So, You’ve Chosen the IUD. What’s Next?

Long-acting reversible contraception methods, or LARCs, are finally getting their due in reproductive health. Made affordable by the Affordable Care Act, and recognized by providers and patients alike as an effective, appropriate, and safe form of birth control for women of all ages, more and more women are choosing LARCs like implants and IUDs as their primary method to prevent an unintended pregnancy. But what happens after a woman decides on a LARC method as her birth control?

Right now, according to Samantha Garbers, assistant professor of Population and Family Health at the Mailman School, LARCs are thought of as a “get it and forget it” method of contraception—but some women using LARCs are better able to “forget it” than others. Young women may experience heavier or irregular menstrual cycles, or pain, particularly in the first few months after insertion. For some women, especially adolescents, these changes can be confusing and difficult to deal with if they aren’t seeking regular counseling. 

“There’s evidence that a certain portion of women who choose a birth control method end up dissatisfied with it—specifically because they don’t know how to manage the side effects,” says Garbers. “They don’t know what to do when they experience a side effect, so they discontinue a method.”

Of the 6.6 million pregnancies that occur in the United States every year, more than half (51 percent) are unintended, a rate that has remained about the same since the 1970s. To reduce this number and help more women have children if and when they decide to, public health experts stress the importance of helping women choose, and continue to use, a birth control method that’s right for them.

As the popularity of LARCs skyrockets, Garbers wants to ensure that as soon as a woman chooses to get an IUD or implant, she has the support and access to resources she needs to continue using it. This support is especially important for young women, where the growth in LARC usage has been strong: in 2005, 0.4 percent of women aged 15-19 were using LARCs—by 2013, that number had risen to 7.1 percent of women in the same age group.

An App for That

Garbers hopes that a smartphone app can help young women who choose LARCs access coping methods for side effects, answers to questions, and other resources. As a recipient of this year’s Calderone Junior Faculty Award, Garbers will use its funding support to determine if this kind of app is the right approach, and if so, to come up with an effective app design.

To begin her research, Garbers will collaborate with School Based Health Centers in New York City operated by the Center for Community Health & Education of New York Presbyterian. At the centers, which are independently run by the CCHE and located on the grounds of several high schools, young women have access to a full range of contraceptive methods, including LARCs. Melanie Gold, who serves as medical director of the School Based Health Centers for the Department of Pediatrics at Columbia University Medical Center and the Morgan Stanley Children’s Hospital, undertook a quality improvement initiative to understand her young female patients’ satisfaction with LARC services, as well as their ongoing questions and needs. Working with Gold, Garbers plans to use these findings to conceptualize and design her app. Next she’ll work with the School Based Health Centers to test app prototypes with teenage patients who are receiving LARC services.

Garbers, who teaches a course in program evaluation and has worked on apps previously, sees these first steps as crucially important. Testing whether or not people will use an app—and use it often enough to make a positive impact on their behavior—is key to any public health intervention relying on technology.

“Apps that make a difference to a person’s health don’t follow the ‘If you build it, they will come’ model,” says Garbers. “You have to find out what people want, build prototypes, test it out, and keep making changes to build something people actually use.”