Long-Acting Reversible Contraceptives (LARCs)
Review the Evidence
40 years of evidence; one comprehensive database
POPLINE is the world’s largest free database of family planning and reproductive health literature. An international resource, POPLINE helps program managers, policy makers, and service providers in low- and middle-income countries and in development-supportive agencies and organizations gain access to scientific articles, reports, books, and unpublished documents. POPLINE has a wealth of evidence on diverse aspects of provision of LARCs:
- LARCs and youth
- LARCs as emergency contraception
- LARCs and task shifting/task sharing
- LARCs and community-based distribution programs
- LARCs and contraceptive security
Open access, peer-reviewed journal
The Global Health: Science and Practice Journal has issued a LARCs-focused supplement highlighting important papers from the 2016 International Conference on Family Planning. Topics include strengthening provider capacity, meeting postpartum family planning needs, improving service delivery through public-private partnerships, and addressing client misconceptions.
Shelton JD, Burke AE. Effective LARC Providers: Moving Beyond Training. Glob Health Sci Pract 2016;4(Supplement 2):S2-S4. Effective and productive providers are the key to successful provision of long-acting reversible contraceptives (LARCs). But LARCs demand more of providers than short-acting resupply methods. In addition to sound training, key elements to developing highly productive providers of LARCs include a thorough understanding of the service delivery system context; selecting providers with the most potential, especially from mid-level cadres; strong mentoring and supportive supervision; and attention to the supply chain and to demand-side support.
White JN, Corker J. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries. Glob Health Sci Pract. 2016;4 Suppl 2:S21-S32. Between 2013 and 2014, IUD services provided to women increased more than threefold–from 22,893 to 79,162–in 417 public facilities in Guatemala, Laos, Mali, and Uganda through a Population Services International pilot that engaged the public sector alongside existing private-sector interventions within an informed choice context. Based on family planning market analyses, the country-specific interventions focused on strengthening policy, service delivery, supply chain management, and demand promotion.
Boddam-Whetham L, Gul X, Al-Kobati E, Gorter AC. Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan. Glob Health Sci Pract. 2016;4 Suppl 2:S94-S108. Vouchers for family planning in Pakistan and Yemen reduced barriers, such as cost and availability, and encouraged public and private providers to improve skills, leading to an increase in uptake of long-acting reversible contraceptives and permanent methods.
Situation Analysis of Community-Based Referrals for Family Planning (Advancing Partners and Communities, 2016; PDF, 1.65MB) showcases the results of a literature review to identify programs linking community-level family planning services to higher-level services at health facilities. Evidence indicates that mobile referral systems are by far the most innovative and promising.
Meeting the Need, Fulfilling the Promise: Youth and Long-acting Reversible Contraceptives (PRB, 2016; PDF, 2.2MB) discusses the advantages and challenges of providing LARCs—specifically implants and IUDs—to youth, and provides case studies from Ethiopia and Madagascar. It also outlines actions for policymakers and donors to make youth access to LARCs a reality. Also available in French (2016; PDF, 2.3MB).
Expanding Access to Long-acting Reversible Contraceptives and Permanent Methods through Task Sharing (PSI, 2016; PDF, 432KB) summarizes the results of a meeting hosted by the LARC and PM Community of Practice Secretariat to discuss current progress and future opportunities for task sharing. Task sharing strategies have the potential to optimize the skills and competencies of health workers at all levels to increase access to voluntary contraceptive services, including long-acting reversible contraceptives (LARCs) and permanent methods (PMs), within the context of informed choice.
Barriers to LARC Uptake Among Youth (HC3, 2015; PDF, 289KB) summarizes the results of a USAID-funded literature review of the research surrounding LARCs and youth. No interventions were found that specifically addressed increasing LARC use among youth in low- and middle-income countries; however, several interventions helped young women access LARCs, even when this was not an explicit goal of the programs.
Lopez LM, Bernholc A, Hubacher D, Stuart G, Van Vliet HAAM. Immediate postpartum insertion of intrauterine device for contraception. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD003036 (2015; PDF, 821KB). Women who want to start intrauterine contraception (IUC) during the postpartum period might beneﬁt from IUC insertion immediately after delivery. Postplacental insertion greatly reduces the risk of subsequent pregnancy and eliminates the need for a return visit to start contraception. Without the option of immediate insertion, many women may never return for services or may adopt less effective contraception. The authors examined the outcomes of IUC insertion immediately after delivery, especially when compared with insertion at other postpartum times. They focused on successful IUC insertion, subsequent removal, and method use.
Uptake and Discontinuation of Long-Acting Reversible Contraceptives (LARCs) in Low-Income Countries (ICF International, 2015; PDF, 1MB) focuses on the contraceptive dynamics of LARC use among married women in low-income countries. The authors use a lifecycle approach to understand how women start these methods, how and why they stop, and what their status is three months after stopping. They also examine how individual and country characteristics affect the risk of discontinuation while still in need (DWSIN). High levels of DWSIN suggest method dissatisfaction and may leave women vulnerable to unwanted pregnancies if they do not start a new method.
Contraceptive CHOICE Project
The Contraceptive CHOICE Project was a large US-based prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years.
Secura GM, Madden T, McNicholas C, Mullersnam J, Buckel CM, Zhao Q, et al. Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy. N Engl J Med 2014;371:1316-23. Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens.
Diedrich JT, Zhao Q, Madden T, Secura GM, Peipert JF. Three-year continuation of reversible contraception. Am J Obstet Gynecol 2015;213:662.e1-8. Three-year continuation of the 2 intrauterine devices approached 70%. Continuation of LARC methods was significantly higher than non-LARC methods.