Exploring Women’s Experiences with Deciding to Use and Access Long-Acting Reversible Contraception

Women spend nearly half their life able to become pregnant. Despite the growing number of contraceptive options available, women continue to select user-dependent options over the user-independent long-acting reversible contraception (LARC). This in part contributes to the current rate of unintended pregnancy and abortion. Increasing LARC use has been proposed as one way to reduce unintended pregnancies and calls have been made for increasing women’s access to LARC. The purpose of this thesis was to explore women’s experiences with deciding to use a LARC and accessing the method. This was explored through two research projects. The first project was a scoping review of the literature. This was completed to identify healthcare professional led LARC services with an evaluation of the services. A systematic search of four electronic databases was completed with 40 articles meeting the inclusion criteria. The identified services included counselling about LARC and providing LARC methods. These services were offered by a range of healthcare provider disciplines including physicians, nurses, pharmacists, and midwives. The services frequently increased LARC uptake by women and clients were satisfied with the services they received. This review suggests there are several service models that can have an impact on LARC use. However, it was noted that the perspectives of potential LARC users were not considered when designing the services, nor were women’s opinions on the services always evaluated. The second project in this thesis was a qualitative study that explored the lived experiences of women who have decided to use a LARC method and have accessed the method in Alberta, Canada. Qualitative Description and Community Based Participatory Research frameworks were followed. Participants were purposefully recruited from the Birth Control Centre, an Edmonton-based clinic. One-on-one virtual interviews were conducted, and the data were analyzed through Reflexive Thematic Analysis. Four themes were generated from the analysis: 1) Actively Seeking Information, 2) Weighing Perceived Benefits and Drawbacks of LARC, 3) Deciding for Yourself, and 4) The Variable Experience of Access. Themes 1 to 3 provide insight into women’s active role in the decision-making process. The fourth theme encompasses the five factors women described to affect their ability to access LARC: the availability and awareness of services, patient-healthcare provider connections, appointment availability and wait times, device availability, and LARC cost and coverage. This study highlights the active role women take when considering LARC methods and their desire to make decisions about LARC themselves. This study also identified accessing LARC as a highly individual experience. The findings from this thesis identified several factors that women perceived to affect access to LARC methods. Additionally, this thesis provides new insights into how women decide to use LARC methods. Further research is required to understand the experiences of women living in rural settings and the experiences of gender diverse individuals. This thesis highlights the opportunities for healthcare providers to engage with women considering LARC and improve women’s ability to access LARC.

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