Unintended pregnancies, which include pregnancies that are mistimed or unwanted, have negative health and economic consequences.1 In 2006, almost half of all pregnancies in the United States were unintended, and in the District of Columbia, 59% of all pregnancies were unintended.2 However, access to family planning services can help individuals achieve desired family size and birth spacing. In addition, publicly funded family planning services prevent 1.94 million unintended pregnancies each year.3
Through a network of 29 health centers, Unity Health Care Inc. (Unity), a federally qualified health center in Washington, DC, provides comprehensive health services to underserved residents. As a grantee of the Title X grant, Unity also ensures access to a broad range of family planning and related preventive health services for low-income or uninsured individuals. A key component of Unity's family planning services is to provide access to Long-Acting Reversible Contraception (LARC), which includes intrauterine devices (IUDs) and progestin implants. LARC is up to 99.9% effective in preventing pregnancy, has high satisfaction and continuation rates, has few side effects, and is shown to be cost effective.4, 5, 6 As a result of these advantages and the potential to reduce unintended pregnancy, professional organizations such as the American College of Obstetricians and Gynecologists (ACOG) recommend that IUDs and implants be offered as first-line contraceptive methods and encouraged as options for most women.7
Given the effectiveness of LARC in preventing unintended pregnancies, Unity initiated several strategies in 2009 to increase the uptake of LARC among their patient population, including system changes, staff development, and patient education. First, family planning staff at Unity gained commitment to make LARC a priority from both leadership and clinicians. Once essential staff committed to this initiative, key investments were made to ensure that LARC inventory is maintained and supplies always available across all clinic locations. Second, staff development is critical to the success of this initiative. Not only are clinicians trained on LARC insertion, but they are taught effective counseling methods to ensure that their patients understand the benefits and downsides of LARC use. Finally, ongoing patient education remains a critical tool. The Unity family planning team provides standardized education materials, provider counseling tools, and LARC demonstration models in exam rooms at all family planning sites to support patient education.
As a result of these three strategies, from 2009 to 2012 there was an 88% increase in the number of providers at Unity who have provided LARC to their patients.8 Unity has also seen an increase in the number of women who are utilizing LARC. In 2012, 9.2% of women seen at Unity who were in need of contraception used a LARC method. This is an increase from 6.4% of women in 2009.9 In addition to promoting LARC use in community clinics, Unity has also focused on increasing LARC uptake in its school-based health centers.
2“Increasing LARC Uptake in an Urban, Underserved, Primary Care Setting.” Unity Health Care. September 2013. Slide 9 in LARC presentation.
5Trussell J (2011). Contraceptive failure in the United States. Contraception. 2011 May;83(5):397–404.
6Trussell J, et al (2013). Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception. Contraception. 2013 Feb;87(2):154–61.
7ACOG Committee Opinion No. 450, American College of Obstetricians and Gynecologists (2009). Increasing Use of Contraceptive Implants and Intrauterine Devices To Reduce Unintended Pregnancy. Obstet Gynecol 2009;114:1434–8.
8“Increasing LARC Uptake in an Urban, Underserved, Primary Care Setting.” Unity Health Care. September 2013. Slide 41 in LARC presentation.
9“Increasing LARC Uptake in an Urban, Underserved, Primary Care Setting.” Unity Health Care. September 2013. Slide 39 in LARC presentation.