Same-day long-acting reversible contraceptive (LARC) placement: a systematic review of the benefits and barriers in the United States

Abstract Background Increasing same-day placement rates of long-acting reversible contraceptives (LARCs) for individuals who are medically eligible and desire to do so is a key component of contraceptive access. The objective of this literature review was to characterize data on the effectiveness and economic impact of programs aimed at increasing same-day LARC placement in the United States (US). Methods A systematic literature review was conducted January 2023 to identify relevant literature from 2012 onwards using Medline, EMBASE, and CINAHL databases. Studies reporting rates of same-day LARC placement, economic benefits related to specific programs or policies, or factors affecting access to same-day LARC placement were included. Key recommendations, including actionable insights to improve access to same-day LARC, were summarized. Results Thirty-three publications, representing 31 unique studies investigating same-day LARC placement across 21 states were included. Seven studies evaluated outcomes pre- and post-implementation of programs for same-day LARC placement, and all reported an increase in the rate of same-day LARC placements post-program implementation. Two studies estimated cost savings (USD) associated with same-day LARC placement, one estimated savings of $2,117 per adolescent per year when compared to requiring a second visit, and the second estimated savings of approximately $80 million through an assumed statewide scale-up of the evaluated program. Actionable insights to promote same-day LARC placement included staff and provider training, streamlining pregnancy and screening requirements, increasing LARC availability, and providing financial assistance. Conclusions Programs for increasing same-day LARC placement were associated with increases in same-day LARC uptake and cost savings.