Better Access to Long-Acting Reversible Contraception Depends on Family Physicians

FOR IMMEDIATE RELEASE: Wednesday, January 9, 2019

Contact:
Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224
lchampli@aafp.org 

WASHINGTON, DC — Although the percentage of family physicians who provide long-acting reversible contraception—intrauterine devices or etonogestrel single rod implants—is rising, the trend must grow more quickly if demand for LARC is to be met.

That’s among the conclusions in research by Meenadchi Chelvakumar, a Robert Graham Center visiting scholar alumna and clinical assistant professor of primary care and population health at Stanford University School of Medicine. She published her findings in “LARC Provision by Family Physicians: Low but on the Rise,” in the January-February issue of the Journal of the American Board of Family Medicine.

Chelvakumar and her coauthors looked at data from the 2014 to 2017 ABFM demographic surveys to identify the percentage of family physicians who regularly provide LARC services. They found that, although eight in 10 provide women’s health services, fewer than one in four offer IUDs and implants.

From 2014 to 2017, the percentage of family physicians who regularly provide IUDs expanded to nearly 22 percent, according to the research. The percentage who provide implants grew to almost 14 percent; and the percentage who provide both rose to 11 percent.

The increases, however, will not meet demand for LARC, Chelvakumar and her coauthors write.

“Women in the United States are increasingly opting for LARC with a growth in use from 6 percent of US women in 2008 to 14 percent of US women in 2014,” Chelvakumar writes. “As demand for LARC increases, it is important to ensure that an appropriate primary care workforce is available to provide these services, allowing all patients to have access to these valuable contraceptive methods.”

Unplanned pregnancy can have socioeconomic impacts on women and families. Research has shown unplanned pregnancy and births are associated with delayed prenatal care, premature birth, and negative physical and mental health for children. Women with an unintended pregnancy are more likely to drop out of school and less likely to participate in the workforce.

“Allowing all patients to have access to LARC is important both to reproductive autonomy and to public health as unintended pregnancies result in substantial health risks to the mother and child, significant direct health care costs, and serious long-term social and economic costs to women and families,” Chelvakumar writes.

Increasing training and reducing administrative or payment barriers for family physicians who provide women’s health care can improve access to LARC, she concludes.

“Given that reproductive planning and pregnancy are central to both the physical health and the socioeconomic well-being of women and families, addressing barriers to LARC provision in primary care is important,” she and her coauthors write. “Training and support to increase the fraction of family physicians who deliver LARC services, as well as promotion of policies which aim to create a more amenable practice environment for family physicians to perform gynecological procedures, will ensure the full benefits of this most effective form of contraception are realized, and that patients’ needs are fully met.”