Women's Use of Long-Acting Reversible Contraception for Birth Timing and Birth Stopping

Abstract

The use of long-acting reversible contraceptive (LARC) methods—intrauterine devices (IUDs) and implants—has recently expanded rapidly in the United States, and these methods together approach the contraceptive pill in current prevalence. Research on LARCs has analyzed their use to reduce unintended pregnancies but not their use to enable intended pregnancies. Knowledge of both is necessary to understand LARCs’ potential impacts on the reproductive life courses of U.S. women. We combine data from two nationally representative surveys to estimate women's likelihood and timing of subsequent reproductive events, including births resulting from an intended pregnancy up to nine years after discontinuing LARC use. We estimate that 62% of women will give birth, and 45% will give birth from an intended pregnancy. Additionally, 18% will have a new LARC inserted, and 13% will transition to sterilization. Most of these reproductive events occur within two years after discontinuing LARC use. Births from an intended pregnancy are especially common when no intervening switch to another contraceptive method occurs. We infer that women's motives for using LARC are varied but include the desire to postpone a birth, to postpone a decision about whether to have a(nother) birth, and to transition definitively to the completion of childbearing.

Examining the impact of Medicaid payments for immediate postpartum long‐acting reversible contraception on the mental health of low‐income mothers

“…[44][45][46] Second, even in the absence of a change in population-level pregnancy protection, mental health may be impacted by enhancing reproductive autonomy via (i) substituting LARC for sterilization, particularly among patients who would otherwise regret sterilization or decide they wish to have more children at a later period, and/or (ii) substituting LARC for less effective contraceptive methods, particularly among patients who do not intend to become pregnant. [75][76][77] The reproductive autonomy mechanism is supported by our finding that the positive effects of IPP LARC reform on mental health are largest among women with multiple children in the household (Table 4).…”

“…Among patients who receive sterilization 25% subsequently desire a reversal of the procedure 76 . At the same time, among patients who discontinue LARC, 35% go on to have an intended pregnancy within 2 years 77 . This suggests that LARC maybe a preferred alternative to sterilization, as it allows its recipients to change their minds about having more pregnancies in the future.…”

Reproductive Oppression Enters the Twenty-First Century: Pressure to Use Long-Acting Reversible Contraception (LARC) in the Context of “LARC First”

“…Among reversible methods, LARC methods provide the highest level of protection against pregnancy, in large part because they are long-acting, “forgettable” methods, meaning that their use is not susceptible to user error (Grimes 2009). Given that an estimated 43 percent of unintended pregnancies in 2000 and 2001 were attributable to inconsistent or incorrect use (Frost, Darroch, and Remez 2008), this feature of LARC could enable women to better control whether and when to have a child, thus enhancing their reproductive autonomy (Eeckhaut, Rendall, and Zvavitch 2021). During the past two decades, LARC use increased more than sixfold, from 1.5 percent of reproductive-aged women in 2002 to 10.4 percent in 2017–2019 (Branum and Jones 2015; Daniels and Abma 2020).…”

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

“…This increase is linked to several factors, such as these methods being the most effective reversible class of contraception available, ease and duration of use, and the potential absence of monthly bleeding for the hormonal releasing intra‐uterine device (IUD) 2,3 . Among contraceptive users in the United States, the percentage using LARC, specifically the IUD and implant, increased from 6% in 2002 to 14% in 2014 1,3,4 and 16% in 2017–2019 5,6 . Given the increasing but comparatively low prevalence of LARC use, we examined reasons for LARC never‐use.…”

“…2,3 Among contraceptive users in the United States, the percentage using LARC, specifically the IUD and implant, increased from 6% in 2002 to 14% in 2014 1,3,4 and 16% in 2017-2019. 5,6 Given the increasing but comparatively low prevalence of LARC use, we examined reasons for LARC never-use.…”