A national survey on contraceptive availability suggests that on-site availability of intrauterine devices and other long-acting, reversible contraceptive methods is less than maximal for both office-based physicians and Title X clinics, according to a report in the Jan. 14 Morbidity and Mortality Weekly Report.
Approximately one-quarter of the 635 office-based physicians and nearly one-third of the 1,368 Title X clinic providers who participated in the CDC survey reported that they refer patients to other providers for IUDs – and even higher proportions said they refer patients out for contraceptive implants.
Increasing on-site availability and thus improving access to such long-acting, reversible contraceptive (LARC) methods could reduce rates of unintended pregnancy in the United States, the report stated.
The high unintended pregnancy rate of nearly 50% is thought to result, in part, from less-frequent use of LARC methods, compared with other user-dependent methods such as condoms and oral contraceptives. LARCs have been shown to be more effective in preventing unintended pregnancies during typical use, according to the report (MMWR 2011;60:1-4).
Previous studies have similarly shown that contraceptive availability – through either on-site provision or through prescription or provider recommendation – is highest for oral contraceptives and lower for the patch, IUD, and vaginal ring. This is one of the few studies, however, to examine provider-specific availability of a wide range of contraceptive methods and the first national study to delineate on-site availability without combining hormonal methods into one category, according to the report.
The survey was mailed to physicians in three specialties: obstetrics/gynecology, family medicine, and adolescent medicine. Title X clinics represented a range of provider agencies, including public health departments and community health centers.
Overall, with the exception of the levonorgestrel-releasing intrauterine device (LNG-IUD, Mirena) – for which on-site availability was reported by 56% of office-based physicians and 47% of Title X clinic providers – office-based physicians were less likely than were Title X clinics to report on-site availability of a range of contraceptive methods.
While nearly all Title X clinics reported having on-site availability of combined oral contraceptives, for instance, approximately half of office-based physicians had them available on-site and half had them available by prescription. One-quarter of office-based physicians offered progestin-only oral contraceptives on-site, in comparison, and almost 30% offered the contraceptive patch on-site. Most of the others reported that these two methods were available by prescription.
Similarly, male condoms were available on-site in nearly all Title X clinics but only in one-quarter of physicians’ offices.
Survey participants were also asked whether specific contraceptive methods were simply "not available" to their patients. The methods most frequently reported as such were female condoms and implants.
Almost 18% of office-based physicians and 10% of Title X providers said female condoms were unavailable, and 8% and 9% of office-based physicians and Title X providers, respectively, said contraceptive implants were unavailable. On the other hand, almost half of the Title X clinic providers said female condoms were available on-site, compared with 7% of in-office physicians. Contraceptive implants were reported by about one-third of the providers in each category to be available on-site.
The survey findings are limited by a low response rate for office-based physicians (47%), the report noted.
The survey did not ascertain reasons why contraceptive methods were unavailable in some cases or not available on-site. Differences in availability can reflect various factors, from variations in reimbursable costs and health insurance trends, to federal and state policies, provider training and patient characteristics, according to the report.