Long-acting reversible contraception (LARC) is significantly more effective(www.nejm.org) than birth-control pills and other methods for which patient compliance is a variable. Intrauterine devices (IUDs) and etonogestrel single-rod implants are also safe, cost-effective and liked by women.(www.ncbi.nlm.nih.gov)
What LARC hasn't been until recently is popular. But that's changing -- at a rate outpacing primary care's readiness.
So reports "Long-acting Reversible Contraception Provision by Family Physicians: Low But on the Rise,"(jabfm.org) published in the January-February issue of the Journal of the American Board of Family Medicine. Its authors include Meenadchi Chelvakumar, M.D., M.P.H., a visiting-scholar alumna at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care and clinical assistant professor of primary care and population health at the Stanford University School of Medicine.
"Women are increasingly opting for LARC, with a growth in use from 6 percent of U.S. women in 2008 to 14 percent of U.S. women in 2014," the report says, citing a 2018 analysis(www.sciencedirect.com) of National Survey of Family Growth data. "As demand for LARC increases, it is important to ensure that an appropriate primary care workforce is available to provide these services, allowing all patients to have access to these valuable contraceptive methods."
The percentage of family physicians who provide LARC services is rising but "still remains low," cautions the report, "with less than a quarter of FPs reporting that they provide any form of LARC."
Authors reviewed data from the 2014 to 2017 American Board of Family Medicine demographic surveys and found that although 82 percent of family physicians said they provided women's health services, only 21.5 percent regularly provided IUDs and only 13.6 percent regularly provided implants.
"Given that reproductive planning and pregnancy are central to the physical health and the socioeconomic well-being of women and families, addressing barriers to LARC provision in primary care is important," authors write.
They note that "the technical skills involved in IUDs and implants are within the scope of FP training," which usually includes family planning. But family medicine residents are less likely to learn IUD insertion than their OB/Gyn peers, "potentially leading to deficits in knowledge and comfort with this procedure among FPs post-residency."
"Even for FPs with adequate LARC training and knowledge, complex reimbursement schemes and clinical environments that are not appropriately equipped for gynecological procedures can hinder a new graduate's ability to continue to provide these procedures," the report adds.
Authors call for "training and support to increase the fraction of FPs who deliver LARC services, as well as promotion of policies which aim to create a more amenable practice environment for FPs to perform gynecological procedures in their primary care practice."
"Allowing patients access to LARC is important to reproductive autonomy and to public health," they write, "as unintended pregnancies result in health risks to the mother and child, significant direct health care costs, and long-term social and economic costs to women and families."
To keep up with increasing demand for LARC, authors write, "it is important to ensure that an appropriate primary care workforce is available to provide these services, allowing all patients to have access to these valuable contraceptive methods."
Related AAFP News Coverage
Fresh Perspectives blog: In Defense of Reproductive Health Care