title: Urban-rural differences in attitudes and practices toward long-acting reversible contraceptives among family planning providers in Texas.
abstract: BACKGROUND
  Despite the elevated rates of teen and unplanned pregnancies across the United States, long-acting reversible contraceptives (LARCs) remain a less utilized birth control method. The present study investigated family planning providers' attitudes and considerations when recommending family planning methods and LARCs to clients. Additionally, this study explored whether urban-rural differences exist in providers' attitudes toward LARCs and in clients' use of LARCs.
  
  
  METHODS
  Data were collected using an online survey of family planning providers at Title X clinics in Texas. Survey data was linked to family planning client data from the Family Planning Annual Report (2008).
  
  
  RESULTS
  Findings indicated that, although providers were aware of the advantages of LARCs, clients' LARC use remains infrequent. Providers reported that the benefits of hormone implants include their effectiveness for 3 years and that they are an option for women who cannot take estrogen-based birth control. Providers acknowledged the benefits of several types of LARCs; however, urban providers were more likely to acknowledge the benefits of hormone implants compared with their rural counterparts. Results also indicated barriers to recommending LARCs, such as providers' misinformation about LARCs and their caution in recommending LARCs to adolescents. However, findings also indicated providers lack training in LARC insertion, specifically among those practicing in rural areas.
  
  
  CONCLUSIONS
  In light of the effectiveness and longevity of LARCs, teenagers and clients living in rural areas are ideal LARC candidates. Increased training among family planning providers, especially for those practicing in rural areas, may increase their recommendations of LARCs to clients.
authors.affiliation: Population Research Center, University of Texas at Austin, TX, USA. mvaaler@yahoo.com
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Vaaler
authors.forename: Lauri K
authors.initials: LK
authors.lastname: Kalanges
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Fonseca
authors.forename: Brian C
authors.initials: BC
authors.lastname: Castrucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D003267:Contraception / Q000379:methods*; D003270:Contraceptive Agents; D003692:Delayed-Action Preparations; D005193:Family Planning Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D013781:Texas; D014505:Urban Population; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents; D003692:Delayed-Action Preparations