Access to Removal of Long-acting Reversible Contraceptive Methods Is an Essential Component of High-Quality Contraceptive Care

Strasser, Julia; Borkowski, Liz; Couillard, Megan; Allina, Amy; Wood, Susan F.

doi:10.1016/j.whi.2017.04.003

Cited by 30 publications

(29 citation statements)

References 12 publications

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“…Several women in our study reported that they did not want or choose immediate postpartum LARC because they did not like that they cannot remove the device themselves. Some women may encounter challenges to getting a LARC device removed when they desire, including resistance from providers and cost barriers [21]. Although Georgia Medicaid does not have any policies that may add barriers to LARC removal the way a few other states do [22], 41% of the women in our study were uninsured by the time of the interview.…”

Section: Discussionmentioning

confidence: 99%

Women’s informed choice and satisfaction with immediate postpartum long-acting reversible contraception in Georgia

DeSisto

Handler

Haider

et al. 2018

Contracept Reprod Med

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BackgroundSeveral state Medicaid agencies have recently started reimbursing for long-acting reversible contraception (LARC) placement immediately postpartum. Women’s perspectives are critical for ensuring that this change increases access to LARC while empowering women to choose the method and timing of contraception that best meets their needs. We conducted a pilot study in Georgia, which recently changed its Medicaid reimbursement policy, to assess women’s informed choice and satisfaction with immediate postpartum LARC.MethodsWe sampled all women with a live birth paid for by Georgia Medicaid during November 2015 through February 2017 who received an immediate postpartum LARC. We then used a one-to-one match to sample women who did not receive immediate postpartum LARC. Women were contacted via telephone for a 25–30 min interview regarding their knowledge, attitudes, and behaviors related to immediate postpartum LARC and their satisfaction with postpartum contraception. We calculated descriptive statistics and components of informed choice overall and by receipt of immediate postpartum LARC, using chi-square tests to calculate differences by group.ResultsWe approached 470 women and completed interviews with 51; 25 (49%) received immediate postpartum LARC (24 implants, 1 intrauterine device). Two-thirds reported their provider discussed the option of receiving immediate postpartum LARC during prenatal care, with over 90% reporting they received all the information they needed to make a decision. Most women believed the ideal time to begin using birth control postpartum is in the hospital immediately after delivery, although this differed significantly by women’s receipt of immediate postpartum LARC. Most women who received immediate postpartum LARC reported they are very or extremely happy with their device, although 40% also reported wanting their device removed at some point.ConclusionsWomen on Medicaid in Georgia report making informed choices regarding immediate postpartum LARC. Among those who received immediate postpartum LARC, women report high levels of satisfaction.

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Section: Discussionmentioning

confidence: 99%

Women’s informed choice and satisfaction with immediate postpartum long-acting reversible contraception in Georgia

DeSisto

Handler

Haider

et al. 2018

Contracept Reprod Med

View full text Add to dashboard Cite

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“…Risks associated with insertion are low and similar to those at interval insertion, including perforation, infection, and vaginal bleeding . Although a higher risk of expulsion exists, this may be mitigated with access to built‐in or affordable removal or replacement services . Table includes elements of a targeted history for any woman considering an immediate postpartum IUD insertion to help explore her risk tolerance, abilities, and barriers.…”

Section: Shared Decision Making and Mitigating Coercionmentioning

confidence: 99%

“…A Cochrane review found that despite a higher rate of expulsion (20%‐27% of women expelled the device) for immediate postpartum insertion compared with 0% to 4.4% for interval insertion, continued long‐term use among those with postpartum insertion was similar to or greater than those women who had interval insertion . Rates of continued use are higher still when women have access to replacement or removal services beyond the postpartum period, which can correct for expelled or malpositioned devices …”

Section: Shared Decision Making and Mitigating Coercionmentioning

confidence: 99%

Immediate Postpartum Contraception: Intrauterine Device Insertion

Escobar

Shearin

2019

J Midwife Womens Health

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Insertion of an intrauterine device (IUD) in the immediate postpartum period is a safe, evidence-based form of contraception appropriate for most women. Despite the higher risk of expulsion as compared with interval insertion, the benefits of insertion in the immediate postpartum period are significant and include improved rates of contraception continuance and reduced instances of short interval birth. Through shared decision making, midwives and other clinicians can assist women in clarifying their reproductive goals and understanding of contraceptive options, including this method. In response to identified gaps in knowledge and insertion technique among midwives, this article provides an overview of immediate postpartum IUD insertion, risks and benefits, and eligibility criteria and describes preinsertion, insertion, and postinsertion care.

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“…First, acknowledging that not all women desire a planned or well-timed pregnancy29 30 (or even, any pregnancy at all) is essential. Supporting women’s contraceptive decisions (to not use LARC, or requesting early removal, for example), is essential to providing high-quality contraceptive care31 and reproductive autonomy 32. Further, these findings contribute to the growing body of work that highlights the inadequacy of dichotomous conceptualisations of pregnancy as either intended or unintended in capturing women’s actual reproductive experiences (see for example30).…”

Section: Discussionmentioning

confidence: 89%

Accidentally-on-purpose: findings from a qualitative study exploring pregnancy intention and long-acting reversible contraceptive use

Coombe

Harris

Loxton

2018

BMJ Sex Reprod Health

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Access to Removal of Long-acting Reversible Contraceptive Methods Is an Essential Component of High-Quality Contraceptive Care

Abstract: Her interests include reproductive health, safety net services, and public financing.

Cited by 30 publications

References 12 publications

Women’s informed choice and satisfaction with immediate postpartum long-acting reversible contraception in Georgia

Women’s informed choice and satisfaction with immediate postpartum long-acting reversible contraception in Georgia

Immediate Postpartum Contraception: Intrauterine Device Insertion

Accidentally-on-purpose: findings from a qualitative study exploring pregnancy intention and long-acting reversible contraceptive use

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