Familiarity and acceptability of LARC and contraceptive choice

January 15, 2020

Awareness of intrauterine devices and contraceptive implants is high among women of reproductive age, but not as high for DMPA and oral contraceptives, according to a recent study.

Familiarity with intrauterine devices (IUDs) and contraceptive implants was high among women of reproductive age enrolled in a contraceptive study at three Midwest federally qualified health centers, but not as high as for injectable depot medroxyprogesterone acetate (DMPA) and oral contraceptives (OCs),according to a secondary analysis.

Findings
A full 89.4% of the 1,007 women had heard of an IUD and 85.9% had heard of an implant, compared to familiarity rates for DMPA and OCPs of 98.1% and 99.7%, respectively. In addition, the majority of women knew someone who had used an IUD (59%) or an implant (63%), and they were more likely to find these methods acceptable.

“Acceptability of long-acting reversible contraception (LARC) was also fairly high, with 57% of women finding either an IUD or implant, or both, highly acceptable after contraceptive counseling,” said Tessa Madden, MD, MPH, senior author of the analysis and principal investigator of the study. “Women with high acceptability of an implant or IUD were more likely to choose one of those methods compared to women with lower acceptability.”

Women with high LARC acceptability were more likely to be adolescents or aged 30 to 45, white or Hispanic, married/cohabitating and uninsured; and less likely to desire a child within the next 1 to 3 years. However, demographic factors were not linked to contraceptive choice for the study, which had an enrollment period between June 2014 and September 2015.

Moreover, women with high LARC acceptability were more likely than women with low or moderate acceptability to desire a hormonal IUD (90.5% vs. 9.5%), a copper IUD (81.1% vs. 18.9%) or an implant (89.8% vs. 10.2%) (< 0.001). But the majority of women with low/moderate LARC acceptability who desired DMPA or OCs had high acceptability of the shorter-acting method they chose: 88.6% and 82.8%, respectively. Furthermore, women with high acceptability of an IUD were more likely to choose an IUD than those with lower IUD acceptability: adjusted relative risk (RRadj) = 9.62; 95% confidence interval (CI): 6.42 to 14.42. Women with high acceptability of an implant were also more likely to choose one than those with lower implant acceptability: ARR = 8.74; 95% CI: 6.17 to 12.38.

Conclusions
“Our findings may assist with centering patient preferences and inform provider approach to discussing contraceptive methods with patients,” said Dr. Madden, an associate professor of ob/gyn at Washington University School of Medicine in St. Louis, Missouri. “Incorporating a question into contraceptive counseling about the acceptability of specific methods may also be helpful in guiding counseling.”

However, despite administering structured contraceptive counseling that presented methods in order of effectiveness, 38.7% of the sample had low acceptability of an IUD and 35.7% had low acceptability of an implant after counseling, suggesting that some women will find certain methods unacceptable even after comprehensive counseling.

“Additionally, our results are only specific to the population included in the study and questions about acceptability were asked after the contraceptive counseling had been performed,” Dr. Madden told Contemporary OB/GYN. “We would be interested to know acceptability scores prior to counseling and whether counseling changed acceptability for some women. If so, is there some way to identify which women would benefit from learning more about contraceptive methods, as opposed to other women for whom acceptability would not change based on additional information?” 

Disclosures:

Dr. Madden serves on a data safety monitoring board for phase 4 safety studies of Bayer contraceptive products.