The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations

Abstract

STUDY QUESTION Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women’s and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN, SIZE, DURATION This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS, SETTING, METHOD We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and wo...

Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries

“…We believe that family planning programmes should give more attention to LARCs. The challenges to increase LARC uptake in Latin America and the Caribbean have been summarised by Bahamondes and colleagues 25 . These challenges include barriers of a subjective nature (misinformation, myths, and beliefs) and of an objective nature (institutional, service-related, training-related, cost-related, and others).…”

Effectiveness of an intrauterine device informative intervention among post-natal women in Western Jamaica

“…This finding is similar to other studies that found common misconceptions about IUDs; including misconceptions that IUDs can puncture the womb, cause infertility, and be used to induce abortions. [ 2 , 3 , 6 , 17 – 20 ]…”

“…IUDs have increased worldwide in popularity as a method of long-acting reversible contraceptives (LARC) [ 1 ]. Yet, in several developing countries such as in Latin America and the Caribbean the rate of use of LARCs (including IUDs) is < 10% [ 2 ]. According to a report published by the United Nations, 71.8% of married/in-union women aged 15–49 years in Jamaica in 2015 reported using contraceptives, but only 1.0% of these women reported using an IUD [ 3 ].…”

“…Knowledge and attitudes about IUDs among the sexually active female population in Jamaica could also be a factor. In the more rural areas of Jamaica, some women may only know about contraceptive methods that are more commonly used such as the male condoms, contraceptive pills, injection, or sterilization [ 2 , 12 , 16 ]. The primary objective of this research was to conduct an informative intervention on IUDs among women attending postnatal clinics in western Jamaica.…”

Out-of-pocket spending for contraceptives in Latin America

“… 11 Several analysts, for instance, have pointed out that the uptake of long-acting reversible contraceptives (LARCs) has been lower that could be expected given prevailing reproductive preferences and the evidence of LARCs’ safety and efficacy. 1 , 5 , 12 The high upfront cost of LARCs has been identified as an important barrier for this uptake. Evidence from recent experiences among adolescents in the US suggests that when financial barriers are removed, both LARC uptake and unintended pregnancy rates are favourably impacted.…”