Contextualizing barriers to long-acting reversible contraception in Delaware.

Area of Science:

• Reproductive Health
• Public Health Interventions
• Sociology of Health

Background:

• Large-scale initiatives like Delaware Contraceptive Access Now (Del-CAN) aim to reduce barriers to long-acting reversible contraception (LARC).
• Despite program efforts, understanding persistent barriers is crucial for improving contraceptive access.

Purpose of the Study:

• To examine enduring barriers to long-acting reversible contraception (LARC) within a large-scale LARC program (Del-CAN).
• To identify how meso and macro-level contexts influence LARC adoption and continuation.

Main Methods:

• Conducted in-depth interviews with 86 women of reproductive age in Delaware (2016-2017).
• Participants were diverse in age, race, and class.
• Analyzed interview data using an inductive coding process to understand attitudes, beliefs, and behaviors regarding contraception.

Main Results:

• Meso and macro-level factors, including provider-patient communication and clinic structures, reinforce LARC barriers.
• Barriers related to knowledge, access, and side effect management persist despite program interventions.
• Provider autonomy and practice-specific policies also contribute to ongoing challenges.

Conclusions:

• Existing large-scale LARC programs may not fully address nuanced, multi-level contextual barriers.
• Persistent barriers are embedded in provider-patient interactions and clinic policies.
• Future interventions must incorporate strategies to address provider-level and systemic issues for greater success.