Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey

Abstract

BackgroundPostpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients.MethodsWe surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery.ResultsThere were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period.ConclusionThe majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.

Do Expectant Mothers’ Breastfeeding Plans Influence Provider Prenatal Contraceptive Counseling?

“…We sought to compare our findings with the literature on this topic; however, we could not identify any published studies that considered maternal feeding intention as a potential factor affecting prenatal contraceptive counseling. Previously identified barriers to postplacental LARC placement include inadequate device availability; inadequate procedure reimbursement; lack of training to place postpartum IUD, including lack of knowledge regarding correct timing; patient lack of interest; and lack of counseling time (Holden et al, 2018; Moniz et al, 2017; Olson et al, 2018). In this study, we focused specifically on barriers to contraception for breastfeeding mothers, and although participants did not note these issues, they did report multiple other barriers to contraception for breastfeeding mothers, including potential medical issues, patient concerns, and colleague resistance.…”

“…Psychometric properties for the survey are thus not available. Previously reported pertinent domains include personal attitudes and preferences; provider knowledge; logistical barriers, including reimbursement; and influences of colleagues (Holden et al, 2018; Moniz et al, 2017; Olson et al, 2018). Limited demographic information was also obtained from survey participants.…”

“…Low rates of PPV attendance and low uptake of postplacental IUDs among high-risk publicly insured women in the United States and among women in low- and middle-income countries worldwide increase the urgency of understanding barriers to this form of breastfeeding-compatible contraception (Boulet et al, 2016; Cleland, Ali, Benova, & Daniele, 2017; Harney, Dude, & Hader, 2017; Henderson et al, 2016). We and others have considered the possibility that prenatal provider counseling may be an unintentional barrier to uptake of postplacental IUDs, (Holden et al, 2018; Moniz et al, 2017; Olson et al, 2018).…”

“…Prior researchers have focused on provider barriers related to device access, reimbursement, and knowledge and attitudes with respect to postplacental IUD provision but have not considered whether provider contraceptive counseling is influenced by maternal feeding plans (Holden et al, 2018; Moniz et al, 2017; Olson et al, 2018). We aimed to determine if maternal feeding intention is considered by prenatal providers during contraceptive counseling and to identify any provider barriers to provision of postplacental IUDs, specifically among mothers who plan to breastfeed.…”

Protocol for a process evaluation of Family Planning Elevated: a statewide initiative to improve contraceptive access in Utah (USA)

“…[8][9][10][11] While data on the benefits of contraceptive access grows, barriers remain for many individuals who are seeking contraceptive care. [12][13][14][15][16][17][18] An increasing number of contraceptive initiatives have emerged in the USA, each with the goal of removing barriers and improving access. [19][20][21][22][23] While there is considerable variance about the best way to measure success in contraceptive initiatives, 24 25 outcome evidence from several initiatives suggests that their efforts have made an impact 19-23 26-28 which other initiatives may hope to replicate.…”