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Jennifer Neilsen, Burt Littman Commented on a Post
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Uncovering Issues in Long-Term Contraception

Barriers to LARC implementation include deficits in healthcare provider (HCP) education and training. Insufficient education on the latest practice guidelines contributes to fewer correctly identified women who are eligible for LARC. Providers who lack training in the insertion and removal of these devices may not suggest LARCs as a first-line method and must refer patients to other HCPs for LARC provision. Referring candidates causes delays in care, access, and the establishment of trust towards providers. Surveys and interviews with women accentuate a lack of information regarding the accessibility of LARCs as well as concerns pertaining to the procedures required and possible side effects.

  1. Do you have patients who reject LARCs because of the procedure?
  2. How important is it to recommend a birth control that fits into a women’s lifestyle?
  3. What alternative birth control options are recommended when a patient rejects a LARC, and why are these recommended?

• Bahamondes, Luis, et al. "Long-acting reversible contraceptive (LARCs) methods." Best Practice & Research Clinical Obstetrics & Gynaecology (2019).
• Baron, Melyssa, Beth Potter, and Sarina Schrager. "A review of long-acting reversible contraception methods and barriers to their use." WMJ 117.4 (2018): 156-159.
• Beshar, Isabel, et al. "Socioeconomic differences persist in use of permanent vs long-acting reversible contraception: An analysis of the National Survey of Family Growth, 2006 to 2010 vs 2015 to 2017." Contraception 103.4 (2021): 246-254.
• Festin, Mario Philip R. "Overview of modern contraception." Best Practice & Research Clinical Obstetrics & Gynaecology (2020).
• Phillips, Jessamyn, and Prabjot Sandhu. "Barriers to implementation of long-acting reversible contraception: A systematic review." Journal of the American Association of Nurse Practitioners 30.4 (2018): 236-243.
• Strasser, Julia, et al. "Bridging the Divide White Paper: Long-Acting Reversible Contraception (LARC) in the United States." (2016).

  • 2 weeks 1 day
    Most of my patients do not avoid IUDs due to procedure related concerns unless they have had a personal or friend/family member who had an embedded or perforated IUD in the past. In this population, I do not try to change their minds. Nuvaring (and now Anovera where covered) and the patch are alternatives for those without contraindications to estrogen. I have not had women reject Nexplanon due to fear of placement. My biggest barrier to getting women devices has been the hospital not paying for postplacental IUDs and inpatient Nexplanons for postpartum patients. I also use ocps in those who are interested and advise them to set an alarm on their phone if they cannot remember to take it at the same time as some habitual activity like brushing teeth. I think it is critical to have contraception that fits a woman's lifestyle as half of US pregnancies are unintended. There is not an easy out once pregnant. Adoption, parenting and abortion can all have long term impact on an individual's life.
  • 2 weeks 1 day
    I do provide an overview of all contraceptive methods to women who are just starting or looking for a new birth control option. With regard to LARC, patients using injectables or implants have generally not been happy with the side effects and have often requested early discontinuation. For this reason, I am not a strong advocate of these methods. I also have a low acceptance rate for IUDs, which I do favor, because of various concerns, I.e. they don't want to carry a device in their uterus, fear of pain during placement, worries about side effects, etc. I really don't understand how to fit a contraceptive choice into a woman's lifestyle per se, or even what that means. Most women generally want oral contraceptives because that is what they are familiar with and what their friends and family use. For those who cannot manage a daily pill intake, contraceptive rings and the new contraceptive patch are reasonable alternatives.
  • 2 weeks 2 days
    I personally have very few women who want a LARC and don’t get for procedure related concerns - especially with IUDs I am willing to prescribe an anxiolytic and do a paracervical block for my patients who are concerned about pain. For those who can’t tolerate a pelvic, nexplanon is an option. If a LARC is not right for a woman or she rejects it, we talk salpingectomy if childbearing complete or short term if not.