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LONG-ACTING REVERSIBLE CONTRACEPTION Overview of Research & Policy in the United States

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LONG-ACTING REVERSIBLE CONTRACEPTION Overview of Research & Policy in the United States LONG-ACTING REVERSIBLE CONTRACEPTION Overview of Research & Policy in the United States Julia Strasser, MPH Liz Borkowski, MPH Megan Couillard, BS Amy Allina, BA Susan Wood, PhD Bridging the Divide: A Project of the Jacobs Institute of Women’s Health June 2016 CONTENTS INTRODUCTION ................................................................................................................... 1 OVERVIEW OF LARC METHODS ....................................................................................... 2 CURRENT USAGE ........................................................................................................................................... 2 HISTORY OF LARC METHODS IN THE US ...................................................................... 5 IUD HISTORY ................................................................................................................................................ 5 First Generation IUDs: Initial Uptake, Challenges, and Rapid Decline ........................................................ 5 First Generation IUDs: Legacy/Impact on Current Uptake .......................................................................... 7 IMPLANT HISTORY ......................................................................................................................................... 8 First Generation Implant: Initial Uptake, Challenges, and Rapid Decline ..................................................... 8 MECHANISM OF ACTION .................................................................................................. 11 PREGNANCY PREVENTION ........................................................................................................................ 11 IUDS .............................................................................................................................................................. 11 Copper IUD ............................................................................................................................................... 11 Hormonal IUDs ......................................................................................................................................... 13 IMPLANT ........................................................................................................................................................ 14 SAFETY AND EFFICACY OF LARC METHODS .............................................................. 15 IUDS .............................................................................................................................................................. 15 Efficacy ....................................................................................................................................................... 15 Safety .......................................................................................................................................................... 17 Sexually Transmitted Infections and Pelvic Inflammatory Disease ................................................................. 18 Insertion & Removal ................................................................................................................................... 19 Contraindications ........................................................................................................................................ 21 IMPLANT ........................................................................................................................................................ 21 Efficacy ....................................................................................................................................................... 21 Safety .......................................................................................................................................................... 22 Insertion and Removal ................................................................................................................................. 22 POSTPARTUM AND POST-ABORTION LARC METHODS ........................................................................ 22 CLINICAL GUIDELINES FOR LARC METHOD USE ..................................................... 24 QUALITY FAMILY PLANNING (QFP) GUIDELINES ................................................................................. 24 FACTORS AFFECTING LARC USE .................................................................................... 26 WOMEN’S PERSPECTIVES ON LARC METHODS ..................................................................................... 26 FINANCIAL BARRIERS TO LARC METHODS ............................................................................................ 26 WOMEN’S PREFERENCES REGARDING CONTRACEPTIVE CHARACTERISTICS .................................... 28 LARC METHODS AND REPRODUCTIVE INJUSTICE ................................................................................ 29 Policies Targeting Women Receiving Public Assistance or Involved in the Justice System ................................ 30 Individual Actions, Experiences, and Choices .............................................................................................. 30 PROVIDERS AND LARC METHODS ........................................................................................................... 32 Provider Knowledge ...................................................................................................................................... 32 Provider Training ........................................................................................................................................ 32 HEALTH SYSTEM FACTORS AFFECTING LARC PROVISION .................................................................. 33 Same-Day LARC Method Placement ......................................................................................................... 34 REDUCING BARRIERS WHILE PRESERVING AUTONOMY ...................................... 36 RESEARCH ON REDUCING COST AND KNOWLEDGE BARRIERS ........................................................... 38 Iowa Initiative to Reduce Unintended Pregnancies ........................................................................................ 40 Contraceptive CHOICE Project (St. Louis, Missouri) ................................................................................ 41 Colorado Family Planning Initiative ............................................................................................................ 42 Delaware Contraceptive Access Now (CAN) .............................................................................................. 43 CURRENT POLICY ISSUES ................................................................................................ 45 PERFORMANCE MEASURES FOR LARC METHOD USE .......................................................................... 45 PAYMENT POLICY ........................................................................................................................................ 46 Private Insurance ......................................................................................................................................... 46 Medicaid ..................................................................................................................................................... 48 Coverage for Removal ................................................................................................................................... 52 Title X and 340B ....................................................................................................................................... 52 PARENTAL CONSENT POLICIES FOR ADOLESCENTS & CONFIDENTIALITY OF CARE ....................... 53 Private Health Plans and Explanation of Benefits ....................................................................................... 54 FUTURE DIRECTIONS ....................................................................................................... 55 CONCLUSION ................................................................................................................................................ 56 APPENDIX A. TABLES ......................................................................................................... 57 APPENDIX B. LIST OF ACRONYMS ................................................................................. 60 REFERENCES ....................................................................................................................... 61 INTRODUCTION Unintended pregnancy rates in the US – long considered a public health challenge – have recently started to decline, along with abortion and teen pregnancy rates. Recent data suggest that unintended pregnancy rates are at their lowest levels in the last several decades (Finer & Zolna, 2016). Researchers attribute this drop to several different factors, including increased access to and use of more effective methods of contraception. Only 5% of unintended pregnancies occur among consistent users of contraception, while 54% occur due to non-use and 41% to inconsistent use (Sonfield, Hasstedt, & Gold, 2014). Long-acting reversible contraceptive (LARC) methods demonstrate great potential in reducing unintended pregnancy, as they require virtually no user adherence and can therefore contribute to the percentage of consistent contraceptive users. LARC methods include two types of contraceptives: intrauterine
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