Policy Changes Helped Increase LARC Use
March 1, 2024 5 minutes read
EXECUTIVE SUMMARY
Long-acting reversible contraception (LARC) use has increased over the past decade, including among adolescents, research shows.
- LARC use more than doubled from 2006 to 2010 and 2015 to 2019, according to the National Survey of Family Growth.
- The most used methods of contraception are the condom, birth control pill, and the withdrawal method.
- About one in four women have used emergency contraception, and one in five women have undergone sterilization.
National health statistics and new research point to increased interest in and use of long-acting reversible contraception (LARC).1-3 One in four women reported using LARC, according to the 2015-2019 National Survey of Family Growth.1
State policies promote LARC use when they allocate Title X funding to intrauterine device (IUD) provision at family planning clinics and invest in more training opportunities, a study shows.2
The American College of Obstetricians and Gynecologists (ACOG) issued a statement about LARC in 2012. The statement may have helped increase LARC initiation, particularly among patients seen by OB/GYNs, says Bianca A. Allison, MD, MPH, lead author of research on this topic and an assistant professor in the department of pediatrics, division of general pediatrics and adolescent medicine at the University of North Carolina School of Medicine in Chapel Hill. “There was an increase in IUD [placement for adolescents] for all providers, and the majority was placed by OB/GYNs,” Allison says.
Allison and colleagues found a decline in implant use among adolescents, although IUD initiation increased.3 (For more information, see the story in this issue on adolescents and same-day LARC use.)
“That was a very unexpected finding because [ACOG’s statement] is trying to increase LARC for everyone, including adolescents,” Allison says. “Our thought was that once pediatricians and providers did counseling for all methods, maybe more young people were electing to get IUDs instead of implants.” Another possibility is that less clinician training was offered for implant placement, she adds.
Usage More Than Doubled
A national survey of all contraception use data shows that LARC use more than doubled from 2006 to 2010 and 2015 to 2019. Overall rates increased from 9.4% to 26.3%. IUD use increased from 7.7% to 21.4%, and use of contraceptive implants rose from 1.9% to 6.3%.1
“The percentage of those who have ever used contraception has not changed from 2006 to 2019 for women ages 15 to 44,” says Kimberly Daniels, PhD, a demographics statistician at the National Center for Health Statistics in Hyattsville, MD. “The National Survey of Family Growth is a household survey of the American population. Women and men are asked to complete a survey and answer questions. This report only uses [information] from the women who participate.”
Based on the most recent data, 99.2% of women in the United States who had ever had sexual intercourse with a male partner used at least one contraceptive method at some point in their life. The most common method was a condom with a male partner, as reported by 94.5% of women in the survey. Next was the birth control pill (79.8%) and withdrawal (65.7%). Nearly 88% of women had ever used a reversible method, such as the birth control pill, an injectable, contraceptive patch, ring, IUD, or implant. The survey also revealed that nearly one in four women had ever used emergency contraception, and about one in five women had undergone sterilization.1 The data show that IUD use is greater than implant use, Daniels says.
Complex Data
The report’s data are complex because the age range surveyed has changed over the past decade. “One of the things I’d be concerned about with age differences is that as individuals [grow] older, they may use more permanent methods of contraception, like a sterilizing procedure,” Daniels notes. This could be a factor that explains some differences in contraceptive data between periods that use different age ranges.
“Most of [the data] is 2015 to 2019 data and ages 15 to 49, but they haven’t always surveyed women from ages 15 to 49,” Daniels explains. “Sometimes, it’s from 15 to 44.”
Many states provide enough support to Title X clinics to ensure access to a full range of contraceptives. But there have been barriers to LARC in states like Alabama, research shows.2
It is an equity and justice issue if LARC is not provided to people who may want this method, says Michael G. Smith, DrPH, MSPH, lead study author and an associate professor in the department of health services management and policy at the East Tennessee State University (ETSU) College of Public Health.
“It is also an equity and justice issue if LARC is provided in a coercive way and pushed on people who don’t want it,” Smith explains. “That’s the balance you have to achieve — making sure they’re available and people can freely choose them without pushing them in a coercive way.”
The problem in Alabama was that LARC was not readily available in programs supported by the Alabama Department of Public Health until some policy changes occurred, Smith and colleagues found.2 The health department demonstrated a big commitment to make sure people of reproductive age in Alabama have access to a full range of contraceptive options, including IUDs. (For more information, see the story in this issue on Alabama’s improvement of LARC access.)
“I think access is improving in Alabama, based on this paper and the work we’ve done with the Alabama Department of Public Health,” says Smith, the program and policy director at the Center for Applied Research and Evaluation in Women’s Health and project director of the Choose Well Evaluation Study at ETSU.
Parental Consent Laws Are a Barrier
An issue affecting young people seeking contraception is state laws that require guardian or parent permission. Title X programs, following federal law, are charged with providing confidential contraceptive care to all patients, including those younger than 18 years of age. However, access for minors remains blocked in some instances because of state actions.
For example, a lawsuit filed in Texas is challenging the federal provision regarding minors seeking contraception. On Dec. 8, 2022, U.S. District Judge Matthew Kacsmaryk issued a decision that the Title X program “violates the constitutional right of parents to direct the upbringing of their children and Texas Family Code.” The decision was appealed. As of Jan. 23, 2024, no decision had been issued by the United States Court of Appeals for the Fifth Circuit.4
States that lose Title X funding also might have barriers to minors obtaining confidential contraception. “One of the federal requirements for Title X is for options counseling, including counseling patients about the option to get an abortion — that’s required for Title X. But abortion bans in Oklahoma and Tennessee prohibit counseling about abortion services since those services are now illegal in those states,” Smith says. “Those states said they could not meet that program requirement anymore, and they lost their Title X funding.”
Although states can fund their own family planning clinics, those clinics are not required — as are Title X clinics — to provide contraceptive access to minors without parental knowledge and approval, Smith notes.
REFERENCES
- Daniels K, Abma JC. Contraceptive methods women have ever used: United States, 2015-2019. Natl Health Stat Report 2023;195:1-18.
- Smith MG, Beatty KE, Khoury AJ, et al. Increases in IUD provision at Alabama Department of Public Health Clinics from 2016 to 2019. J Public Health Manag Pract 2023;29:E176-E180.
- Allison BA, Yates L, Tadikonda A, et al. Single-visit long-acting reversible contraception initiation among adolescents before and during COVID-19. J Adolesc Health 2024;74:367-374.
- Deanda v. Becerra. Dec. 8, 2022. https://law.justia.com/cases/f...
National health statistics and new research point to increased interest in and use of long-acting reversible contraception (LARC). One in four women reported using LARC, according to the 2015-2019 National Survey of Family Growth.
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