Increasing access to LARC removal in pediatrics to support adolescent reproductive justice in the United States.
| Title: | Increasing access to LARC removal in pediatrics to support adolescent reproductive justice in the United States. |
|---|---|
| Authors: | Hartheimer JS; The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.; Allison BA; Division of General Pediatrics and Adolescent Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.; Perry MF; Division of General Pediatrics and Adolescent Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. |
| Source: | Perspectives on sexual and reproductive health [Perspect Sex Reprod Health] 2024 Jun; Vol. 56 (2), pp. 85-89. Date of Electronic Publication: 2024 Jun 04. |
| Publication Type: | Editorial; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Alan Guttmacher Institute Country of Publication: United States NLM ID: 101140654 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-2393 (Electronic) Linking ISSN: 15386341 NLM ISO Abbreviation: Perspect Sex Reprod Health Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: New York, NY : Alan Guttmacher Institute, c2002- |
| MeSH Terms: | Long-Acting Reversible Contraception* ; Health Services Accessibility* ; Device Removal* ; Pediatrics*; Humans ; Adolescent ; United States ; Female ; Young Adult ; Pregnancy |
| Abstract: | Background: In the United States (U.S.), adolescents and young adults are increasingly using contraception, including long-acting reversible contraception (LARC) [e.g., subdermal implants (e.g., Nexplanon®) and intrauterine devices (IUDs)]; however, access to LARC device removal may be difficult for adolescents and young adults. Reproductive justice is the right to bodily autonomy, have children, not have children, and safely parent the children we have.; Methods: In this commentary, we discuss that while the specialties of family medicine and obstetrics and gynecology have incorporated the principles of reproductive justice into their contraceptive care, further work is needed to ingrain this philosophy into pediatrics training. Since LARC devices are historically only removable by health care providers, pediatricians may act as gatekeepers to removing LARC, obstructing the reproductive justice of adolescents and young adults.; Results: We describe that adolescents and young adults in the U.S. face unique barriers to LARC removal including limited access to the health care system, potential breaches in confidentiality, and provider bias. These barriers may lead adolescents and young adults to remove their own LARC device when experiencing unwanted side effects or desiring pregnancy. While IUD self-removal is a safe and accessible option, safety and efficacy data on subdermal implant self-removal is currently limited.; Conclusion: In order to promote reproductive justice in adolescents and young adults, we recommend that (1) pediatricians should address potential barriers to LARC removal prior to insertion, (2) pediatricians must offer unbiased LARC removal, (3) pediatricians who place LARC must be knowledgeable about complicated LARC removal, and (4) pediatricians should discuss LARC self-removal options with adolescents and young adults.; (© 2024 University of Ottawa.) |
| References: | Lindberg LD, Firestein L, Beavin C. Trends in U.S. adolescent sexual behavior and contraceptive use, 2006–2019. Contracept: X. 2021;3:100064. doi:10.1016/j.conx.2021.100064.; Committee on Adolescence. Contraception for adolescents. Pediatrics. 2014;134(4):e1244‐e1256. doi:10.1542/peds.2014‐2299.; Menon S, Committee on Adolescence. Long‐acting reversible contraception: specific issues for adolescents. Pediatrics. 2020;146(2):e2020007252. doi:10.1542/peds.2020‐007252.; Sister Song. Reproductive Justice. Sister Song; 2022 [accessed 2023 Jan 23] https://www.sistersong.net/reproductive-justice.; American College of Obstetricians and Gynecologists' Committee on Health Care for Underserved Women, Contraceptive Equity Expert Work Group, and Committee on Ethics. Patient‐centered contraceptive counseling: ACOG Committee statement number 1. Obstet Gynecol. 2022;139(2):350‐353. doi:10.1097/AOG.0000000000004659.; RHEDI: Reproductive Health Education In Family Medicine. Reproductive Justice Context. RHEDI; 2023 [accessed 2023 May 4] https://rhedi.org/reproductive-justice-context/.; Amico JR, Bennett AH, Karasz A, Gold M. “She just told me to leave it”: Women's experiences discussing early elective IUD removal. Contraception. 2016;94(4):357‐361. doi:10.1016/j.contraception.2016.04.012.; Britton LE, Williams CR, Onyango D, Wambua D, Tumlinson K. “When it comes to time of removal, nothing is straightforward”: a qualitative study of experiences with barriers to removal of long‐acting reversible contraception in Western Kenya. Contracept: X. 2021;3:100063. doi:10.1016/j.conx.2021.100063.; Higgins JA, Kramer RD, Ryder KM. Provider bias in long‐acting reversible contraception (LARC) promotion and removal: perceptions of young adult women. Am J Public Health. 2016;106(11):1932‐1937. doi:10.2105/AJPH.2016.303393.; Committee on Health Care for Underserved Women. ACOG committee opinion no. 649. Racial and ethnic disparities in obstetrics and gynecology. Obstet Gynecol. 2015;126(6):e130‐e134. doi:10.1097/AOG.0000000000001213.; Murray Horwitz ME, Pace LE, Ross‐Degnan D. Trends and disparities in sexual and reproductive health behaviors and service use among young adult women (aged 18‐25 years) in the United States, 2002–2015. Am J Public Health. 2018;108(S4):S336‐S343. doi:10.2105/AJPH.2018.304556.; Bryson A, Koyama A, Hassan A. Addressing long‐acting reversible contraception access, bias, and coercion: supporting adolescent and young adult reproductive autonomy. Curr Opin Pediatr. 2021;33(4):345‐353. doi:10.1097/MOP.0000000000001008.; American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care. Confidentiality in Adolescent Health Care: ACOG Committee Opinion No. 803. Obstetrics and Gynecology. 2020 Apr.; Amico JR, Bennett AH, Karasz A, Gold M. “I wish they could hold on a little longer”: physicians' experiences with requests for early IUD removal. Contraception. 2017;96(2):106‐110. doi:10.1016/j.contraception.2017.05.007.; Fox KR, Kameoka AM, Raidoo S, et al. Patient barriers to discontinuing long‐acting reversible contraception. Matern Child Health J. 2024;28(2):192‐197. doi:10.1007/s10995‐023‐03878‐z.; Foster DG, Grossman D, Turok DK, et al. Interest in and experience with IUD self‐removal. Contraception. 2014;90(1):54‐59. doi:10.1016/j.contraception.2014.01.025.; Chochol MD. Self‐removal of implanted contraceptive during an exacerbation of Paranoid Schizophrenia. Prim Care Companion CNS Disord. 2022;24(4):42365. doi:10.4088/PCC.21cr03202.; Gbolade BA. Attempted self‐removal of Implanon®: a case report. Asian Pac J Reprod. 2015;4(3):247‐248. doi:10.1016/j.apjr.2015.06.011.; Shepherd DJ. Self‐removal of a contraceptive implant. J Fam Plann Reprod Health Care. 2012;38(3):208. doi:10.1136/jfprhc‐2012‐100350.; Tyson N, Lopez M, Merchant M, Postlethwaite D. Subdermal contraceptive implant insertion trends and retention in adolescents. J Pediatr Adolesc Gynecol. 2021;34(3):348‐354. doi:10.1016/j.jpag.2020.12.019.; Broussard K, Becker A. Self‐removal of long‐acting reversible contraception: a content analysis of YouTube videos. Contraception. 2021;104(6):654‐658. doi:10.1016/j.contraception.2021.08.002.; Amico JR, Heintz C, Bennett AH, Gold M. Access to IUD removal: data from a mystery‐caller study. Contraception. 2020;101(2):122‐129. doi:10.1016/j.contraception.2019.10.008.; Dethier D, Qasba N, Kaneshiro B. Society of Family Planning clinical recommendation: extended use of long‐acting reversible contraception. Contraception. 2022;113:13‐18. doi:10.1016/j.contraception.2022.06.003.; Manzer JL, Bell AV. The limitations of patient‐centered care: the case of early long‐acting reversible contraception (LARC) removal. Soc Sci Med. 2022;292:114632. doi:10.1016/j.socscimed.2021.114632.; Harper CC, Comfort AB, Blum M, et al. Implementation science: scaling a training intervention to include IUDs and implants in contraceptive services in primary care. Prev Med. 2020;141:106290. doi:10.1016/j.ypmed.2020.106290.; Dehlendorf C, Mengesha B, Ti A. Improving Contraceptive Counseling through Shared Decision‐Making Curriculum. Innovating Education in Reproductive Health. 2015 [accessed 2023 May 16] https://www.innovating-education.org/2016/03/2743/.; Baker CC, Creinin MD. Long‐acting reversible contraception. Obstet Gynecol. 2022;140(5):883‐897. doi:10.1097/AOG.0000000000004967.; Prine L, Shah M. Long‐acting reversible contraception: difficult insertions and removals. Am Fam Physician. 2018;98(5):304‐309.; Organon. Clinical Training Program (CTP) for NEXPLANON. Nexplanon Training; 2022 [accessed 2023 May 4] https://nexplanontraining.com/.; UCLA Family Planning. Difficult Implant Removal: Dry Model. Innovating Education in Reproductive Health. 2015 [accessed 2023 May 4] https://www.innovating‐education.org/2019/03/difficult‐implant‐removal‐dry‐model/.; UCLA Family Planning. Difficult Implant Removal: Animal Model. Innovating Education in Reproductive Health. 2015 [accessed 2023 May 4] https://www.innovating-education.org/2019/03/difficult-implant-removal-animal-model/.; Stifani BM, Madden T, Micks E, Moayedi G, Tarleton J, Benson LS. Society of family planning clinical recommendations: contraceptive care in the context of pandemic response. Contraception. 2022;113:1‐12. doi:10.1016/j.contraception.2022.05.006.; Glaser K, Fix M, Karlin J, Schwarz EB. Awareness of the option of IUC self‐removal among US adolescents. Contraception. 2021;104(5):567‐570. doi:10.1016/j.contraception.2021.06.018.; Collins F, Gilmore K, Petrie KA, Benson LS. Developing an intrauterine device self‐removal guide: a mixed methods qualitative and small pilot study. Contracept Reprod Med. 2022;7(1):10. doi:10.1186/s40834‐022‐00177‐w.; Boston Medical Center. Intrauterine Device (IUD) Self Removal. ClinicalTrials.gov; 2022[accessed 2023 May 4] https://clinicaltrials.gov/ct2/show/NCT05191238.; PICCK. How to remove your intrauterine device (IUD) by yourself. Partners in Contraceptive Choice and Knowledge. [accessed 2023 May 10] https://picck.org/resource/self-removal-of-iud/.; Wilkinson TA, Maslowsky J, Berlan ED. The pediatrician in the post‐roe landscape. JAMA Pediatr. 2022;176(10):967‐968. doi:10.1001/jamapediatrics.2022.2868. |
| Grant Information: | SFPRF 15-CM2 Society of Family Planning Research Fund; #2020143 United States DDCF Doris Duke Charitable Foundation |
| Entry Date(s): | Date Created: 20240605 Date Completed: 20240720 Latest Revision: 20240917 |
| Update Code: | 20260130 |
| DOI: | 10.1111/psrh.12270 |
| PMID: | 38837867 |
| Database: | MEDLINE |
Editorial; Research Support, Non-U.S. Gov't