Health Care Barriers to Provision of Long-Acting Reversible Contraception in Wisconsin

Abstract

Introduction: Long-acting reversible contraceptives (LARC), specifically implants and intrauterine devices (IUD), are highly effective, low maintenance forms of birth control. Practice guidelines from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Academy of Pediatrics recommend that LARC be considered first-line birth control for most women; however, uptake remains low. In this study, we sought to understand practices and barriers to provision of LARC in routine and immediate postpartum settings as they differ between specialties.

Methods: We surveyed 3,000 Wisconsin physicians and advanced-practice providers in obstetrics-gynecology/women's health (Ob-gyn), family medicine, pediatrics, and midwifery to assess practices and barriers (56.5% response rate). This analysis is comprised of contraceptive care providers (n=992); statistical significance was tested using chi-square and 2-sample proportions tests.

Results: More providers working Ob-gyn (94.3%) and midwifery (78.7%) were skilled providers of LARC methods than those in family medicine (42.5%) and pediatrics (6.6%) (P < .0001). Lack of insertion skill was the most-cited barrier to routine provision among family medicine (31.1%) and pediatric (72.1%) providers. Among prenatal/delivery providers, over 50% across all specialties reported lack of device availability on-site as a barrier to immediate postpartum LARC provision; organizational practices also were commonly reported barriers.

Conclusions: Gaps in routine and immediate postpartum LARC practice were strongly related to specialty, and providers' experience heightened barriers to immediate postpartum compared to routine insertion. Skills training targeting family medicine and pediatric providers would enable broader access to LARC. Organizational barriers to immediate postpartum LARC provision impact many providers.

Figure 1.

Survey Flow Diagram Abbreviations: Ob-gyn, obstetrics and gynecology; RR, risk ratio. ^a Practicing in obstetrics and gynecology. ^b Adjusted for the proportion of the unknown eligibility who are eligible.

Figure 2.

Proportion of Contraceptive Providers Surveyed, by and Within Specialty, Who Are Skilled Inserters of 1 or More LARC Methods Providers who reported both personally inserting LARC and being “very” or “extremely” confident in insertion of a specific LARC method were classified as “skilled [device] inserters.” Error bars represent 95% confidence intervals. Abbreviations: IUD=Intrauterine device. LARC=Long-acting reversible contraceptives.