New develoment: More women report making the move to LARC

Over 80% report increase in LARC method use

While pills remain a popular birth control choice, more women are selecting long-acting reversible contraception (LARC), say respondents to the 2011 Contraceptive Technology Update Contraception Survey. More than 80% of respondents say they have seen an increase in LARC methods.

LARC, or "get it and forget it" methods, include the contraceptive implant (Implanon, now followed by Nexplanon, Merck & Co. of Whitehouse Station, NJ), and the two intrauterine devices (IUDs), the copper T380A (ParaGard IUD, Teva North America, North Wales, PA) and the levonorgestrel intrauterine contraceptive (Mirena, Bayer HealthCare Pharmaceuticals, Wayne, NJ).

Patricia McKenzie, NP, director of women's health at Waianae Comprehensive Health Center, Waianae, HI, reports a "huge" increase in LARC method use following Title X funding specifically for IUD and contraceptive implant purchase. "More importantly, all providers were precepted in insertion, removal, and problems with LARC, so provider comfort was great," she notes.

The initial results from the St. Louis Contraceptive Choice Program might be inspiring clinicians to do more with LARC methods. The project enrolled 9,256 women in four years, with the last woman enrolled in September 2011. Three-quarters of all women enrolled chose a LARC method; more than 40% of young women ages 14-17 (93 out 148) chose the implant, and more than 40% of young women ages 18-20 (364 out of 510) chose an IUD. Among those who chose a LARC method, 86% were still using their method at one year, compared to 55% of women who chose non-long-acting methods.1

Word of mouth ups use

What is leading to the increase in LARC method use? Some clinicians say it's coming from recommendations from current users of such options.

Donna Gray, NP, a nurse practitioner at Wyoming County Health Department in Silver Springs, NY, says, "A lot of clients are hearing from other friends that are using these long-term methods and love them, so now they come in to get one of them. They find out how convenient they are — not to have to do anything on a daily basis or a schedule."

Clinicians at the STD/Family Planning Clinic at the Skagit County Health Department in Mount Vernon, WA, talk about all methods at the initial visit, notes Cathy Smith, ARNP, a family nurse practitioner and clinician at the facility. Many patients who hear about LARC methods for the first time are attracted by the idea of three or five years of contraception with minimal effort, she states.

Marlene Carver, NP-C, a nurse practitioner at Graham County Department of Public Health in Robbinsville, NC, agrees. "I think our clients are more educated about all the methods that are available to them now," Carver says. Education, availability, the introduction of Implanon, and decreased fears about IUDs have contributed to the uptick in use at Carver's facility, she states.

Jacquelyne Bodden, RN, MS, WHNP-BC, program director and nurse practitioner at SWCAP (Southwest Wisconsin Community Action Program) Reproductive Health Care Center in Platteville, WI, says, "When you have a couple of patients satisfied with a method, they tell their friends, and then their friends will want to try the method. That is how we finally got women trying Implanon, and now it is our most popular long-term method."

Smith agrees. Implanon insertion rates at her facility are going up, and most women requesting it have a friend or know someone who has the method and is happy with it, she reports.

Comfort level rises

The myth that nulliparous women cannot use intrauterine contraception might finally be banished. Both the World Health Organization and the Centers for Disease Control and Prevention consider the IUD an acceptable choice for women who have not had a baby.2,3

Sharon Carlisle, CNM, lead clinician at Planned Parenthood of Southwest and Central Florida in Tampa, FL, sees her own increased comfort level with insertion in nulliparous women as one of the reasons use of LARC methods has moved up in her practice. Another factor? The realization that IUD insertion takes only slightly more time than an annual well-woman exam and easily can be worked into an already busy schedule, she states.

Celest Horst, LPN, clinic manager at Hastings Family Planning in Hastings, NE, says, "I think what has led to the increase is that now we talk to patients who are nulliparous more about using IUDs. Before, we were only offering it to women who have had children."

Clinicians at Comprecare Clinic in San Jose, CA, have seen an increase in long-term methods such as the IUD with some patients, especially after pregnancy when contraception is desired for a longer length of time, notes Lisa Friedrichs-Sherard, NP, an obstetrics and gynecology nurse practitioner at the San Jose facility. A small portion of patients also is interested in trying Implanon, she notes.

Note cost-effectiveness

While LARC methods might have higher initiation costs than pills, they are tops in cost-effectiveness. By five years of use, IUDs and the contraceptive implant are the two most cost-effective methods of reversible contraception.4

The Charlotte, NC-based Arch Foundation (www.archfoundation.com) is a not-for-profit foundation established to assist low-income patients who do not have insurance coverage for the Mirena IUD. Patients who meet specific eligibility criteria might be able to receive the Mirena device free of charge. The ParaGard Patient Assistance Program also offers assistance to patients who meet certain eligibility criteria to receive the Copper T IUD free of charge. (To download a brochure on the program, go to www.paragard.com, and click on "Healthcare Providers," "HCP Resources," and "Patient Assistance Program Brochure.")

Eighty-five percent of patients at Planned Parenthood of Southwest and Central Florida pay full price for intrauterine contraception, says Carlisle. Thanks to the generosity of the Arch Foundation and the ParaGard Assistance Program, the remaining percentage who cannot afford them are recipients of free Mirenas or ParaGards, she states.

Some women who are losing insurance coverage come in to Wyoming County Health Department in Silver Springs, NY, to have Mirenas inserted so they don't have to worry about getting any birth control when their insurance runs out, says Gray. Most insurance policies will cover long-term methods, says Gray. Patients also like that a LARC method saves them from going to the drug store every month or worrying about refills should they be out of the country.

"Several younger clients have more serious plans for the future, like college, and don't want a child for a while, so they are using these methods," observes Gray.

References

  1. Mestad R, Secura G, Allsworth JE, et al. Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception 2011; 84:493-498.
  2. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Fourth ed. Geneva: WHO; 2009.
  3. Centers for Disease Control and Prevention. US medical eligibility criteria for contraceptive use, 2010. MMWR Early Release 2010;59:1-86.
  4. Chiou CF, Trussell J, Reyes E, et al. Economic analysis of contraceptives for women. Contraception 2003; 68:3-10.