“I don't know enough to feel comfortable using them:” Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus

Abstract

Objective To assess multiple dimensions of long acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women. Study Design We conducted an internet-based study of 1,982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women’s understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems, and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate, and linear regression statistics. Results Few college women had used (5%) or heard of (22%) LARC, and most self-reported “little” or “no” knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0–20), and scores differed across sociodemographic groups (p-values<0.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation, and contraceptive history. Perceived barriers to IUDs included: not wanting a foreign object in body (44%); not knowing enough about the method (42%); preferring a “controllable” method (42%); cost (27%); and not being in a long-term relationship (23%). Implant results were similar. “Not knowing enough” was women’s primary reason for IUD (18%) and implant (22%) nonuse. Conclusion Lack of knowledge (both perceived and actual) was the most common barrier among many perceived individual, systems, and community-level factors precluding these college women’s LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability, and uptake of LARC on campuses.

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“…Following on from the Contraceptive CHOICE Project [3] and also other studies [5,7,8,12], targeted, specialized, and-when appropriate-repeated provision of information about all available methods of safe contraception would in the present authors' view lead in the longer term to more widespread and more individualized usage of the safe methods of contraception that are available on the market, particularly LARC.…”

Introducing a “same day referral” program for post-coital IUD insertion in Ontario: A mixed-methods study with pharmacists

“…Further, in recent years there has been a plethora of efforts in North America to expand access to long-acting, reversible contraception [21][22][23]. Misinformation among providers, a dearth of trained providers, high up-front costs, and lack of awareness among women have limited the availability and accessibility of IUDs, both as ongoing methods of contraception and as EC [24][25][26].…”

Ongoing Implementation Challenges to the Patient Protection and Affordable Care Act’s Contraceptive Mandate

“…Moreover, research over the last decade has documented women’s lack of basic understanding of contraceptive methods, how they work, and how they can be effectively used, especially LARCs. 12 Targeted public health and media campaigns focused on the ACA and its reproductive health provisions are urgently needed. Clinicians can play a critical role in educating women about their contraceptive options, with cultural sensitivity and without coercion, and in informing them of how to best advocate for their full family planning insurance benefits.…”