How many visits does it take to provide long-acting reversible contraception (LARC)? provider perspectives from Colorado and Iowa

Although long-acting, reversible contraception (LARC), such as the IUD or implant, are among the most effective, cost-effective, and convenient methods for preventing unwanted pregnancy, use of LARC is quite low in the U.S. compared to other methods. Persistent barriers to LARC provision include method cost, patient and provider attitudes, and provider experience with insertion and removal, as well as clinic protocols, such as requiring multiple clinic visits for device insertion. To improve knowledge, acceptance, and utilization of LARC, grantees in Colorado and Iowa received dedicated funding to train providers, advertise LARC methods, and provide subsidized devices. Evaluators collected data from clinicians and clinic directors at 44 sites, through online surveys and in-depth telephone interviews, to identify successes and challenges in providing LARC. Quantitative data were analyzed using STATA, and qualitative data were analyzed using a grounded theory approach. Nearly all agencies offered different LARC methods onsite (94% implant, 91% Mirena IUD, 91% ParaGard IUD), and approximately one-third of agencies offered same day LARC insertions (33% IUD, 39% implant). Clinic directors highlighted ongoing barriers to same day provision, including concerns about patient decision-making, protocols for STI and pregnancy testing, and referrals to other providers. Multivariate analyses indicate that both agency level characteristics, such as being a Title X provider and having a laboratory onsite, and individual clinician characteristics, such as years of experience and professional training, may impact same day provision. Clinic policies should address barriers to same day insertion of LARC methods, in order to improve the provision of LARC.