Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey

Emily C Holden, Erica Lai, Sara S Morelli, Donald Alderson, Jay Schulkin, Neko M Castleberry, Peter G McGovern, Emily C Holden, Erica Lai, Sara S Morelli, Donald Alderson, Jay Schulkin, Neko M Castleberry, Peter G McGovern

Abstract

Background: Postpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients.

Methods: We surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery.

Results: There were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period.

Conclusion: The majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.

Keywords: Immediate postpartum long-acting reversible contraception.

Conflict of interest statement

This study was approved by the Rutgers Health Sciences Institutional Review Board (Newark, NJ). Project number: Pro20170000321. It was initially approved on 4/10/17.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participants included in the study. A total of 4 participants who completed the survey were excluded because they did not meet inclusion criteria. CARN Collaborative Ambulatory Research Network. ACOG American College of Obstetrics and Gynecology

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Source: PubMed

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