The gap between contraceptive preference and use

Although long-acting and permanent birth control methods, known as LARC and sterilization respectively, appeal to many people, systemic barriers can make them harder to begin using. Past Bixby studies have identified both lack of public funding and lack of provider training as two such barriers. A new study, led by TxPEP and coauthored by Dr. Daniel Grossman, adds to that research by focusing on postpartum women and the gap between the methods they prefer and the ones they actually use following delivery.

The study found that, among 1,700 publicly insured postpartum women in Texas, only about half of those who preferred a long-acting method were actually using one six months after delivery. The “use gap” was roughly the same for women who preferred sterilization.


Credit: Maya Blum

The study authors identified immediate insertion as one way to increase LARC use among interested women. Of the eight hospitals that served study participants, only one offered immediate insertion—and 34.7 percent of their patients were using LARC at six months postpartum, compared to just 20 percent at the other seven facilities. This finding echoes another recent Bixby study, which found that offering immediate postpartum placement of implants greatly increased their use rate.

Other potential solutions for closing the gap between contraceptive preference and use among postpartum women include expanding insurance coverage, especially for undocumented women, and improving provider knowledge of all methods. Bixby’s Beyond the Pill program is one such training program increasing providers' knowledge and skills relating to LARC.