Urban–Rural Differences in Attitudes and Practices Toward Long-Acting Reversible Contraceptives among Family Planning Providers in Texas

Published:January 24, 2012DOI:



      Despite the elevated rates of teen and unplanned pregnancies across the United States, long-acting reversible contraceptives (LARCs) remain a less utilized birth control method. The present study investigated family planning providers’ attitudes and considerations when recommending family planning methods and LARCs to clients. Additionally, this study explored whether urban–rural differences exist in providers’ attitudes toward LARCs and in clients’ use of LARCs.


      Data were collected using an online survey of family planning providers at Title X clinics in Texas. Survey data was linked to family planning client data from the Family Planning Annual Report (2008).


      Findings indicated that, although providers were aware of the advantages of LARCs, clients’ LARC use remains infrequent. Providers reported that the benefits of hormone implants include their effectiveness for 3 years and that they are an option for women who cannot take estrogen-based birth control. Providers acknowledged the benefits of several types of LARCs; however, urban providers were more likely to acknowledge the benefits of hormone implants compared with their rural counterparts. Results also indicated barriers to recommending LARCs, such as providers’ misinformation about LARCs and their caution in recommending LARCs to adolescents. However, findings also indicated providers lack training in LARC insertion, specifically among those practicing in rural areas.


      In light of the effectiveness and longevity of LARCs, teenagers and clients living in rural areas are ideal LARC candidates. Increased training among family planning providers, especially for those practicing in rural areas, may increase their recommendations of LARCs to clients.
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      Margaret L. Vaaler, PhD, is a Research Specialist at the Texas Department of State Health Services. Her research interests focus on the relationship between attitudes and health behaviors, patterns in help-seeking behavior, health disparities, and maternal and child health.


      Lauri K. Kalanges, MD, MPH, is currently the Section Director and Medical Director for Health Promotion and Chronic Disease Prevention at the Texas Department of State Health Services.


      Vincent P. Fonseca, MD, MPH, is the Director of Medical Informatics at Intellica Corporation and the co-founder of the Population Health Institute of Texas. His interests are improving the delivery of publicly funded health-related services and improving the health of defined populations.


      Brian C. Castrucci, MA, is the Director of the Maternal and Child Health program at the Georgia Department of Community Health.