Increasing LARC use in an effort to reduce unintended pregnancies: A look at the Iowa initiative to reduce unintended pregnancies

Long-acting reversible contraception (LARC), which includes the intrauterine device (IUD) and the implant, is increasingly being recommended as a first line option for nearly all women. While these are among the most effective and safe methods available, U.S. use is relatively low. In 2007, 16 agencies in Iowa were funded, as part of the Iowa Initiative to Reduce Unintended Pregnancies, with the aim of promoting LARC use and removing barriers to uptake. Agencies used funding to offer low or no cost LARC devices, market their services, and improve the climate for family planning in the state. This paper uses an interrupted time series design, using data from 2004 through 2012, to assess the impact of the Iowa Initiative on reducing unintended pregnancies and increasing LARC use in the state. During the Initiative period, use of IUDs and implants as primary methods of contraception increased substantially (208% and 1,100% respectively), the percent of unintended pregnancies declined by 11%, and pregnancies terminated by abortion declined by 25%. The declines in Iowa were greater when compared to neighboring states and to the U.S. as a whole. Findings also demonstrate that LARC adoption increased with local marketing efforts and dropped again when they were terminated. These results suggest that this Initiative was a strong contributor to these changes. This is another in a growing number of studies suggesting that the availability of LARC at low or no cost is strongly associated with its adoption.