February 27, 2014 — Summary of "A New Year's Resolution: Promoting Long-Acting Reversible Contraception," Likis, Journal of Midwifery & Women's Health, Feb. 11, 2014.
When it comes to preventing unintended pregnancies, long-acting reversible contraception (LARC) "may not be a magic bullet, but it is as close to one as currently exists," according to an editorial by Frances Likis, editor-in-chief of the Journal of Midwifery & Women's Health.
Likis notes that about half of U.S. pregnancies are unintended, a figure that has remained steady for three decades, except for a "discouraging increase" between 2001 and 2008. While there is a "plethora of contraceptive methods" that could help reduce unintended pregnancies, it "is increasingly evident ... that [LARC] are clearly superior methods when it comes to effectiveness," Likis writes.
Types and Benefits of LARC
The three types of LARC available in the U.S. are the levonorgestrel-releasing intrauterine system, sold as Mirena or Skyla; the copper intrauterine device (IUD), sold as ParaGard; and the etonogestrel implant, sold as Implanon or Nexplanon. "These methods are highly effective, [are] used separately from sex, do not require ongoing user effort, and have high rates of continuation and satisfaction," Likis writes.
Likis cites a study on LARC, called the Contraceptive CHOICE Project, that offered women "the reversible contraceptive method of their choice at no cost" and counseling about the methods, including the specification that IUDs and the implant are the most effective options. The study found that the risk of unintended pregnancy was nearly 22 times higher among oral contraceptive, contraceptive patch and contraceptive vaginal ring users than among IUD and implant users.
The study also found that 67% of the first 2,500 women who enrolled in the study chose an IUD or implant. By comparison, 6.4% of U.S. women ages 18 to 45 reported using IUDs and 1.8% reported using implants in a 2013 survey by the American College of Nurse-Midwives.
The findings suggest "that contraceptive affordability and counseling can increase LARC use," Likis writes, noting that expanded contraceptive coverage under the Affordable Care Act (PL 111-148) should help improve affordability of these methods. She adds that "counseling is crucial" because "many women do not understand the effectiveness of contraceptive methods."
Suggestions for Clinicians
Likis highlights three ways clinicians can help increase the number of women using LARC.
First, clinicians' knowledge of LARC must be up-to-date and correct. Likis notes that "myths and misconceptions" about LARC abound among both consumers and clinicians. The American College of Obstetricians and Gynecologists' website includes a "variety of resources" on "education, training, practice, and coding and billing" regarding LARC, she adds.
Second, clinicians and their staff members should talk about LARC with all women, including adolescents, who ask about contraception and are potential candidates for the methods. CDC provides evidenced-based criteria to assess which methods are medically appropriate for patients. Counseling should include "patient-friendly terminology that conveys the benefits of these methods," according to Likis.
Third, Likis urges clinicians to make LARC "quickly and easily" accessible for women and have the methods available in their practices "at all times." Clinicians should offer "same-day insertion and avoid unnecessary delays," such as waiting for results from cervical cancer screening tests to come back.
"Few decisions impact a woman's life as much as choosing whether and when to have children," Likis continues, concluding that as 2014 begins, health care providers "should resolve to ensure that [their patients] are well informed about LARC and offer LARC as first-line methods to adolescents and women seeking contraception."