204047 Long-acting reversible contraception (LARC) in the US: Are contraceptive providers adequately trained?

Wednesday, November 11, 2009: 8:30 AM

Cynthia C. Harper, PhD , Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Tina Raine, MD, MPH , Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Jillian T. Henderson, PhD, MPH , OB-GYN, University of California, San Francisco, San Francisco, CA
Maya Blum, MPH , Center for Reproductive Health Research & Policy, University of California, San Francisco, San Francisco, CA
Kirsten Thompson, MPH , Bixby Center for Global Reproductive Health, Ob-Gyn Dept, University of California, San Francisco, San Francisco, CA
J. Joseph Speidel, MD, MPH , Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Rates of unintended pregnancy and abortion are far higher in the United States than in other developed countries. However, highly effective long-acting, reversible contraception (LARC) is infrequently used. We conducted a national, probability survey among contraceptive providers to assess their capacity and skills in offering LARC methods (n=1,410). We surveyed obstetrician-gynecologists, family practice physicians and nurse practitioners, and obtained a 70% response a high rate for provider surveys. While virtually all providers offered oral contraceptives, only one-third offered the implant and two-thirds intra-uterine contraception. Ninety-five percent of providers considered the IUD to be safe and their patients to be interested in the method. Seventy-five percent considered it under-used, and over half thought cost was an important obstacle. Fewer, however, were aware of updated indications for use, especially among women at higher risk of unintended pregnancy, including immediate post-abortion (30%), nulliparous (58%), teenagers (42%) or HIV-positive (42%). Almost 40% were not comfortable inserting intrauterine contraception, and 75% not comfortable inserting implants. However, many were interested in training in these long-acting methods. We will use multivariate statistical analysis to assess the varying practices and training needs among obstetrician-gynecologists, family practice physicians and nurse-practitioners. We will also analyze pregnancy prevention practices by type of practice, including private practice, public, and clinic or hospital-based. These results identify a need to train providers to be prepared to serve women at high risk of unintended pregnancy with the most effective methods and for policy efforts to improve affordability of long-acting methods.

Learning Objectives:
1. Describe the knowledge and experience of contraceptive providers with LARC methods. 2. Explain how provider training and practice setting are associated with LARC provision practices. 3. Compare the LARC training needs of obstetrician-gynecologists, family practice physicians, and nurse practitioners.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted several studies on long-acting, reversible contraception.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.