Implementing Best Practices for the Provision of Long-acting Reversible Contraception: A Survey of Obstetrician-Gynecologists

摘要

The most effective long-acting reversible contraceptives (LARCs) are intrauterine devices (IUDs) and contraceptive implants. Although LARCs are safe for nulliparous women and adolescents in the immediate postpartum and postabortion periods, the proportion of reproductive-aged women using contraceptives is low. The results of a 2010 American College of Obstetricians and Gynecologists (ACOG) survey found that obstetrician-gynecologists (ob-gyns) underutilize LARCs. Between 2007 and 2012, LARC use increased from 3.7% to 11.6%. Despite this promising increase, overall use of LARCs remains low because of a number of financial, knowledge, and logistical barriers that prevent women interested in LARC methods from accessing them. A number of studies have demonstrated that the requirement to return for an additional visit for placement prevents women desiring LARC from accessing their preferred contraceptive method. This possibly increases risk of unintended pregnancy. Many medical organizations, including the ACOG, the World Health Organization, and the Centers for Disease Control and Prevention, have recommended same-day provision of LARCs, immediately postpartum, and to eligible adolescents and nulliparous women as best practices for LARC placement.