Emphasizing the “Person” in Person-Centered Contraceptive Care and LARC Access
Person-centered care is care that responds to an individual’s preferences, needs, and values. Individual contraceptive preferences are influenced by a wide range of historical and social factors; these include racism, sexism, economic injustices, histories of trauma, and cultural preferences. The people who use contraception are equally diverse and the needs of adolescents compared to postpartum women or transgender men are distinct. Providing person-centered contraceptive care is a key component of achieving reproductive justice. Originally coined by a group of Black women in 1994, reproductive justice is defined as the human right to have a child, or not have a child, and to parent children in a safe and sustainable environment. Using a reproductive justice framework, person-centered care must also consider the context in which individuals live and the other factors that influence contraceptive choice and access.
IMI’s recently released report, “Advancing Person-Centered LARC Access among the Medicaid Population” emphasizes person-centered care while using a reproductive justice framework. LARC stands for long-acting reversible contraception and comes in two forms: the intrauterine device (IUD) and the progesterone arm implant. Compared to other forms of contraception, LARC is frequently associated with unique implementation and logistical barriers that can limit access. These barriers are often particularly salient for those enrolled in Medicaid. The report provides an overview of the key barriers that Medicaid managed care organizations, health clinics, and clinicians most often face in advancing LARC access. It also highlights three innovative case studies of Medicaid stakeholders who are currently implementing initiatives to address ongoing barriers and improve equitable access to LARC.
The Medicaid program has historically used racist and coercive contraceptive care practices, such as forced sterilization or forced use of LARC, to limit the bodily autonomy of poor and Black women. Racism in reproductive health and within the Medicaid program continues to exist today. Research shows how clinicians frequently use LARC centric and coercive contraceptive counseling when providing care to women of color. While many state Medicaid agencies and Medicaid health plans provide specific reimbursement for LARC devices and LARC insertion procedures, fewer provide reimbursement for LARC removal. Individuals in the postpartum period who receive a LARC after delivery may have limited options for an insurance covered LARC removal if their Medicaid coverage expires 60 days after delivery.
However, increased awareness and a commitment to eliminate racist and coercive behaviors has led to the development of person-centered LARC initiatives, like the case studies highlighted in the report. Our research found that success was linked to initiatives that offered LARC equitably among a range of other shorter acting and barrier contraceptive methods, emphasized person-centered contraceptive counseling, acknowledged the historical, social, and economic factors that influence contraceptive preferences, and collaborated with other sectors of the healthcare system. By advancing these strategies, Medicaid stakeholders have an opportunity to address racism in reproductive health head-on. The report also highlights how services can be tailored to certain groups of individuals, such as adolescents or individuals in the postpartum period.