Increasing Long-Acting Reversible Contraception Utilization in a Community Health Center (FQHC) setting

Access to Long-Acting Reversible Contraception (LARC), including intrauterine devices and implants, has been shown to significantly decrease rates of unplanned pregnancy. However, providers and clinic staff often report barriers to increasing the use of LARC among clients.  Denver Health (DH), an integrated safety-net health system and Title X provider, implemented new approaches to increase access to LARC for low-income women. Launched in 2009, DH’s program removed cost barriers while providing on-site education and procedures training to clinic and school-based providers. Additionally, a health education program was expanded to more than 20 school-based and community health centers across Denver.

This study included 8,188 unique patients, age 12 to 45, who received a LARC between January 2012 and December 2014 in the outpatient setting. Placement and method were determined using retrospective data and confirmed through chart review. Sixty-five percent were Hispanic and 18% were non-Hispanic White. Forty-nine percent had public insurance, 41% were uninsured and less than 10% had commercial insurance. Method use varied by age and race/ethnicity with IUDs preferred over implants by slightly older women (average age of 28 and 22, respectively) and White women who received 24% of all IUDs and only 11% of all implants.  Over the three years 8,755 LARCs were inserted and the number inserted steadily increased each year: 2,363 in 2012; 2,985 in 2013; and 3,407 in 2014. 

Clinical outcome data examining expulsions and removals post-insertion will be discussed, along with strategies to involve the health team in increasing LARC uptake among women seeking contraception.