Research
General gynecology
The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception

Preliminary results from this study were presented in a poster presentation at the Annual Reproductive Health Meeting held through a partnership of the Association of Reproductive Health Professionals, Planned Parenthood Federation of America, and the Society of Family Planning, Washington, DC, Sept. 17-20, 2008.
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Objective

To introduce and promote the use of long-acting reversible methods of contraception (LARC; intrauterine contraceptives and subdermal implant) by removing financial and knowledge barriers.

Study Design

The Contraceptive CHOICE Project is a prospective cohort study of 10,000 women 14-45 years who want to avoid pregnancy for at least 1 year and are initiating a new form of reversible contraception. Women screened for this study are read a script regarding long-acting reversible methods of contraception to increase awareness of these options. Participants choose their contraceptive method that is provided at no cost. We report the contraceptive choice and baseline characteristics of the first 2500 women enrolled August 2007 through December 2008.

Results

Sixty-seven percent of women enrolled (95% confidence interval, 65.3–69.0) chose long-acting methods. Fifty-six percent selected intrauterine contraception and 11% selected the subdermal implant.

Conclusion

Once financial barriers were removed and long-acting reversible methods of contraception were introduced to all potential participants as a first-line contraceptive option, two-thirds chose long-acting reversible methods of contraception.

Section snippets

Materials and Methods

The Contraceptive CHOICE Project is a prospective cohort study of 10,000 women in the St. Louis region. Each participant is provided the contraceptive method(s) of her choice at no cost to her for 3 years duration. The CHOICE protocol was approved by the Washington University in St. Louis School of Medicine Human Research Protection Office before initiation of participant recruitment.

CHOICE is a convenience sample of women in the St. Louis region. Participants are recruited at specific clinic

Results

From August 2007 through December 2008, we screened 4107 women for eligibility. Eighty-six percent (3522) met the eligibility criteria to participate in the study and were offered the opportunity to enroll. The most common reasons for ineligibility included a desire to continue with their current contraceptive method (84%) or had not been and were not planning on being sexually active with a man (11%). Of the 3522 eligible women, 2500 enrolled. After adjusting for age, eligible women were

Comment

In the United States, currently less than 3% of women use a LARC method. In this initial planned analysis of CHOICE, 56% chose IUC and 11% chose a subdermal implant. Thus, two-thirds of participants who were not using a contraceptive method or were willing to switch to a new method chose LARC. The overwhelming selection of LARC methods among the first 2500 women enrolled in CHOICE is evidence of a greater than expected interest in the use of the most effective, reversible methods of

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Supported by an anonymous foundation. This research was also supported in part by a Midcareer Investigator Award in Women's Health Research (K24 HD01298), by a Clinical and Translational Science Award (UL1RR024992), and by Grant no. KL2RR024994 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research.

Reprints not available from the authors.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

Cite this article as: Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol 2010;203:115.e1-7.

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