title: Availability of Long-Acting Reversible Contraception in Kansas Health Departments.
abstract: OBJECTIVE
  Unintended pregnancy persists as a public health problem in the United States. Local health departments (LHDs) could play an important role in preventing unintended pregnancy by promoting and providing long-acting reversible contraception (LARC, intrauterine devices [IUDs] and implants), particularly in rural states that may lack robust family planning service infrastructure. The objective of this study was to determine availability of LARC in LHDs in Kansas.
  
  
  METHODS
  From October 2015 to January 2016, LHD administrators in Kansas were contacted to participate in a structured, cross-sectional phone survey assessing LARC availability, staff trained to place LARC, the process for obtaining LARC, and barriers to offering LARC. The main outcome measure was the proportion of Kansas LHDs offering LARC.
  
  
  RESULTS
  Of 101 eligible LHDs, staff from 98 agreed to be interviewed (97.0%). Of 69.4% providing family planning services, 20.6% provided LARC (20.6% provided IUDs, 11.8% provided implants and IUDs, and none provided implants only). Overall, only 29.4% of LHDs reported discussing contraception routinely regardless of reason for visit. Rural health departments were less likely to offer testing for sexually transmitted infections and LARCs and less likely to have trained staff on site to insert LARCs when compared to nonrural LHDs.
  
  
  CONCLUSIONS
  LARC methods are not commonly available in Kansas LHDs. Small LHDs in a rural state like Kansas could benefit from increased capacity to provide LARC to populations with limited access to health care. An increase in funding to prevent unintended pregnancy through expanded LARC access could result in substantial state savings and lead to fewer unintended pregnancies.
authors.affiliation: University of Kansas Medical School, Kansas City, Kansas.
authors.forename: Tawana
authors.initials: T
authors.lastname: Evans
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical School, Kansas City, Kansas.
authors.forename: Megha
authors.initials: M
authors.lastname: Ramaswamy
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical School, Kansas City, Kansas.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Satterwhite
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006078:Government Programs / Q000592:standards / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D007615:Kansas; D009111:Local Government; D000075523:Long-Acting Reversible Contraception / Q000379:methods / Q000706:statistics & numerical data*; D011634:Public Health / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: contraception; health department; intrauterine devices; long-acting reversible contraception; unintended pregnancy