Long-Acting Reversible Contraceptives (LARCs)

Why are LARCs an essential part of the method mix?

Successful family planning programs should include a broad mix of contraceptive methods. Offering short-acting methods such as injectables, oral contraceptive pills, and barrier methods; long-acting reversible contraceptives (LARCs) like the intrauterine device (IUD) and implants; and permanent methods like vasectomy and tubal ligation allows programs to meet the varied and changing needs of their diverse clients. LARCs are an essential part of the method mix because they include both hormonal and nonhormonal options, are highly effective for years at a time, and are removable at any time.

Definitions

  • Long-acting reversible contraceptives (LARCs): Contraceptive methods, including the IUD and the implant, that provide protection from pregnancy for years at a time
  • Intrauterine device (IUD): A small, flexible plastic frame that a trained provider inserts into a woman’s uterus to provide very effective, safe, and long-term protection from pregnancy; both copper and hormonal IUDs are available 
  • Implants: Small, flexible plastic rods or capsules that are placed just under the skin of the upper arm and release a progestin hormone into the body
  • Unmet Need: Percentage of women who do not want to become pregnant but are not currently using contraception

Key messages

  • Long-acting reversible contraceptives (LARCs) are the most effective forms of reversible contraception—once inserted, they require no regular resupply or action on the part of the user.
  • LARCs can help women and couples achieve their reproductive intentions to delay, space, or limit childbearing.
  • Including LARCs in the method mix has great potential to decrease contraceptive discontinuation and reduce unintended pregnancies.
  • Successful voluntary LARC programs require adequate supplies and provider training to ensure that all clients who choose LARCs are able to have them inserted and removed in a timely, safe manner.

Overview

The intrauterine device (IUD) and the contraceptive implant are long-acting reversible contraceptives (LARCs). Both IUDs and implants can be removed at any time, and fertility is rapidly restored. LARCs are the most effective forms of reversible contraception—during the first year of typical IUD or implant use, fewer than 1% of women will become pregnant. Unlike most short-acting methods, IUDs and implants are not “user dependent.” Once a provider inserts them, they require no daily action or coital adherence on the part of the user, lowering the risk of unplanned pregnancy due to user error or unintentional discontinuation.

Many women in low- and middle-income countries who want no more children are using less effective, short-acting methods of contraception. Looking only at a country’s contraceptive prevalence rate can mask an unmet need for long-acting methods that offer women a more reliable way to limit their number of pregnancies. Addressing unmet need for “limiting methods” by increasing access to LARCs is an important strategy for reducing unintended pregnancies. LARCs are also an appropriate option for women who want to space their births—that is, they want more children but want to delay their next pregnancy.

Young people are at high risk for early and/or unintended pregnancy and can benefit from increased access to LARCs. Emerging evidence demonstrates the safety and effectiveness of LARCs for young people. The World Health Organization, USAID, global health and development organizations, and medical professional associations have issued statements affirming the safety and appropriateness of LARCs for young people. In fact, the American Academy of Pediatrics issued a policy statement recommending LARCs as the first-line contraceptive choice for adolescents.

Family planning programs throughout the world need to prepare to meet the growing demand for LARCs by acknowledging and addressing barriers on the supply side by reducing stockouts of commodities and consumable supplies; introducing task sharing so that nurses, midwives, and even health extension workers can help meet demand for services; and implementing ongoing quality assurance measures. On the demand side, programs must address provider biases and client concerns by ensuring providers are well trained, competent, supportive of LARC usage, and able to offer quality counseling and timely insertion and removal services to clients. Another key to making LARCs accessible to greater numbers of clients is ensuring that they are affordable. Although the initial cost of commodities and service provision for some LARCs can be higher than for shorter-acting methods and can be seen as a barrier, LARCs are far more cost-effective in the long term, as fewer resupply and clinic visits are needed.

Topic last updated: June 28, 2017