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Patient Barriers to Discontinuing Long-Acting Reversible Contraception.

Kacie R Fox¹, Alyssa M Kameoka², Shandhini Raidoo¹

¹Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA.

Maternal and Child Health Journal

|December 29, 2023

Summary

Barriers to discontinuing long-acting reversible contraception (LARC) are common, affecting 26% of patients. These obstacles are often provider- or system-related and disproportionately impact certain demographic groups.

Keywords:

Contraception Discontinuation Implant Intrauterine device Reproductive autonomy Reproductive justice

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Area of Science:

Reproductive Health
Contraception Access
Healthcare Barriers

Background:

Long-acting reversible contraception (LARC) is a highly effective method of birth control.
Patient-centered care necessitates understanding and addressing barriers to contraceptive method discontinuation.
Previous research has not fully elucidated the frequency and nature of barriers encountered when discontinuing LARC.

Purpose of the Study:

To determine the prevalence of barriers experienced by individuals attempting to discontinue LARC.
To identify demographic factors associated with experiencing barriers to LARC discontinuation.
To characterize the types of barriers encountered during LARC discontinuation.

Main Methods:

An online survey was administered to 376 individuals aged 18-50 in the U.S. who had used and discontinued or attempted to discontinue LARC.
Respondents recruited via Amazon MTurk provided demographic data and detailed experiences with LARC removal.
Analysis included calculating the frequency of barrier types and comparing their occurrence across demographic groups.

Main Results:

Approximately 26% (99 out of 376) of surveyed individuals reported at least one barrier to LARC removal.
Barriers were more frequently reported by individuals with public health insurance, a history of abortion, or a history of childbirth.
Disproportionate reporting of barriers was also observed among individuals identifying as Latinx, Asian, or Middle Eastern.

Conclusions:

A significant portion of patients face barriers when attempting to discontinue LARC, indicating a common issue in reproductive healthcare.
These discontinuation barriers are frequently provider- or system-driven, suggesting opportunities for intervention.
Healthcare providers should critically examine their counseling and clinical practices to mitigate potential biases contributing to LARC discontinuation barriers.