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ACOG Strengthens LARC Recommendations

September 22, 2015

Washington, DC — Updated data, paired with new options for long-acting reversible contraceptive (LARC) methods, have led the American College of Obstetricians and Gynecologists (ACOG) to strengthen its recommendations regarding use of LARC methods as the most effective and safe forms of reversible contraception.

The updated Committee Opinion, “Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy,” released today by the College’s Committee on Gynecologic Practice and the Long-Acting Reversible Contraception Working Group, urges obstetrician-gynecologists to encourage patient consideration of implants and intrauterine devices (IUDs), educate patients on LARC options, and advocate for insurance coverage and appropriate payment and reimbursement for every type of contraceptive method.

“ACOG has long recommended LARC as the most effective reversible contraceptive option for most women, including those who have not given birth and adolescents who are sexually active,” said David E. Soper, MD, Chair of the College’s Gynecologic Practice Committee. “We continually see more and more data to support and strengthen our recommendations at the same time that more LARC options are becoming available.”

Reports from the Contraceptive CHOICE Project, an observational clinical trial, show that improving access to and knowledge about LARC methods increases use and may decrease unintended pregnancies, abortions, repeat abortions and adolescent birth rates. Additionally, LARC methods, such as implants and IUDs, were 20 times more effective at preventing pregnancy among CHOICE Project participants than oral contraceptive pills, patches or rings.

Currently, there are five LARC devices available in the United States: one single-rod etonogestrel implant FDA-approved for up to three years and four brands of IUDs. The copper IUD is approved for up to 10 years of use. Additionally, three levonorgestrel-releasing intrauterine systems are available: two approved for use up to three years and one approved up to five years of use.

ACOG encourages ob-gyns to familiarize themselves with changes in practice guidelines and adopt best practices for LARC insertion, which are highlighted in a box in the opinion.

“All women should have access to safe contraceptive methods, including LARC,” said Eve Espey, MD, MPH, Chair of the College’s LARC Working Group. “By familiarizing themselves with local, state (including Medicaid), federal, and private programs that improve affordability of all contraceptive methods, ob-gyns can support access to LARC in all clinically appropriate circumstances. We continue to urge ob-gyns to become familiar with LARC methods and to incorporate LARC counseling and insertion into their practices.”

Committee Opinion 642, “Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy,” is published in the October issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

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American Congress of Obstetricians and Gynecologists
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