While use of long-acting reversible contraceptives (LARC) is relatively low in the United States, areas of North Carolina and South Carolina have seen an uptick in use in recent years, WFAE/NPR's "Shots" reports.
Background
LARC methods, such as intrauterine devices and implants, are highly effective, safe forms of birth control. The American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists endorse them as an effective method of preventing teenage pregnancy. In addition, the federal government has called on state Medicaid programs to facilitate LARC access.
However, use among U.S. women is lower compared with women in other developed countries. According to Megan Kavanaugh, a senior research scientist at the Guttmacher Institute, about 10 percent of U.S. women use them, while usage rates "are in the high teens, maybe low 20s" in other developed countries.
According to "Shots," the comparatively low uptake among U.S. women could be linked to the potentially high cost of LARC methods, as well as outdated concerns about their safety.
Carolinas see uptick in use
Kavanaugh said improving training for providers and bolstering education for patients could spur an uptick in LARC use among U.S. women.
For instance, since 2009, all providers in Gaston County, N.C., clinics have been trained on how to administer LARC methods. The county also uses federal funding to help cover LARC costs for uninsured patients. Currently, according to "Shots," LARC usage rates in that region have reached nearly 30 percent among teenagers.
Gaston County Medical Director Velma Taormina attributed a drop in the county's teenage pregnancy rate in large part to the increased use of LARC methods. The county's teenage pregnancy rate has been declining faster than the state overall, and it nearly eliminated disparities between black and white teen pregnancy rates. "We feel very strongly that this is making a huge impact here," Taormina said.
LARC use also has been increasing in South Carolina. In 2012, the state's Medicaid program implemented a payment policy to reimburse providers for offering LARC immediately after a woman gives birth. Staff with Palmetto Health-USC School of Medicine travel in a mobile training clinic to educate health providers how to provide LARC to patients.
B.Z. Giese, director of the South Carolina Birth Outcomes Initiative, said OB-GYNs in her program offer LARC immediately post-delivery because about 50 percent of women enrolled in Medicaid who give birth do not return for their postpartum checkup.
According to Giese, getting LARC after giving birth generates cost savings and "is a convenience." Giese estimates that at some South Carolina hospitals, the proportion of women opting for LARC post-birth increased from zero a few years ago to about one-third currently (Tomsic, "Shots," WFAE/NPR, 10/6).
