Abstract
Introduction
Prior longitudinal studies of long-acting reversible contraception (LARC) satisfaction
and continuation guaranteed their participants access to LARC removal. Under real-world
conditions, LARC users who wish to discontinue may experience barriers to LARC removal.
Methods
A prospective cohort study recruited 1,700 postpartum Texans without private insurance
from 8 hospitals in 6 cities. Our analysis included the 418 respondents who initiated
LARC in the 24 months after childbirth. A content analysis of open-ended survey responses
identified three categories of LARC users: satisfied, resigned, and dissatisfied.
Satisfied LARC users were using their method of choice. Resigned users were using
LARC as an alternative method when their preferred method was inaccessible. Dissatisfied
users were unhappy with LARC. Multinomial logistic regression models identified risk
factors for resignation and dissatisfaction. Cox proportional hazards models assessed
differences in LARC discontinuation by satisfaction and sociodemographic characteristics.
Results
Participants completed 1,505 surveys while using LARC. LARC users were satisfied in
83.46% of survey responses, resigned in 5.25%, and dissatisfied in 11.30%. Resignation
was more likely if respondents were uninsured or wanted sterilization at the time
of childbirth. The risk of dissatisfaction increased with time using LARC and was
higher among uninsured respondents. U.S.-born Hispanic LARC users were more likely
than foreign-born Hispanic LARC users to be dissatisfied and less likely to discontinue
when dissatisfied. Dissatisfaction—but not resignation—predicted discontinuation.
Cost, lack of insurance, and difficulty obtaining an appointment were frequent barriers
to LARC removal.
Conclusions
Most postpartum LARC users were satisfied, but users who wished to discontinue frequently
encountered barriers.
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Biography
Elizabeth J. Ela, PhD, completed this research as a postdoctoral fellow with the Texas Policy Evaluation Project at the University of Texas at Austin. She studies contraceptive use, reproductive health, and maternal health.
Biography
Kathleen Broussard, MA, is a doctoral candidate in the Department of Sociology at the University of Texas at Austin. Her research focuses on reproductive health-seeking behaviors and how medicine and health care shape the meaning and experience of abortion, pregnancy, and childbearing.
Biography
Kristen L. Burke, MA, is a graduate student in the department of Sociology and a trainee in the Population Research Center at the University of Texas at Austin. Her research interests include access to reproductive health services and U.S. fertility trends.
Biography
Katie Hansen, MD, is a resident physician in the Department of Obstetrics and Gynecology at Oregon Health & Science University.
Biography
Lauren Thaxton, MD, MBA, MSBS, is an Obstetrician-Gynecologist with subspecialty in Complex Family Planning. She is also an Assistant Professor at the Dell Medical School Department of Women's Health and studies novel, patient-centered interventions for reproductive health.
Biography
Joseph E. Potter, PhD, is Professor of Sociology and Faculty Research Associate, The University of Texas at Austin Population Research Center. His research focuses on postpartum contraception and the impact of changes in family planning funding on births, abortions, and contraceptive use.
Article info
Publication history
Published online: April 19, 2022
Accepted:
February 24,
2022
Received in revised form:
February 1,
2022
Received:
March 18,
2021
Footnotes
Supported by a grant from the Susan Thompson Buffett Foundation, United States and a center grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD042849) awarded to the Population Research Center at the University of Texas at Austin, United States. An earlier version of this abstract was presented as a poster at the 2019 annual meeting of the Society for Family Planning, October 19–21, Los Angeles, CA.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health, George Washington University.
