The authors suggest that high unintended pregnancy rates in the U.S. may be the result of relatively low use of long-acting reversible contraceptive (LARC) methods, such as the contraceptive implant and intrauterine devices. According to the World Health Organization’s evidence-based Medical Eligibility Criteria for contraceptive use, almost all women are eligible for implants and intrauterine devices.
Despite high up-front costs and the need for office visits for insertion and removal, LARC methods share the following advantages over other methods:
- Are independent from coitus and user motivation and adherence
- Have the highest effectiveness, continuation rates, and user satisfaction
- Do not require frequent visits for resupply
- Require no additional funding for consistent use once they have been placed
- Are highly cost-effective
- Are reversible, with a rapid return to fertility after removal
LARC methods should be offered as first-line contraceptive methods and encouraged as options for most women. To increase use of LARC, barriers such as lack of health care provider knowledge or skills, low patient awareness, and high upfront costs should be addressed.
Committee on Gynecologic Practice. Increasing Use of Contraceptive Implants and Intrauterine Devices To Reduce Unintended Pregnancy. 2009. ACOG Committee Opinion. 450.