I am of the personal opinion that LARCs, or Long-Acting Reversible Contraception methods, are the best thing since sliced bread—better even, because sliced bread is simply not going to keep you from getting pregnant.
Let’s take a moment to break down the term: LARC refers to devices such as an IUD (intrauterine device) or implant, which effectively prevent pregnancy (“Contraception”), do not affect the user’s fertility after being removed (“Reversible”), and are effective for years (the amount of years depends on the specific method) once inserted by a medical provider (“Long-Acting)”. They are effective and popular in part because they eliminate user error; unlike the pill, the ring, or barrier methods like condoms and dental dams, they can be left to their own (excuse the pun) devices. They are also discreet and hidden, so they are a great option for people for whom privacy or confidentiality is a concern.
LARCs are also getting more and more attention, through studies and expert recommendations, as a particularly effective option for teenagers.
A 2012 committee opinion from the American College of Obstetricians and Gynecologists stated, “Increasing adolescent access to LARC is a clinical and public health opportunity for obstetrician–gynecologists.” It pointed out that LARCs have extremely high success rates for both perfect and typical usage, “with pregnancy rates of less than 1% per year.” They also have the highest rates among reversible contraceptives of user satisfaction and continued use.
A 2013 study, motivated by medical providers’ reluctance to prescribe IUDs to teenagers, investigated “whether 15-19-year-old IUD users were more likely to experience complications, failure, or early discontinuation than adult users aged 20-24 years and 25-44 years.” It found that serious complications of IUD usage were rare for all age groups, and that the IUD is just as useful for teenagers as it is for adults aged 20 years and older (though it did note that the hormonal IUD was perhaps a better choice for teenagers than the copper IUD). And in 2014, the American Academy of Pediatrics joined the American College of Obstetricians and Gynecologists in recommending LARCs as the most effective contraceptive method used by adolescents.
In 2015, the CDC released its own study examining trends in LARC usage by 15-19-year-olds. Like the 2013 study, this one asked why IUDs and implants were used relatively rarely by teenagers despite being effective, safe, and easy to use. They wrote:
“A key strategy for further reducing teen pregnancy is increasing awareness, access, and availability of long-acting reversible contraception (LARC), specifically intrauterine devices (IUDs) and implants. IUD use was more common among U.S. women in the 1970s before concerns about safety led to a decline; however, with approval of redesigned IUDs and implants, there has been growing interest in the use of LARC. LARC requires no effort after insertion, and can prevent unintended pregnancy for at least 3 to 10 years, depending on the type of LARC. During the first year of typical use, both IUDs and implants have lower failure rates (<1%) than oral contraceptives (9%) and condoms (18%), the two methods teens use most often. Among teens, LARC also has high acceptability and higher continuation rates than shorter-acting methods. Further, LARC is safe and appropriate for teens: major professional societies, including the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, have endorsed LARC as a first-line contraceptive choice for teens that can be combined with condoms to provide the best protection against pregnancy and sexually transmitted diseases.”
Based on these studies and recommendations, as well as the fact that LARCs are easy to use, easy to keep private, and hard to mess up; can regulate periods; and do not produce the same side effects that may arise from hormonal contraceptives that include estrogen, I personally think LARCs are the safest and most effective contraceptive method for teenagers and young adults.
So why aren’t they more common for those age groups?
Though they are now prescribed more and more, the CDC study still notes that national LARC usage among teens is estimated to be under 5%. Teens and parents may harbor (inaccurate but perhaps historically-based) concerns about safety. Cost is also a concern, but under the Affordable Care Act birth control should be fully covered—so it’s likely that you can access LARC without paying exorbitantly out of your own pocket.
Awareness is low, in part because medical providers often do not inform teenagers and their parents about LARCs as a good option. Providers may not be trained in LARC insertion, may believe that IUDs are only for women who have had children (a myth based on the testing and FDA approval of the Mirena only for women with children). The CDC writes, “Strategies to address provider barriers to offering LARC include: 1) educating providers that LARC is safe for teens; 2) training providers on LARC insertion and a client-centered counseling approach that includes discussing the most effective contraceptive methods first; and 3) providing contraception at reduced or no cost to the client.”
Do some research, and ask your medical provider about Long-Acting Reversible Contraception. It’s so much better than sliced bread.