Long-Acting Reversible Contraceptives for Incarcerated Women: Feasibility and Safety of On-Site Provision.
BACKGROUND
Many incarcerated women have an unmet need for contraception. Providing access to long-acting reversible contraceptive (LARC) methods--IUDs and implants--before release is one strategy to meet this need and potentially prepare them for reentry to the community, but the safety and feasibility of providing these methods in this setting have not been described.


METHODS
A retrospective descriptive study of all LARC insertions at the San Francisco County Jail in 2009-2014 was conducted. Data from community clinic and jail clinic databases were assessed to examine baseline characteristics of LARC initiators, complications from insertion, method continuation, and pregnancy and reincarceration rates. Correlates of method discontinuation were assessed in multivariate logistic regression analyses.


RESULTS
Eighty-seven LARC devices were inserted during the study period--53 IUDs and 34 implants. There were no cases of pelvic inflammatory disease or other insertion complications in IUD users and no serious complications in implant users. Median duration of known use was 11.4 months for IUDs and 12.9 months for implants. Women who discontinued a LARC method most commonly cited a desire to get pregnant (32%). Black women were more likely than whites to discontinue use (odds ratio, 4.4).


CONCLUSIONS
It is safe and feasible to provide LARC methods to incarcerated women. Correctional facilities should consider increasing access to all available contraceptives, including LARC methods, in a noncoercive manner as a strategy to reduce reproductive health disparities among marginalized women at high risk of unplanned pregnancies.
Assistant professor, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore. carolynsufrin@gmail.com.
Carolyn
C
Sufrin
Student at the School of Medicine, University of California, San Francisco.
Tianyi
T
Oxnard
Director, Jail Health Services, San Francisco Department of Public Health.
Joe
J
Goldenson
Assistant director of program management, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.
Kristin
K
Simonson
Assistant professor, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.
Andrea
A
Jackson
D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D005193:Family Planning Services / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D011329:Prisoners; D011330:Prisons; D012189:Retrospective Studies; D012495:San Francisco; D055815:Young Adult
D003271:Contraceptive Agents, Female