Long-acting reversible contraception access
Local governments can invest in this strategy using State and Local Fiscal Recovery Funds (SLFRF) from the American Rescue Plan Act (ARPA).
- This strategy can help residents access health services. The U.S. Department of Treasury has indicated that strategies that help achieve this outcome are eligible for the use of Fiscal Recovery Funds.
- Investments in this strategy are SLFRF-eligible as long as they are made in qualified census tracts or are designed to assist populations or communities disproportionately impacted by COVID-19.
Program overview
Access to highly effective contraceptives: Long-acting reversible contraceptives (LARCs) are the most effective form of birth control. Access to LARCs is associated with an increase in contraceptive use and a reduction in teen pregnancy and unwanted pregnancy.
Options for patients: The two most common types of LARCs are intrauterine devices (IUDs) and contraceptive hormonal implants. IUDs are small, T-shaped devices that are inserted into the uterus. Implants are thin, matchstick-sized plastic rods that are inserted into the skin of the upper arm. There are a range of different options available within each of these categories, varying in terms of whether they use hormones, which hormones and dosages are used, and length of efficacy.
Low-maintenance, long-term birth control: LARCs provide highly (>99%) effective birth control that lasts 3-10 years without any ongoing action required from patients. This method can be used safely by both teens and adults, regardless of whether they have previously given birth, and can be removed at any time at the patient’s discretion.
Inserted and removed in a range of clinical settings: The short insertion and removal procedure for LARCs can be performed by multiple types of clinicians (typically family medicine doctors, gynecologists, nurse practitioners, or physician assistants) who have been trained on the surgical procedures associated with LARC insertion and removal. LARC insertion and removal can be performed in a range of clinical settings, including both primary care practices and non-traditional locations such as school-based health centers or mobile health vans.
Recommended through contraceptive counseling: Clinicians and health counselors provide comprehensive contraceptive counseling to patients on a variety of birth control options, which can include LARCs. This counseling is an important mechanism by which patients learn about LARCs and make a decision as to which contraceptive option is best for them.
- Strategies
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Reproductive health and education
- Cost per Participant
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Variable
Multiple studies with rigorous designs provide some evidence for long-acting reversible contraceptives (LARC) as a strategy to increase contraceptive use, reduce teen pregnancy, and reduce unintended pregnancy.
- This assessment is based on a 2019 research synthesis. More research is needed to confirm the effects of efforts to increase access to LARCs and to determine which intervention components have the greatest effect.
Reduce cost of LARCs: Offering LARCs at low or no cost is one of the best ways to increase their utilization. Funding to cover the cost can come from private donors, local and state governments, and foundations. Title X clinics (which are federally funded to provide family planning options) in particular are a key site to ensure low or no-cost LARC access.
Remove procedural barriers: Policies and requirements from states, health care systems, or insurance providers can function as bureaucratic or procedural hurdles that make it more difficult for patients to receive LARCs. This may include mandatory sexually transmitted infection (STI) testing prior to the day of insertion, requiring two visits before insertion, or preventing women from getting a LARC immediately after giving birth. Removing these barriers increases utilization of these methods.
Incorporate messages about STIs and condom use: While LARCS are highly effective at preventing pregnancy, they do not prevent the transmission of STIs. Some studies show that LARC users may be less likely to use condoms than oral contraceptive users, so it is important to provide guidance on STI prevention techniques along with providing LARCs.
Conduct regular evaluations: It is important to regularly assess the efficacy of efforts to increase access to LARCs, any barriers that may exist, and how many patients are utilizing services. Evaluation tools such as the State and Community Awardee Performance Measure Reporting Tool from the Centers for Disease Control and Prevention can be helpful to track the different performance metrics associated with LARC access interventions.