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Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical

Aliye Runyan1, Robert A Welch2, Katherine J Kramer3

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Access to Long-Acting Reversible Contraception (LARC) is crucial for preventing unintended pregnancies. This study found significant delays and barriers to LARC access, impacting patient choice and retention.

Keywords:
LARC placement delaysinner-city clinicintrauterine devicelong-acting reversible contraceptionremoval rates

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Area of Science:

  • Reproductive Health
  • Contraception Research
  • Public Health

Background:

  • Long-Acting Reversible Contraception (LARC) offers effective pregnancy prevention.
  • Accessibility of desired LARC methods is key to reducing unintended pregnancies.
  • Inner-city populations face unique challenges in accessing healthcare services.

Purpose of the Study:

  • To evaluate access to Long-Acting Reversible Contraception (LARC) in an inner-city patient population.
  • To identify barriers and delays in LARC placement.
  • To analyze factors influencing LARC method choice and early removal.

Main Methods:

  • Retrospective electronic chart review of women desiring LARC placement.
  • Analysis of 311 LARC insertions over a one-year period.
  • Examination of reasons for delays, method preferences, and early removal.

Main Results:

  • 38% of patients experienced delays in LARC placement, averaging 5 weeks.
  • Provider absence, pending cultures, and Mirena availability were key barriers.
  • Teenagers favored Nexplanon, while older women preferred Mirena; early removal rates differed by race and age.

Conclusions:

  • Barriers to LARC access, including provider availability and method stockouts, require intervention.
  • Understanding demographic differences in LARC use and removal is essential for targeted strategies.
  • Addressing side effects and improving access are critical for effective LARC utilization in urban settings.