Promoting Reproductive Justice in the Office: LARC Removal Counseling at Time of Insertion
Authors: Andrade Carolina , Sanchez Sheralyn , Wong Melissa , Mallett Veronica , Reddy Sireesha 
Published: July 2024

Purpose: While access to receiving LARC devices is increasing, it is not apparent if there is an infrastructure for providing equal access to LARC removal. The purpose of this study was to assess how patients perceive LARC counseling by providers at the time of insertion. In addition, explore the information that providers include in their LARC removal counseling at the time of insertion.

Methods: The study population included participants of both patients and providers. Our patient participants included people between the ages of 18 to 50 years old who have or previously have had any form of intrauterine contraceptive device or subdermal contraceptive implant. Subjects will be recruited from the Texas Tech El Paso Obstetrics and Gynecology Clinics. The provider participants included residents, attending OB/GYNs, and nurse-midwives in the Texas Tech Health Science Center at El Paso Department of Obstetrics and Gynecology. Patients completed an anonymous survey depending on which type of device they had. If they have had both the intrauterine contraceptive device and the subdermal contraceptive implant, they were eligible to complete one survey for each device. Participants completed surveys on an iPad. Providers were surveyed once, either through paper surveys or emailed surveys. Survey responses were anonymous. Data was analyzed using SAS 9.4 software.

Results: Overall, 246 participants reported having a subdermal implant (45.5%) or IUD (54.5%), majority of the participants were between the ages of 18-30 (72.8%), Hispanic (78.9%), had insurance or grant accessibility (67.5%). There were 17 providers consisting of medical residents, physicians, and nurse midwives who completed the survey. Based on provider surveys, 80.0% of providers counseled patients at 100% of visits about getting device removed. In addition, 80.0% of providers informed their patients to return to the office for device removal. About 93.3% of providers never discuss the cost of removing the device. Regarding the patient surveys, in response to the question, “How well do you understand the process of getting the device removed,” results were reported into two groups: ’extremely poorly/poorly/neutral” and “somewhat well/very well.” There was no statistically significant difference among the patients with an IUD who either poorly understood the process or understood the process as least somewhat well. For patients with a subdermal implant, 73.68% of those who poorly understood the process of removal stated that providers did not discuss the cost of removing the device versus 37% of those who understood the process well where providers did not discuss the cost of device removal (p < 0.001). About 68.42% of patients with a subdermal implant who poorly understood the process of device removal stated that providers did tell them they needed to come back to the office for device removal; 94.62% of patients with a subdermal implant who understood the process of device removal well stated that providers told them to return to the office for removal (p < 0.001). On whether providers discussed insurance coverage for device removal, 63.44% of patients who understood the process well states yes versus only 21.44% of patients who poorly understood the process of device removal.

Conclusions: In patients with subdermal implants, a low percentage of providers discussed the cost of removal and whether or not insurance covered the cost of removal. Results implicate a need for an infrastructure to increase access for LARC removal services. However, further studies with larger patient and provider pools would be necessary for statistically significant results, particularly for IUDs.