Low Maintenance Contraceptives
The National Campaign estimates 82 percent of teen pregnancies are unplanned or unwanted, and according to the Centers for Disease Control and Prevention, 4 out of 5 pregnancies among women 19 and younger were unintended.
Low maintenance contraceptives, also called Long Acting Reversible Contraception (LARC,) are the most effective reversible methods of birth control available to reduce unplanned teen pregnancy. Examples of LARCs include the subdermal contraceptive implant and intrauterine devices. Since LARC does not require the user to consistently do anything to work, they are recommended for use among teens to prevent unintended pregnancy.
The American Academy of Pediatrics recommends LARC as first-line options for teens. According to the American Congress of Obstetricians and Gynecologists, LARC are safe and appropriate contraceptive methods for most women and adolescents.
LARC Resources for Providers
- Low Maintenance FAQs for Providers
- Low Maintenance FAQs for Patients
- The Implant: Common Questions and Answers
- Low Maintenance Contraceptives (Brochure)
- Long Acting Reversible Contraceptives: A First-Line Approach to Prevent Teen Pregnancy
- LARC Insertion & Removal Series - Innovating Education in Reproductive Health - ACOG LARC Program
Mirena® (LNG IUS)—Bayer HealthCare Pharmaceuticals
- Watch an Online Insertion and Removal Video
- View More Information
- Request a Training or Representative
Kyleena ® (LNG IUS)— Bayer HealthCare Pharmaceuticals
- Watch an Online Insertion and Removal Video
- View More Information
- Request a Training or Representative
Skyla® (LNG IUS)— Bayer HealthCare Pharmaceuticals
Liletta® (LNG IUS)— AbbVie & Medicines 360
- Watch an Online Insertion Video
- For more information, call: 1-855-LILETTA
- Request a Training
ParaGard® (Copper IUS)— CooperSurgical, Inc.
- Watch an Online Insertion and Removal Video
- For more information, call: 1-877-PARAGARD Option #1, Option #3
- Request a Training
Nexplanon® (Implant) – Organon
- For more information, call: 1-844-674-3200
- Request a Training
Frequently Asked Questions for Providers
LARCs include the etonogestrel (ENG) implant and hormonal and non-hormonal intrauterine devices (IUDs). They are the most effective reversible forms of birth control available, with more than 99 percent effectiveness.
- Implant
- IUD
Almost all patients are excellent LARC candidates. In fact, The AAP recommends that pediatricians should be able to educate adolescent patients about LARC methods, including the progestin implant and IUDs. Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents. The American Congress of Obstetricians and Gynecologists (ACOG) recommends IUDs and implants as first line birth control for most women and endorses LARC as the most effective reversible birth control methods available to women and adolescents, including those that are not sexually active or are nulliparous.
Read “Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy” for additional information.
In addition, the United States Medical Eligibility Criteria for Contraceptive Use (2010) and the Selected Practice Recommendations for Contraceptive Use (2013) from the CDC provide clear guidelines for LARC use based on patient characteristics and/or medical conditions.
Additional resources:
U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition
For patients, barriers could be:
- Cost
- Concerns about privacy/confidentiality
- Lack of knowledge regarding options and where to get a LARC
- Persistent myths that LARCs are harmful or cause infertility
- Fear of side effects, fear of pain, fear of having something inside them
For providers, potential barriers may be:
- Beliefs that LARCs are too time consuming or will slow down office flow
- Upfront costs to stocking LARCs
- Required training for staff and providers
- Billing and reimbursement concerns
- Out of date protocols; Misinformation about LARCs
- Lack of necessary equipment
- Lack of knowledge about where to refer patients for LARC services if they do not provide them in the office
Yes! LARCs are still recommended for women that are not sexually active. Obtaining a highly effective method of birth control, such as an IUD or implant, will ensure your patient is covered when they do become sexually active to prevent an unintended pregnancy.
In addition to pregnancy protection, LARCs can offer non-contraceptive benefits such as treatment of dysmenorrhea, heavy menstrual bleeding, and suppression of menses.
The AAP recommends that pediatricians should be able to educate adolescent patients about LARC methods, including the progestin implant and IUDs. Given the efficacy, safety, and ease of use, LARC methods should be considered first-line contraceptive choices for adolescents.
The ACOG says that LARCs are safe and appropriate contraceptive methods for most women and adolescents. The LARC methods are top-tier contraceptives based on effectiveness, with pregnancy rates of less than 1 percent per year for perfect use and typical use. These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives. Adolescents are at high risk of unintended pregnancy and may benefit from increased access to LARC methods.
When choosing contraceptive methods, adolescents should be encouraged to consider LARC methods. Intrauterine devices and the contraceptive implant are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy and abortion in young women.
There are many opportunities for health care providers to provide LARC counseling during visits with sexually active adolescents, including preventive health, abortion, prenatal and postpartum visits.
Complications of IUDs and the contraceptive implant are rare and differ little between adolescents and older women. Health care providers should consider LARC methods for adolescents and help make these methods accessible to them. Learn more about the ACOG’s stance on LARC.
The CDC recently updated its health care provider recommendations regarding contraceptive use.
The recommendations provide evidence-based guidance that reduces medical barriers to contraception. Please visit the CDC website to review the practice recommendations and access related tools.
IUDs and implants may be inserted by a trained physician, physician’s assistant, or advanced practice nurse (nurse practitioner or nurse midwife).
- Partner with an experienced LARC clinician to obtain hands on experience
- Seek out training opportunities and continuing education, some may offer pelvic simulator experience
- Contact the device manufacturers for training and more information
Additional Resources:
- American Congress of Obstetricians and Gynecologists (ACOG) LARC Program
- American Academy of Pediatrics
- Contraception for Adolescents, American Academy of Pediatrics (AAP)
- Family Planning National Training Centers
- Reproductive Health Access Project
- The Contraceptive Choice Project
- The National Campaign to Prevent Teen and Unplanned Pregnancy
- UCSF Intrauterine Devices and Implants: A Guide to Reimbursement
- US Medical Eligibility Criteria, Select Practice Recommendations for Contraceptive Use
