What avenues will raise LARC method awareness?
What avenues will raise LARC method awareness?
EXECUTIVE SUMMARY
Findings from a new community-based research study indicate using social networks and peer education might be a way to increase acceptance of long-acting reversible contraception (LARC) among low-income women.
• Use of intrauterine devices (IUDs) and the contraceptive implant in the United States is among the lowest of any developed country. Intrauterine and implant contraceptive methods are used by 15% of contraceptors worldwide.
• Many of the women surveyed in the study were unsure if IUDs were safe (59%) or effective (64%). Almost half (45%) were aware of implants, yet most reported not knowing how long they lasted (90%) or if they were safe (72%) or effective.
Findings from a new community-based research study indicate using social networks and peer education might be a way to increase acceptance of long-acting reversible contraception (LARC) among low-income women.1
Use of intrauterine devices (IUDs) and the contraceptive implant in the United States is among the lowest of any developed country.2,3 Intrauterine and implant contraceptive methods are used by 15% of contraceptors worldwide, including 11% in Great Britain, 23% in France, 27% in Norway, and 41% in China. Most of those contraceptors rely on the IUD.4
Charlene Collier, MD, MPH, a Robert Wood Johnson Foundation Clinical Scholar at Yale University in New Haven, CT, and fellow investigators developed and administered a survey given to urban women with family incomes below 200% of the federal poverty level. They distributed the survey at outdoor health fairs, local beauty salons, and bus stops. Along with community partner New Haven Healthy Start, a nonprofit agency aimed at reducing infant mortality and morbidity, the team recruited 200 women, with an average age of 27, to take the survey. The survey assessed women’s contraceptive experience, reproductive intentions, and LARC awareness, knowledge, and interest. Of the women, 39% were black, 40% were Hispanic, and 14% were white.
More than half (54%) of study participants were current contraceptive users, and 39% reported not desiring pregnancy within five years. Sixty-three percent were aware of IUDs, and 37% knew how long an IUD could be used; however, many were unsure if IUDs were safe (59%) or effective (64%). Almost half (45%) were aware of implants, yet most reported not knowing how long they lasted (90%) or if they were safe (72%) or effective (77%).
Among women aware of IUDs, about one-fifth (21%) said they could consider using one. Interest in using an IUD was associated with having a friend who had one, as well as wanting to delay pregnancy for two to five years. Among women aware of implants, 18% said they would consider using one. Implant interest was associated with Hispanic ethnicity and having a friend with an implant.
Researchers hope the survey findings will promote efforts to dispel misinformation and increase education about these highly effective forms of birth control. Many of the responses centered on fear of side effects, Collier noted in a press statement issued with the findings’ presentation. Information needs to reach women about misconceptions that LARC methods cause cancer or infertility, she stated.
Get out the message
Providers need to dispel common myths about IUDs, agrees Jeffrey Peipert, MD, MPH, MHA, Robert J. Perry professor of obstetrics and gynecology and vice chair for clinical research at Washington University School of Medicine in St. Louis. Peipert spoke on the importance of LARC methods at the 2013 Contraceptive Technology conferences.5 Peipert and colleagues at the Washington University School of Medicine evaluated the use of IUDs and other reversible birth control methods in the Contraceptive CHOICE project in St. Louis. (To read more the CHOICE project, see the Contraceptive Technology Update article, "More women moving to LARC methods — Will your facility follow the trend? April 2013, p. 37, and "The Get It and Forget It’ methods are here: Remove obstacles to use, April 2012, p. 37.)
Emphasize the following facts about IUDs, says Peipert. They
- do NOT cause pelvic infection;
- are NOT abortifacients;
- do NOT decrease the likelihood of future pregnancies;
- do NOT cause ectopic pregnancies;
- do NOT cause cancer.5
To survey knowledge and attitudes about intrauterine contraception among reproductive-aged women in the St. Louis area, CHOICE researchers mailed an eight-page survey to 12,500 randomly selected households in the area. Just half of women surveyed said they believed intrauterine contraception was safe. About 11-36% of respondents indicated concerns that intrauterine contraception is associated with complications such as infection, infertility, and cancer. More than one-half (61%) underestimated its effectiveness.6
LARC methods are the most effective contraceptive options, noted Peipert at the conference. They are forgettable and not dependent on compliance or adherence. In the CHOICE Project, LARC methods were first-line, and all contraceptive methods were free, Peipert noted. Research published by the CHOICE Project investigators shows that the effectiveness of LARC is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women.7
The policy implications lie in LARC methods’ cost-savings, said Peipert. Use of LARC methods reduces unintended pregnancies, he stated.
REFERENCES
1. Collier C. Long-acting reversible contraceptive use among urban, low-income women. Presented at the 61st annual clinical meeting of the American College of Obstetricians and Gynecologists. New Orleans, May 2013.
2. Clifton D, Kaneda T, Ashford L. Family planning worldwide 2008 data sheet. Washington, DC: Population Reference Bureau; 2008.
3. Hubacher D. The checkered history and bright future of intrauterine contraception in the United States. Perspect Sex Reprod Health 2002; 34(2):98-103.
4. United Nations — Department of Economic and Social Information and Policy Analysis. World Contraceptive Use 2011. Geneva; 2011.
5. Peipert JF. The importance of long-acting reversible contraception. Presented at the Contraceptive Technology conferences. San Francisco, March 2013; Washington, DC, April 2013.
6. Hladky KJ, Allsworth JE, Madden T, et al. Women’s knowledge about intrauterine contraception. Obstet Gynecol 2011; 117(1):48-54.
7. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012; 366(21):1,998-2,007.
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