Long Acting Reversible Contraception (LARC)

Ann Baggot, APNP, consults with a patient

Long acting reversible contraceptive (LARC) methods include contraceptive implants, such as Nexplanon, and intrauterine devices (IUDs), such as Liletta and ParaGard. LARC methods last between three and twelve years and are over 99% effective at preventing pregnancy. Once inserted by a clinician, LARCs do not require further maintenance, which in turn helps reduce the risk of an unintended pregnancy. LARC methods also enjoy strong user satisfaction and continuation rates. According to the US Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and the American College of Obstetricians and Gynecologists (ACOG), LARC methods are safe and effective for women of all ages, including teens and early 20s, whether or not they have previously had children or plan to have children in the future.

LARC methods are highly effective at reducing incidence of unintended pregnancy and abortion. In addition, people who use LARC methods, especially when initiated shortly after giving birth, are more likely to achieve recommended interpregnancy spacing (the length of time between pregnancies) of at least 18 months. ACOG and the CDC agree that longer spacing between pregnancies can reduce preterm birth, low birth weight, and infant mortality.

The mission of the University of Wisconsin Department of Obstetrics and Gynecology at the University of Wisconsin School of Medicine and Public Health is to improve the health and quality of life for people across the reproductive life span. The age at which a person gives birth and the spacing and number of their children are important predictors of individual and family health and well-being. These are, in turn, important predictors of the overall health of the community in which we live. It is broadly recognized that communities are healthiest when people are educated and have access to the health care they need to plan and space their children. For these and other reasons, providing patient-centered contraceptive counseling about LARC as well as all other methods to prevent pregnancy is an important priority for our department.

The Ryan Residency Training Program

The Ryan Residency Training Program at Meriter hospital was developed to expand training in contraception and abortion for Ob-Gyn residents and to increase health care access for patients in the immediate or early post‐partum period (<10 weeks). The program provides free LARC devices (Nexplanon, Mirena, and ParaGard), when placed by a trainee, to patients below 300% of the federal poverty level who have no insurance coverage for LARC at the time of placement. Eligible patients for LARC under the Ryan Residency Training Program include adolescents (13 to 19 years old), people who need to prevent pregnancy due to significant medical complications, and people who need to prevent pregnancy due to significant social circumstances.

Patients who are eligible according to a LARC eligibility checklist will be informed by their provider about the Ryan LARC program at the 32 week visit, and interested parties will be asked to provide consent for participation at the 36 week visit. LARC devices are then placed by Ob-Gyn or Family Medicine residents or Certified Nurse Midwife students, under the supervision of attending physicians, either during the immediate post placental period (just after giving birth – Liletta and Paragard) or prior to discharge from the hospital (Nexplanon).

More information about LARC

People who are interested in long acting reversible contraception (LARC) can talk to their primary care or Ob-Gyn providers, or contact any of our providers.

Healthwise: Intrauterine Device (IUD) for birth control

The implant

ACOG LARC Program

UC-San Francisco Bixby Center LARC Project

Selected research about LARC

Game change in Colorado: Widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women (Ricketts, Klinger, & Schwalberg, 2014)

Advocating for immediate postpartum LARC: increasing access, improving outcomes, and decreasing cost (Rodriguez, Evans, & Espey, 2014)

Postpartum contraception in publicly-funded programs and interpregnancy intervals (Thiel de Bocanegra et al., 2013)

The Contraceptive CHOICE Project: Reducing barriers to long-acting reversible contraception (Secura et al., 2010)