Familiarity and acceptability of long-acting reversible contraception and contraceptive choice

Abstract Background Contraceptive choice is a preference-sensitive decision affected by contraceptive attributes, patient experience, and reproductive history. Familiarity with and acceptability of specific contraceptive methods may influence patient decisions. Objective To describe the acceptability of and pre-visit familiarity with long-acting reversible contraception (LARC; intrauterine devices [IUD] and contraceptive implants) compared to depo-medroxyprogesterone acetate (DMPA) and oral contraceptive pills (OCPs) in women presenting for contraceptive care and investigate the relationship between acceptability and contraceptive choice. Study Design This was a secondary analysis of a study designed to compare two contraceptive care programs conducted at three Midwest federally qualified health centers (FQHCs). After contraceptive counseling, participants completed a baseline interviewer-administered survey prior to the healthcare provider visit. We asked participants questions about pre-visit familiarity with and acceptability of the IUD, implant, DMPA, and OCPs. We assessed familiarity using two questions: 1) Before today have you ever heard of the [method]? and 2) Do you know any woman who has the [method]. Acceptability was assessed for each method on a 0-10 scale with 0 being ‘strongly dislike’ and 10 being ‘strongly like.’ We dichotomized the scores into high acceptability (7-10) and low/moderate acceptability (0-6) for analysis. We examined differences in demographic and reproductive characteristics between women with high and low LARC acceptability using chi-square. We used univariate and multivariable Poisson regressions to examine the relationship between participants’ characteristics, method acceptability, and method choice. We adjusted for any covariate that changed the effect size of acceptability by more than 10%. Results There were 1,007 women included in the analysis; 900 (89%) women reported they had heard of the IUD and 592 (59%) knew someone who had used the IUD. Eight hundred sixty-five (86%) women had heard of the implant and 636 (63%) knew someone who had used it. Knowledge of DMPA and OCPs was high (>98% for both). Five hundred seventy-six women (57%) found one or both LARC methods highly acceptable. Women with high LARC acceptability were more likely to be adolescents or aged 30-45 years, white, Hispanic, married/cohabitating, and uninsured, and less likely to desire a child in the next 1-3 years. They were more likely to desire a hormonal IUD (90.5% vs 9.5%), copper IUD (81.1% vs 18.9%) or implant (89.8% vs 10.2%) compared to women with low acceptability (p Conclusions Pre-visit familiarity with IUDs and implants was high in our FQHC population although not as high as DMPA and OCPs. In adjusted analyses, women who found an IUD or implant highly acceptable and knew someone who used the method were more likely to choose those respective methods at the end of their visit.