Breaking barriers to contraceptive access among recent latino immigrants in South Carolina: A community based participatory research study
Awarded 2016
Community-Based Participatory Research Grants
Emily Mann, PhD
Medical University of South Carolina

Objectives: Unintended pregnancy rates are highest among low-income women the US. Efforts to address this reproductive health issue include increasing access to long-acting reversible contraceptives (LARC) because they are the most effective methods of pregnancy prevention outside of permanent sterilization. While state Medicaid policies have expanded access to immediate postpartum insertion of LARC in recent years, little is know about how Medicaid recipients experience the implementation of the policy. This study explored low-income women’s views about and experiences with unintended pregnancy, contraceptive counseling, LARC acceptability, and LARC use in the context of South Carolina’s policy. Method: Interviews were conducted with 30 low-income women, ages 18-34, between November 2016 and March 2018. To participate, women had to be South Carolina Medicaid recipients and had at least one live birth in the past two years. Participants were recruited through health clinics, social service programs, and community-based organizations. Interviews were audio-recorded, transcribed, and coded using an inductive approach. Results: All of the participants had experienced at least one unintended pregnancy and nearly all wanted to avoid future pregnancies. Most of the participants had been counseled about their contraceptive options during prenatal care and nearly all were presented with the option to have a LARC inserted immediately following the birth of their most recent child. However, two-thirds of the study participants did not find LARC acceptable and declined to use a LARC. Half of the current LARC users experienced sustained negative side effects and wanted to discontinue use but encountered barriers to removal. Conclusion: The findings indicate that efforts to facilitate immediate postpartum access to LARC use among this population have some limitations. Negative perceptions of LARC and providers’ approaches to contraceptive counseling discouraged the majority of participants from using a LARC. Among participants who had elected to get a LARC, the majority had either discontinued use prior to the interview or expressed a desire to discontinue use. While LARC remains the most effective group of contraceptive methods on the market, LARC is not one-size-fits-all. Medicaid recipients would benefit from a more tailored approach to contraceptive counseling that is respectful of their concerns and priorities, which may not always reflect those of their providers.