From the Guidelines
To effectively address the global issue of over 218 million women lacking access to modern contraception, healthcare systems must prioritize a tiered approach to counseling, presenting the most effective contraceptive methods first, such as long-acting reversible contraception (LARC), including intrauterine devices and contraceptive implants, as recommended by the CDC and the U.S. Office of Population Affairs 1.
Key Strategies
- Making a range of contraceptive options widely available, including hormonal and non-hormonal methods
- Removing financial barriers through subsidized or free contraception
- Establishing mobile clinics for rural areas
- Training healthcare workers in contraceptive counseling
- Creating culturally sensitive education programs
Rationale
The use of LARC has been shown to significantly reduce rates of unintended pregnancy, as demonstrated by Project CHOICE, which achieved high uptake of LARC and a substantial reduction in unintended pregnancy rates when financial barriers were removed 1. Additionally, a study on postpartum contraceptive use in Colorado found high levels of acceptance of LARC among teen mothers, highlighting the potential for increased use of these methods when financial barriers are removed 1.
Implementation
Healthcare providers have an obligation to inform clients about the most effective contraceptive methods available, even if they cannot provide them on-site, ensuring that clients can make fully informed decisions about their reproductive health 1. By prioritizing education, accessibility, and affordability, and presenting the most effective methods first, healthcare systems can improve maternal and child health outcomes, reduce maternal mortality, and empower women to make reproductive choices that support their educational and economic opportunities.
From the Research
Overview of Contraceptive Access
- Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs 2.
- The frequency of stockouts of contraceptive methods varies by method and sector, and is more dynamic than previously thought 2.
- Long-acting reversible contraceptives (LARCs) consistently account for a larger portion of couple years of protection, despite their limited availability compared to other methods 2.
Unmet Need for Contraception
- In 2017, the modern contraceptive prevalence rate (mCPR) among women of reproductive age who are married or in a union in the FP2020 focus countries was 45.7%, unmet need for modern methods was 21.6%, and the demand satisfied with modern methods was 67.9% 3.
- Between 2012 and 2017, the number of women of reproductive age who are married or in a union who use modern methods increased by 28.8 million 3.
- The estimate of additional users up to 2017 for women of reproductive age who are married or in a union suggests that the 120×20 goal for all women is overly ambitious 3.
Contraceptive Use and Access
- In the United States, 76.2% of women aged 18-49 years were considered to be at risk for unintended pregnancy, and 60.7% had ongoing or potential need for contraceptive services 4.
- Among women with ongoing or potential need for contraceptive services, 15.2% used a long-acting reversible method, 25.0% used a short-acting reversible method, and 29.5% used a barrier or other reversible method 4.
- A person-centered metric of contraceptive access, which considers individuals' self-defined contraceptive needs, may be more effective in monitoring contraceptive access and designing policy and programmatic strategies to increase access 5.