Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic

Abstract

Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States.

Continuation of Reversible Contraception Following Enrollment in the Zika Contraception Access Network (Z‐CAN) in Puerto Rico, 2016–2020

“…Similar to our findings, another 12‐month study (with a U.S. inner‐city patient population) retrospectively reviewed medical charts of patients desiring LARC placement and found fewer discontinuations among patients who received LARC replacements compared with new insertions (29 vs. 71 percent) (Runyan et al. 2021).…”

“…Past contraceptive experiences are an integral part of the contraception decision-making process, (Downey et al 2017), and participation in Z-CAN did not require noncontraceptive use at baseline or willingness to switch to a different method. Similar to our findings, another 12-month study (with a U.S. inner-city patient population) retrospectively reviewed medical charts of patients desiring LARC placement and found fewer discontinuations among patients who received LARC replacements compared with new insertions (29 vs. 71 percent) (Runyan et al 2021).…”

How NPs can eliminate practice barriers to intrauterine device use

“…Of the 6 million annual pregnancies in the US, 45%-51% are unintended. Unintended pregnancy rates are highest among low-income women, women of color, and women ages 18-24 2. Though birth rates for women under age 30 are declining, the rate of unintended pregnancies in the US remains higher than in many other developed countries 3,4.…”

“…Unintended pregnancy rates are highest among low-income women, women of color, and women ages 18-24. 2 Though birth rates for women under age 30 are declining, the rate of unintended pregnancies in the US remains higher than in many other developed countries . 3,4 A goal of Healthy People 2030 is to decrease the proportion of unintended pregnancies from 43% to 36.5%.…”

“…While progress has been made in lowering the rate of unintended pregnancy in the US, unnecessary barriers to contraception access and use persist. In a retrospective chart review of women desiring LARC over a 1-year period, delays occurred for 38% of patients due to factors including absence of a qualified provider, waiting for sexually transmitted infection (STI) test results, and device unavailability 2…”