title: Projections and opinions from 100 experts in long-acting reversible contraception.
abstract: OBJECTIVE
  This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods.
  
  
  METHODS
  We identified 182 authors of 59 peer-reviewed papers on LARC use published since 2013. A total of 104 completed an internet survey. We used descriptive and multivariate analyses to assess LARC use barriers and respondent characteristics associated with LARC projections and opinions.
  
  
  RESULTS
  The most commonly identified barrier was the cost of the device (63%), followed by women's knowledge of safety, method acceptability and expectations about use. A shortage of trained providers was a commonly cited barrier, primarily of primary care providers (49%). Median and modal projections of LARC use in the absence of these barriers were 25-29% of contracepting women. There was limited support for provider incentives and almost no support for incentives for women to use LARC methods, primarily out of concern about coercion.
  
  
  CONCLUSIONS
  Clinical and social science LARC experts project at least a doubling of the current US rate of LARC use if barriers to method provision and adoption are removed. While LARC experts recognize the promise of LARC methods to better meet women's contraceptive needs, they anticipate that the majority of US women will not choose LARC methods. Reducing unintended pregnancy rates will depend on knowledge, availability and use of a wider range of methods of contraception to meet women's individual needs.
  
  
  CONCLUSIONS
  Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women's reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use.
authors.affiliation: University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA. Electronic address: fosterd@obgyn.ucsf.edu.
authors.forename: Diana Greene
authors.initials: DG
authors.lastname: Foster
authors.affiliation: University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
authors.forename: Rana
authors.initials: R
authors.lastname: Barar
authors.affiliation: University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Gould
authors.affiliation: University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
authors.forename: Ivette
authors.initials: I
authors.lastname: Gomez
authors.affiliation: University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Nguyen
authors.affiliation: University of California, San Francisco, Advancing New Standards in Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
authors.forename: M Antonia
authors.initials: MA
authors.lastname: Biggs
mesh_terms: D003267:Contraception / Q000379:methods / Q000523:psychology / Q000639:trends*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003273:Contraceptive Devices / Q000191:economics / Q000639:trends*; D005104:Expert Testimony; D005193:Family Planning Services / Q000191:economics / Q000600:supply & distribution; D005260:Female; D005544:Forecasting; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D015999:Multivariate Analysis; D058007:Physicians, Primary Care / Q000191:economics / Q000600:supply & distribution; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology; D012052:Reimbursement, Incentive; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D003271:Contraceptive Agents, Female
keywords: Barrier to use; Contraceptive implant; Intrauterine contraceptives; Policy recommendations; Projection