LARC use was not different from no contraceptive use in terms of time to repeat delivery.

Corrigendum to: Cost-benefit analysis of enhancing the uptake of long-acting reversible contraception in Australia.

ObjectiveLong-acting reversible contraception (LARC) is the most effective form of reversible contraception, but its use in Australia is low compared with other countries. The aim of this study was to evaluate the economic effect of an increase in LARC uptake to international rates.MethodsAn economic model was designed to assess two scenarios, namely increasing the current rate of LARC uptake of 12.5% to the international benchmark of 14.8% among: (1) women currently using the oral contraceptive pill (OCP); and (2) women at risk of pregnancy and not using contraception. Model inputs included cost of contraceptive methods, discontinuation rates and abortion and miscarriage costs associated with unintended pregnancies.ResultsWomen who switch from an OCP to LARC would save A$114-157 per year. Those not currently using any contraception who adopt LARC would incur costs of A$36-194 per year, but would reap savings from the reduction in unintended pregnancies. Over 5 years there would be a net saving of A$74.4 million for Scenario 1 and A$2.4 million for Scenario 2.ConclusionGreater use of LARC would result in a net gain in economic benefits to Australia. These benefits are largely driven by women switching from an OCP to LARC who have reduced costs, as well as women wishing to avoid pregnancy who choose to use LARC rather than no method. This evidence will support women making an informed contraceptive choice and policy makers in increasing the accessibility of LARC.What is known about the topic?LARC is the most effective form of reversible contraception, but uptake in Australia is relatively low.What does this paper add?There are economic benefits to society for women who switch from an OCP to LARC, as well as for women who switch from no contraception to LARC.What are the implications for practitioners?The findings of this study will support women in making an informed contraceptive choice and policy makers in increasing the accessibility of LARC.

Cost-benefit analysis of enhancing the uptake of long-acting reversible contraception in Australia.

Objective Long-acting reversible contraception (LARC) is the most effective form of reversible contraception, but its use in Australia is low compared with other countries. The aim of this study was to evaluate the economic effect of an increase in LARC uptake to international rates. Methods An economic model was designed to assess two scenarios, namely increasing the current rate of LARC uptake of 12.5% to the international benchmark of 14.8% among: (1) women currently using the oral contraceptive pill (OCP); and (2) women at risk of pregnancy and not using contraception. Model inputs included cost of contraceptive methods, discontinuation rates and abortion and miscarriage costs associated with unintended pregnancies. Results Women who switch from an OCP to LARC would save A$114-157 per year. Those not currently using any contraception who adopt LARC would incur costs of A$36-194 per year, but would reap savings from the reduction in unintended pregnancies. Over 5 years there would be a net saving of A$74.4 million for Scenario 1 and A$2.4 million for Scenario 2. Conclusion Greater use of LARC would result in a net gain in economic benefits to Australia. These benefits are largely driven by women switching from an OCP to LARC who have reduced costs, as well as women wishing to avoid pregnancy who choose to use LARC rather than no method. This evidence will support women making an informed contraceptive choice and policy makers in increasing the accessibility of LARC. What is known about the topic? LARC is the most effective form of reversible contraception, but uptake in Australia is relatively low. What does this paper add? There are economic benefits to society for women who switch from an OCP to LARC, as well as for women who switch from no contraception to LARC. What are the implications for practitioners? The findings of this study will support women in making an informed contraceptive choice and policy makers in increasing the accessibility of LARC.

Impact Of Long-acting Reversible Contraceptives On Bone Density During Simulated Microgravity

Hormonal contraception is routinely used by premenopausal women, including female astronauts, to suppress ovarian function and menstrual cycling. Combined oral contraceptive pill (COC, ethinyl estradiol and progestin) use leads to a suppression of bone turnover and reduced bone mineral density (BMD) gain with long-term exercise. Long-acting, reversible contraceptives (LARC, progestin-only) provide many practical advantages over COC. With increasing numbers of women in the US astronaut corps, we risk sending female crew members into microgravity without a clear understanding of the impact of LARC use on bone health. PURPOSE: We hypothesize that LARC use will blunt decreases in BMD associated with hindlimb unloading (HU). METHODS: Virgin female Sprague-Dawley rats (n=26; 4-mo-old) were singly housed and randomly assigned to placebo and LARC groups, via a slow-release etonogestrel pellet (0.00ug/d vs. 0.30ug/d) implanted under the skin. Animals were further randomized into ambulatory and HU subgroups (n=6-7/subgroup), with HU initiated a week following pellet insertion and lasting for 6 weeks. Pre/post HU, proximal tibia metaphysis (PTM) were scanned in vivo with peripheral quantitative computed tomography (pQCT). Univariate and repeated measures 2-way ANOVA were used. RESULTS: There was a time*loading group interaction (p<0.01) for body weight and food consumption. HU animals weighed less over the last 4 weeks of the study but consumed more food over 6 weeks of HU vs. ambulatory animals. Soleus wet weights were significantly lower in HU compared to ambulatory animals (p<0.001). There was a main effect of time for (p<0.001) PTM total, cancellous, and cortical volumetric BMD and total and cortical areas. For marrow area at the PTM there was a time*loading group interaction (p=0.044), such that over time the HU animals had a decrease in marrow area compared to the ambulatory animals. No impact of LARC on these outcomes was detected. CONCLUSIONS: Early results indicate that LARC use does not alter the PTM bone response to mechanical unloading of simulated microgravity assessed by in vivo pQCT. This work is supported by the Translational Research Institute for Space Health through Cooperative Agreement NNX16AO69A.

Dual-Contraception Use Among Adolescent Girls and Young Women Before and After Implementation of the Affordable Care Act

To assess dual-contraception use among young, sexually active contraceptive users, before and after implementation of the Affordable Care Act (ACA). Secondary data analysis using the 2006–2010 and 2013–2015 cohorts of the National Survey for Family Growth (NSFG). The NSFG was conducted in participants’ homes by a trained female interviewer. Data were included for 2,151 participants, ages 15 to 24 years, who were sexually active and had used contraception in the past 12 months. Participants were assigned to the pre-ACA (2006–2010 NSFG cohort) or post-ACA (2013–2015 NSFG cohort) group. The primary outcome was dual-contraception use in the past 12 months. The independent variable was ACA period (pre-ACA vs. post-ACA). Covariates included contraception type—categorized as short-, intermediate-, or long-acting reversible contraception (SARC, IARC, or LARC)—age, race, education, and marital status. Weights were used to estimate population-level outcomes. We assessed the relationship between dual-contraception use (never, sometimes, or always) and period (pre- or post-ACA), adjusting for covariates. Contraception Type × ACA Period and Race × ACA Period interaction terms were used to determine the association among contraception type, race, and changes in dual-contraception use. Compared with pre-ACA findings, there was a significant post-ACA decrease in SARC use (78.2% vs. 67.5%; p < .01) and a significant increase in LARC use (8.9% vs. 21.8%; p < .01) but no significant changes in the consistency of dual-contraception use among SARC users (OR, 1.88, 95% CI [0.64, 5.46], p = 0.25) or LARC users (OR = 1.62, 95% CI [0.42, 6.18], p = .48), or between White and Black women (OR, 1.45, 95% CI [0.66, 3.18], p = 0.35). There was no direct association between changes in contraception use and decreased condom use and, therefore, no indirect association between changes in contraception use and increased sexually transmitted disease rates. Health care providers should continue to promote consistent condom use among sexually active young women while realizing the public health goal of 100% condom use may not match young women’s personal health goals. Additional research is needed to further understand the post-ACA rise in sexually transmitted disease rates among Black women.

Condom Use With Long-Acting Reversible Contraception vs Non–Long-Acting Reversible Contraception Hormonal Methods Among Postpartum Adolescents

Increased use of long-acting reversible contraception (LARC; intrauterine devices [IUDs] and implants) has likely contributed to declining US teenage pregnancy and birth rates, yet sexually transmitted infection (STI) rates among teenagers remain high. While LARC methods are highly effective for pregnancy prevention, they, as with all nonbarrier methods, do not protect against STIs, including HIV. Studies of the general adolescent population suggest condom use is lower among LARC vs non-LARC hormonal methods users (birth control pill, contraceptive patch, vaginal ring, or injection). Despite the high use of LARC among postpartum teenagers, no studies have examined whether condom use differs by contraceptive method in this population. To compare condom use among sexually active postpartum teenagers using LARC vs those using non-LARC hormonal methods. Cross-sectional analysis using 2012 to 2015 data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a multisite and population-based surveillance system that collects data on maternal attitudes, behaviors, and experiences before, during, and shortly after pregnancy. We used data from 37 sites. Using multivariable survey-weighted logistic regression, we assessed the association of condom use by contraceptive methods. Participants were teenage mothers (≤19 years) with a recent live birth reporting LARC or non-LARC hormonal method use. Data were analyzed between March 2018 and April 2018. Condom use with LARC vs condom use with non-LARC hormonal methods. Among the 5480 (weighted N = 245 847) postpartum teenage mothers in our sample, most were aged 18 to 19 years, unmarried, had current Medicaid coverage, were first-time mothers, had reported their pregnancy was unintended, and almost half were non-Hispanic white. Overall, condom use was reported by 28.8% of these teenagers. Users of LARC compared with non-LARC hormonal methods were half as likely to use condoms (17.8% vs 35.6%; adjusted prevalence ratio [aPR], 0.50; 95% CI, 0.41-0.60). Users of IUDs (15.1%) were less likely to report condom use than those using an implant (21.5%; aPR, 0.70; 95% CI, 0.51-0.98), patch, ring, or injection users (24.9%; aPR, 0.61; 95% CI, 0.47-0.79), and pill users (47.2%; aPR, 0.32; 95% CI, 0.25-0.40). Self-reported condom use was low overall among postpartum teenage mothers and lower among users of LARC vs non-LARC hormonal methods. Given the high rates of STIs among teenage mothers combined with higher use of LARC among postpartum teenaged mothers, interventions to promote condom use for STI/HIV prevention during the postpartum period are critically important.

Insights from outside BJOG

Insights from outside BJOG