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WMJ Vol. 117 No. 4: Original Research

Health Care Barriers to Provision of Long-Acting Reversible Contraception in Wisconsin

Emily M. Olson, MD; Renee D. Kramer, MPH; Crystal Gibson, MPH; Cynthia K. Wautlet, MD, MPH; Nicholas B. Schmuhl, PhD; Deborah B. Ehrenthal, MD, MPH



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Introduction: Long-acting reversible contraceptives (LARC), specifically implants and intrauterine devices (IUDs), are highly effective, low maintenance forms of birth control. Practice guidelines from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Academy of Pediatrics recommend that LARC be considered first line birth control for most women; however, uptake remains low. In this study, we sought to understand practices and barriers to provision of LARC in routine and immediate postpartum settings as they differ between specialties.

Methods: We surveyed 3,000 Wisconsin physicians and advanced-practice providers in obstetrics- gynecology/women’s health (Ob-gyn), family medicine, pediatrics, and midwifery to assess practices and barriers (56.5% response rate). This analysis is comprised of contraceptive care providers (n=992); statistical significance was tested using chi-square and 2-sample proportions tests.

Results: More providers working Ob-gyn (94.3%) and midwifery (78.7%) were skilled providers of LARC methods than those in family medicine (42.5%) and pediatrics (6.6%) (P < .0001). Lack of insertion skill was the most-cited barrier to routine provision among family medicine (31.1%) and pediatric (72.1%) providers. Among prenatal/delivery providers, over 50% across all specialties reported lack of device availability on-site as a barrier to immediate postpartum LARC provision; organizational practices also were commonly reported barriers.

Conclusions: Gaps in routine and immediate postpartum LARC practice were strongly related to specialty, and providers’ experience heightened barriers to immediate postpartum compared to routine insertion. Skills training targeting family medicine and pediatric providers would enable broader access to LARC. Organizational barriers to immediate postpartum LARC provision impact many providers.

Author Affiliations: University of Wisconsin School of Medicine and Public Health (UWSMPH) (Olson); Department of Population Health, UWSMPH (Kramer); Wisconsin Department of Health Services (Gibson); Department of Obstetrics and Gynecology, UWSMPH (Anderson, Schmuhl, Ehrenthal), Madison, Wis.

Corresponding Author: Deborah Ehrenthal, MD, MPH, WARF Office Building Room 658, 610 Walnut St, Madison, WI 53726; phone 608.265.0559; fax 608.263.2820; email ehrenthal@wisc.edu.