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Use of Long-Acting Reversible Contraception by Obstetrics and Gynecology Residents: An Examination of Access for All Women

Evans, Megan, L., MD, MPH; Espey, Eve, MD, MPH; Ogburn, Tony, MD; Zite, Nikki, B., MD, MPH

doi: 10.1097/AOG.0000000000002489
Contents: Current Commentary

Although long-acting reversible contraception (LARC) use is increasing in the general female population, only 12% of all women who use contraception and 4.8% of nulliparous women in the United States use either the intrauterine device (IUD) or contraceptive implant. In several studies, however, female physicians prefer LARC for contraception. In 2016, an anonymous electronic survey was administered to all U.S. obstetrics and gynecology residents before the start of the annual in-training examination administered by the Council on Resident Education in Obstetrics and Gynecology. The survey included questions about LARC, including personal use. Fifty percent of female residents or the female partners of male residents used IUDs for contraception, 31.3% used combined oral contraceptives, and 3% used a contraceptive implant. Among nulliparous residents, 37.7% used IUDs. This rate of IUD use was five times the rate reported by the general female population and eight times the nulliparous rate in the United States. Obstetrics and gynecology residents understand the benefits of LARC, but have minimal barriers to access. When barriers and cost are removed and the full range of contraceptive options is offered, the majority of contracepting women and adolescents choose LARC. With the high rates of unintended pregnancy and maternal morbidity and mortality in the United States—especially among poor and minority women—all women, regardless of income, race–ethnicity, and career, should have awareness of and access to these effective contraceptive methods.

The majority of female obstetrics and gynecology residents and female partners of male residents use long-acting reversible contraception as their primary contraception; decreasing barriers would likely increase access and use for all women.

Departments of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts, University of New Mexico, Albuquerque, New Mexico, University of Texas Rio Grande Valley, Brownsville, Texas, and University of Tennessee Medical Center, Knoxville, Tennessee.

Corresponding author: Megan L. Evans, MD, MPH, Assistant Professor, Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Box #22, Boston, MA 02111; email: mevans2@tuftsmedicalcenter.org.

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

Presented at the Council on Resident Education in Obstetrics and Gynecology Education Retreat, August 3–4, 2017, Seattle, Washington.

The authors thank Janis L. Breeze, MPH, Tufts Clinical and Translational Science Institute, Tufts University, Tufts Medical Center, for her aid with statistical analysis as well as the Council on Resident Education in Obstetrics and Gynecology for aid with survey development and distribution during the 2016 in-service obstetrics and gynecology examination. Ms. Breeze's time was paid for through departmental funding for statistical support.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.