Cost and benefit All LARCs are designed to last for at least three years, with some options (Paraguard Copper IUD) lasting for at least ten years. Although they have higher up-front costs (out-of-pocket costs can range between $500 and $1300), that cost purchases coverage for longer than other contraceptive methods, which are often purchased on a monthly basis (for hormonal birth control methods like pills, patches, or rings.) When accounting for upfront costs, failure rates, and side effects, researchers estimate that the most cost effective means of contraception are the Copper IUD, vasectomy, and the levonorgestrel IUD (such as a Mirena). One researcher estimates that use of the levonorgestrel IUD can be up to 31% cheaper than using non-LARC methods such as birth control pills, patch, ring, or injectables. Regardless, the initial
out of pocket cost is still too high for many patients, and is one of the biggest barriers to LARC use. Studies conducted in California and St. Louis have shown that rates of LARC usage are dramatically higher when the costs of the methods are either covered or removed. The Colorado Family Planning Initiative (CPFI), a six-year $23 million privately funded program to expand access to LARCs, This program specifically provided no-cost LARCs to low-income women across the state of Colorado, with the intention of preventing unintended pregnancies within specific groups deemed at high-risk of unintended pregnancy. This program decreased unplanned adolescent pregnancies in Colorado by about half. There was a similar decline of unplanned pregnancies in unmarried women under 25 who have not finished high school. Use of LARC methods by children of child-bearing age in the state increased to 20% during the 2009–2014 period. A 2017 study found that CPFI "reduced the teen birth rate in counties with clinics receiving funding by 6.4 percent over five years. These effects were concentrated in the second through fifth years of the program and in counties with relatively high poverty rates."
Promotion The United Kingdom Department of Health has actively promoted LARC use since 2008, particularly for young people; following on from the October 2005
National Institute for Health and Clinical Excellence guidelines, which promoted LARC provision in the United Kingdom, accurate and detailed counseling for women about these methods, and training of healthcare professionals to provide these methods. Giving advice on these methods of contraception has been included in the 2009
Quality and Outcomes Framework "good practice" for primary care. The use of long-acting reversible contraceptives in the United States has increased nearly fivefold from 1.5% in 2002 to 7.2% in 2011–2013. Increasing access to long-acting reversible contraceptives was listed by the
Centers for Disease Control and Prevention as one of the top public health priorities for reducing teen pregnancy and unintended pregnancy in the United States. One study of female family planning providers showed that they were significantly more likely to use LARCs than the general population (41.7% compared to 12.0%) suggesting that the general population has less information or access to LARCs.
LARC-First models and backlash Guidelines released in 2009 by the
American College of Obstetricians and Gynecologists (ACOG) state that LARC methods are considered to be the first-line option for birth control in the United States, and are recommended for the majority of women. According to the CDC Medical Eligibility Criteria for Contraceptive Use, LARC methods are recommended for the majority of women who
have had their first menstruation, regardless of
whether they have had any pregnancies. The
American Academy of Pediatrics (AAP) in a policy statement and technical report published in October 2014 recommended LARC methods for adolescents. In the years since ACOG made these recommendations, many researchers have evaluated the impact of the LARC-first model. Because it prioritized the importance of effectiveness of method in contraceptive counseling, patient preferences and priorities were not given adequate attention within contraceptive counseling. Researchers have found that patients experience over-enthusiasm about a particular method as coercive. ACOG practitioners have since come forward with an attempt at re-balancing recommendations to center patient needs and desires in contraceptive counseling. ==See also==