LARC Now Considered a Top Method to Prevent Unintended Pregnancy

December 19, 2014|3:30 p.m.| Kristen Lewandowski

Studies published this fall in the New England Journal of Medicine and in the nonprofit Guttmacher Institute's Perspectives on Sexual and Reproductive Health have reinforced what many health providers and public health specialists already know: long-acting reversible contraception (LARC) is an excellent method of preventing unintended pregnancy. In the first study, researchers at Washington University School of Medicine in St. Louis tracked 1,400 teenage girls for several years and found lower pregnancy, birth, and abortion rates in girls who were educated about and given access to LARC. The second study discussed Colorado Department of Public Health and Environment's anonymous donor-funded Family Planning Initiative, which provided free or low cost LARC to low-income women across the state and subsequently reported an almost 30 percent drop in births to low-income teens, among other successes. 

The National Campaign to Prevent Teen and Unintended Pregnancy (the National Campaign) estimates that 30 percent of girls will become pregnant before age 20, a number that jumps to 50 percent for African American or Latina teens, and lists the 2010 public cost of teen pregnancy at $9.4 billion. Further, the National Campaign reports that half of all pregnancies in the United States are unplanned (the number rises to 70 percent among unmarried women in their twenties).

Ellen Pliska, ASTHO's director for family and child health, says that unplanned pregnancies can have negative consequences for both women and children, making LARC an important public health tool.

"Unintended or mistimed pregnancies are associated with increased risks for poor health outcomes for both the mother and the baby, including delayed access to prenatal care, preterm birth, and other negative physical and mental health effects," Pliska says. "Given the large unintended pregnancy rate, particularly among teens, highly effective contraception that doesn't require the user to remember to take it or take it correctly…is critical."

LARC, which is available either as a contraceptive implant or in multiple forms as an intrauterine device, is praised for its low long-term cost, safety, and complete reversibility once removed. While it doesn't guard against sexually transmitted infections, LARC is considered more effective at preventing pregnancy than any other birth control method except abstinence, and some forms of LARC are effective for up to 10 years. The American Congress of Obstetricians and Gynecologists states that LARC should be the first-line contraceptive recommendation for women and sexually active adolescents. ASTHO provides a LARC fact sheet and other resources for patients and providers on its LARC website.

Despite its efficacy, many girls and women are either unaware of LARC's benefits or unable to pay the high upfront cost, which can range from $400 to $1,000 (not including fees for insertion or removal at a doctor's office) for uninsured or underinsured women. In addition, not all health providers are familiar with LARC.

"While the Affordable Care Act mandates that approved prescription contraception be covered at 100 percent, not all insurance plans comply, and stocking LARC can be difficult for providers and facilities due to the reimbursement process," Pliska says. "Providers may also feel less confident in placing devices or have misperceptions about LARC and may not recommend them, and patients often don't know about the effectiveness and safety of LARC."

Dr. Larry Wolk, Executive Director and Chief Medical Officer of the Colorado Department of Public Health and the Environment, attributes Colorado's Family Planning Initiative success in part to its private donor support.

"The funding we received allowed us to remove all barriers, ranging from cost to training and education for both patients and healthcare providers," Wolk says. "Once those barriers are removed, LARC [can] become as ubiquitous as other forms of less expensive and potentially more accessible birth control, but without the potential for failure as a result of human error."Once those barriers are removed, LARC [can] become as ubiquitous as other forms of less expensive and potentially more accessible birth control, but without the potential for failure as a result of human error.

Spurred by Colorado's success, other states are beginning to find ways to incorporate LARC into their maternal and child health programs. New York state and local health officials have announced a commitment to make LARC more accessible to women statewide, especially immediately postpartum, where research has shown LARC use to be extremely effective at preventing future unintended pregnancy. ASTHO established a multistate LARC learning community to help identify opportunities, challenges, and technical assistance needs to improve states' ability to implement LARC, particularly immediately postpartum.

To learn more about reproductive health and ASTHO's LARC Learning Community, see ASTHO's Maternal and Child Health website, view our LARC Fact Sheet, and check out our LARC provider education resources.