California Family Planning Providers' Challenges to Same Day Long-Acting Reversible Contraception (LARC) Provision

Long-acting reversible contraception (LARC), which includes IUDs and the single-rod contraceptive implant, are highly effective and well-liked by those who use them. Yet, many women face multiple barriers to their use.  The American College of Obstetricians and Gynecologists recommends same-day LARC insertions as a way of reducing barriers for patients seeking contraception.  Little is known about the extent to which providers are able to offer LARC in one visit. In the fall of 2011, 1,000 California family planning providers were surveyed regarding their LARC delivery practices.  Among the 636 responding providers, 72% offered a LARC method onsite. The majority required two or more visits to insert an IUD (58%); half required two visits to insert an implant (50%). In analyses of the minimum number of visits required for LARC provision by provider type, nearly all (95%) Planned Parenthood providers could insert a LARC method at the initial visit, whereas the majority of all other provider types could not.  Reasons for delaying insertions included the need to wait for STI and pregnancy test results (68%), clinic flow and scheduling issues (51%), the need to order the method (29%), and the desire to reduce the time burden on the client at the first visit (10%). Multivariate analyses indicated that provider type is associated with same day LARC provision. Clinic policies may need to address a variety of system and provider barriers to same day LARC insertions in order to better meet the needs of clients and expand access to contraceptive care.