Can Pediatricians Provide Long-Acting Reversible Contraception?

Abstract

Study Objective: In the United States, 40% of high-school students have sex; few use highly effective and safe long-acting reversible contraceptives (LARCs): intrauterine devices and implants. Pediatricians are key health providers for many adolescents, yet few provide LARCs. Our objective was to understand the pragmatics of provision of LARCs (rather than beliefs or attitudes) and identify barriers to and opportunities for LARC provision by community-practicing pediatricians. Design: We conducted a qualitative descriptive study using semistructured interviews. Qualitative methods are valuable for generating conceptual models of complex phenomena. Setting: Set in a midsized Midwestern city, our study was community-based. Participants, Interventions, and Main Outcome Measures: We interviewed 23 pediatricians to understand their views about providing contraception (including LARCs) to adolescents. For analysis, we developed a coding schema and applied it using a priori and open coding. Results: Several interrelated themes regarding challenges to provision of LARC emerged: limited motivation for on-site LARC provision or referral streams, low pediatric patient interest in LARC, lack of pediatrician training about LARC provision, and inadequate structural elements for on-site placement of LARCs in pediatric offices. Each challenge could be remedied, because pediatricians were motivated to provide adolescent patients with high-quality care. Improvements in these interrelated conditions could facilitate pediatrician provision of LARC. Conclusion: Pediatricians and their patients want to prevent pregnancy, but current practice norms limit LARC provision by pediatricians. To increase LARC access in pediatrician offices, we suggest training in LARC provision and patient education for medical students, residents, and pediatricians; communicating about LARC methods with adolescents to increase patient demand; and systemic changes to improve referral processes and/or allow on-site LARC placements.

Factors associated with never‐use of long‐acting reversible contraception among adult reproductive‐aged women in Ohio

“…Contraceptive experiences do not always match contraceptive preference—some individuals who prefer LARC may not have received LARC, and vice versa 36 . People's contraception preferences and experiences are shaped by myriad factors, and some providers have been shown to coerce individuals into using LARC (including refusing removal when patients request it) 2,39,40 and other providers have been shown to fail to mention LARC as a contraceptive option for certain groups of individuals 13,14 . Thus, targeting providers with training to improve patient education and facilitate positive patient‐provider communication, including training about reproductive autonomy and racism in reproductive healthcare, may help providers address better patients' concerns about LARC.…”

“…In addition, uptake has been slowed by challenges such as scheduling, 9 potential users' discomfort with “newer” contraceptive methods, 10 distrust because of a history of reproductive coercion targeting women of color and women living with physical and intellectual disabilities, 2,11 and some providers' reluctance to remove LARC after insertion 12 . Additionally, both potential users and providers may lack knowledge about LARC or hold misconceptions, such as outdated beliefs about LARC being inappropriate for certain groups of patients based on age, marital status, or parity 13–17 …”

“…Additionally, many individuals are misinformed about LARC or report not knowing much about the method class 22–24 . Some providers promote misinformation about LARC 13,25 . Furthermore, many individuals simply do not prefer LARC because they are satisfied with another method, have concerns about safety or side effects, or want more autonomy to discontinue their contraceptive method, among other reasons 2,26 .…”

“…12 Additionally, both potential users and providers may lack knowledge about LARC or hold misconceptions, such as outdated beliefs about LARC being inappropriate for certain groups of patients based on age, marital status, or parity. [13][14][15][16][17] In Ohio, a Midwestern U.S. state, state lawmakers have previously implemented policies to reduce cost-related barriers to accessing contraception among women living on low incomes. Since 2006, women living on low-incomes, specifically women with household incomes below 185% of the federal poverty level, have been able to take advantage of the Medicaid "family planning waiver" to obtain contraceptive care without fees.…”

Entrenamiento para colocación del implante subdérmico anticonceptivo con etonogestrel a residentes del posgrado de pediatría de la Universidad de Costa Rica.

“…1La anticoncepción reversible de larga duración (LARC, por sus siglas en inglés), se refiere a métodos como los implantes anticonceptivos subdérmicos y dispositivos intrauterinos que proporcionan un método de planificación altamente eficaz, que no requiere de una toma diaria o aplicación mensual o trimestral (usuaria independiente). (3,4) En Estados Unidos, se considera competentes a los pediatras para proveer de anticoncepción a las adolescentes, pues es una importante intervención para la prevención del embarazo no deseado en esta edad. (4) El desconocimiento de los métodos LARC, falsas ideas sobre los dispositivos intrauterinos e implantes y poco tiempo para la consejería anticonceptiva son algunos de los aspectos que se mencionan como impedimentos para que la población adolescente no reciba contracepción LARC por parte de los especialistas en pediatría que los atienden en su consulta.…”