Obstetrician-gynecologists may help lower unintended pregnancy rates by increasing access to contraceptive implants and intrauterine devices (IUDs) for patients, according to a Committee Opinion paper issued by The American College of Obstetricians and Gynecologists (ACOG).
ACOG recommends the following in reducing barriers and increasing access to implants and IUDs such as long-acting reversible contraception (LARC) methods:
- For all women at risk of unintended pregnancy, obstetrician–gynecologists should provide counseling on all contraceptive options, including implants and IUDs.
- Encourage consideration of implants and IUDs for all appropriate candidates, including nulliparous women and adolescents.
- Adopt best practices for LARC insertion.
- Advocate for coverage and appropriate payment and reimbursement for every contraceptive method by all payers in all clinically appropriate circumstances.
- Become familiar with and support local, state (including Medicaid), federal, and private programs that improve affordability of all contraceptive methods.
Five LARC devices are currently available: one single-rod etonogestrel implant and four IUDs. In the Contraceptive CHOICE Project clinical trial, patients received a contraceptive method of their choice at no cost after standardized counseling that emphasized method efficacy. Study reports have demonstrated that improved access to and knowledge of LARC methods increases method uptake and may lower unintended pregnancy, abortion, repeat abortion, and adolescent birth rates. Superiority of LARC methods over short-acting methods was also demonstrated in the CHOICE Project with 20 times higher efficacy than oral contraceptive pills, patches or rings. In addition, increased use of LARC methods can reduce rapid repeat pregnancy among adolescents and repeat abortion among women who have had an induced abortion.
ACOG recommends the following best practices for LARC insertion:
- Provide long-acting reversible contraception (LARC) methods the same day as requested, whenever possible, if pregnancy can reasonably be excluded.
- Offer LARC methods at the time of delivery, abortion, or dilation and curettage for miscarriage.
- Screen for sexually transmitted infections at the time of intrauterine device (IUD) insertion; if the screening test result is positive, treat the infection without removal of the IUD.
- Offer the copper IUD as the most effective method of emergency contraception.
For more information visit ACOG.org.