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

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.