Help college-age women plan forward with LARCs
Results of a recent national survey indicate about half of women ages 18-25 identified personal goals they want to achieve before having children.1Long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and the contraceptive implant, can help young women achieve their goals.
Case in point: In a national survey of 700 women sponsored by the manufacturer of the contraceptive implant, Nexplanon [Merck & Co., Whitehouse Station, NJ], about half of women ages 18-25 (228 out of 466 women who said they are not planning to have children in the next year, or at all) want to achieve their personal goals before having children.
Contraceptive methods are tools to help meet life goals and are not a goal in and of themselves, says Linda Dominguez, NP, a nurse practitioner at Southwest Women’s Health in Albuquerque and chairperson of the Association of Reproductive Health Professionals. When clinicians are solely focused on a "prescriptive approach," they overlook the opportunity to engage the woman and her partner in exploring present and future life planning, she notes. A patient’s personal, educational, financial, and relationship goals are fundamental motivators and milestones; ideally, her contraceptive method should support those goals, states Dominguez.
"Often clinicians avoid asking personal’ questions that are not of a purely clinical nature," observes Dominguez. "But in sexual and reproductive health, it is imperative to discuss and explore life goals and the contraceptive choices that can help to meet those landmarks."
Finding a safe, effective contraceptive method for young women is key; about half of all pregnancies are unintended;2women ages 18-19 and 20-24 have the highest rates of unintended pregnancies.3
With 43% of unintended pregnancies stemming from incorrect or inconsistent contraceptive use,4long-acting reversible methods could help women achieve their contraceptive and personal goals. While use of LARC methods is growing, overall use remains low: about 9%.5
Young women need accurate information on LARC methods. Data indicates between 50% and 60% of young women have never heard of the IUD,6-9while more than 90% have no knowledge about implants.7
Incorporating young women’s perspectives on LARC methods into family planning facilities’ efforts to provide these methods to a younger population might increase their use among young women, notes a recent study of provider and patient perspectives on long-acting methods.10
Get ready to see data on LARC methods from a large cluster randomized trial conducted by the University of California, San Francisco (UCSF) Bixby Center for Global Reproductive Health.
Trial looks at impact of LARC training
To explore ways to improve LARC access, the center recently concluded the UCSF and Planned Parenthood National Trial of Contraceptive Acceptability. Working in partnership with 40 Planned Parenthood health centers, the trial tested the impact of a clinic-wide training about LARC. The training included information geared for health educators, clinicians, front-desk staff, clinic managers, and billing experts, says lead investigator Cynthia Harper, PhD, associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UCSF School of Medicine and faculty member of the Bixby Center. Twenty Planned Parenthood health centers received the training intervention, and twenty control Planned Parenthood health centers offered standard care, she states.
The Planned Parenthood health centers enrolled clients ages 18-25 who received contraceptive counseling for one year of follow-up. The study had 500 participating staff and 1,500 participating patients; its 12-month follow-up rate for clients was 84%. Planned Parenthood health centers also collected service statistics for more than 200,000 annual female contraceptive clients.
Scientists are analyzing the data, and research will be presented later this year, says Harper. The research questions will compare outcomes in intervention versus control health centers, and they will focus on such questions as:
- What proportion of clients selected LARC versus other contraceptive methods?
- What proportion of clients continued to use their selected contraceptive after one year?
- What was the client rate of unintended pregnancy at one year?
- Are there differences in provider LARC knowledge, attitudes, or practices?
The trial’s objective is aimed at helping women have increased access to LARC methods in the United States, especially women who are at the highest risk of unintended pregnancy, says Harper. College-age women are an important age group, because they have many years during which they don’t want to get pregnant. Providers traditionally have not been talking to these women about LARC methods, she notes.
"We are trying to teach [providers] that a much wider set of women can use IUDs and implants," says Harper.
- Merck & Co. Merck and Her Campus ask college-aged women to take the pledge to plan it forward for their futures by evaluating how today’s decisions can affect tomorrow. Press release. Accessed at http://bit.ly/16IDTPW.
- Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States,1994 and 2001. Perspect Sex Reprod Health 2006; 38(2):90-96.
- Finer LB. Unintended pregnancy among U.S. adolescents: Accounting for sexual activity. J Adolesc Health 2010; 47(3):312-314.
- Frost JJ, Darroch JE, Remez L. Improving contraceptive use in the United States. New York: Guttmacher Institute; 2008.
- Finer LB, Jerman J, Kavanaugh ML. Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertil Steril 2012; 98(4):893-897.
- Fleming KL, Sokoloff A, Raine TR. Attitudes and beliefs about the intrauterine device among teenagers and young women. Contraception 2010; 82(2):178-182.
- Spies EL, Askelson NM, Gelman E, et al. Young women’s knowledge, attitudes, and behaviors related to long-acting reversible contraceptives. Womens Health Issues 2010; 20(6):394-399.
- Stanwood NL, Bradley KA. Young pregnant women’s knowledge of modern intrauterine devices. Obstet Gynecol 2006; 108(6):1,417-1,422.
- Whitaker AK, Johnson LM, Harwood B, et al. Adolescent and young adult women’s knowledge of and attitudes toward the intrauterine device. Contraception 2008; 78(3):211-217.
- Kavanaugh ML, Frohwirth L, Jerman J, et al. Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives. J Pediatr Adolesc Gynecol 2013; 26(2):86-95.