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Factors Influencing the Provision of Long-Acting Reversible Contraception in California

Biggs, M. Antonia PhD; Harper, Cynthia C. PhD; Malvin, Jan PhD; Brindis, Claire D. DrPH

doi: 10.1097/AOG.0000000000000137
Contents: Original Research

OBJECTIVE: To assess long-acting reversible contraception (LARC) beliefs and practices among site directors who represent the family planning services delivered in their practices.

METHODS: Medical directors from 1,000 sites listed in the Family Planning Access Care and Treatment program (California's family planning Medicaid program) provider database were mailed a survey in the fall of 2011 regarding their LARC beliefs and practices. Participants responded by mail, online, or telephone. Data on family planning clients served and LARC dispensing were obtained from administrative claims data. All analyses were limited to advanced practice clinician respondents. General estimating equation models identified the respondent and practice characteristics associated with LARC provision.

RESULTS: After three follow-up mailings and telephone calls, 68% of eligible sites responded to the survey (636/939). Most respondents were physicians (448/587). They were most likely to consider women with a history of pelvic inflammatory disease unsuitable for hormonal (27%, n=161) and copper (26%, n=154) intrauterine devices. Smokers were the most likely to be considered unsuitable for the implant (16%, n=96). Nearly three fourths of respondents routinely discussed intrauterine devices (413/561) and half (271/558) discussed implants with their contraceptive patients. Characteristics that predicted onsite LARC provision included LARC training, beliefs, and health care provider type.

CONCLUSION: Although there has been significant progress in expanding access and understanding about LARC, many clinicians from sites offering family planning services held beliefs limiting the provision of intrauterine devices and were unfamiliar with the implant, suggesting the need for targeted trainings aimed at informing clinicians of recent developments in LARC recommendations.


A survey of directors representing the family planning services delivered in their practices demonstrates expanded access and understanding about long-acting reversible contraception, yet unfamiliarity persists.

Bixby Center for Global Reproductive Health, University of California, San Francisco, California.

Corresponding author: M. Antonia Biggs, PhD, Bixby Center for Global Reproductive Health, 3333 California Street, Suite 265, University of California, San Francisco, CA 94118; e-mail:

Supported by funds from the State of California, Department of Health Services, contract 05-45122. All analyses, interpretations, or conclusions are those of the authors and not of the funders.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.