Health providers’ beliefs hinder women’s access to contraceptive options

In 2009, the American College of Obstetricians and Gynecologists recommended long-acting reversible contraception (LARC) as contraceptive options safe for nearly all women. LARC, which includes intrauterine devices and implants, are the most effective reversible contraceptive methods. However, many health care providers do not offer LARC to eligible women, due to factors such as a lack of awareness or training, misconceptions about LARC safety and financial obstacles.

New research from the UCSF Bixby Center provides insights into how family planning providers' beliefs and practices affect women's access to LARC. The researchers surveyed clinicians from 1,000 sites participating in California's family planning Medicaid program, Family PACT. They found that:

• One-fourth of providers were not routinely discussing IUDs with contraceptive patients, and nearly half were not routinely discussing the implant.
• Providers were most concerned about offering and IUD to women with a history of pelvic inflammatory disease, followed by women who have never given birth, women with a history of ectopic pregnancy, and teenagers. All of these women can safely use IUDs.
• Only around half correctly believed that it is safe to provide IUDs immediately following an abortion or childbirth.
• Also incorrectly, some providers considered smokers and women with a history of hypertension inappropriate candidates for an implant.

Although there has been significant progress in expanding understanding about LARC, these results show that many clinicians unnecessarily limit LARC access. Targeted trainings are needed to inform clinicians of current LARC eligibility criteria. Such efforts will help ensure that women are informed about all the contraceptive choices available to them.