Contextualizing barriers to long-acting reversible contraception in Delaware.

Objective: We conducted this study to examine barriers to long-acting reversible contraception (LARC) that persist in the context of a large-scale LARC program, Delaware Contraceptive Access Now (Del-CAN), that has actively endeavored to remove such barriers.

Study Design: In 2016-2017, we conducted in-depth interviews with 86 self-identified women of reproductive age, diverse along the lines of age, race, and class, in the state of Delaware on their attitudes, beliefs, and behaviors regarding contraception. We analyzed the interviews using an inductive coding process.

Results: We found that, even in the midst of Del-CAN's efforts, meso and macro-level contexts, including provider-patient communication and clinic/practice structures, reinforced LARC barriers related to knowledge, access, and side effects.

Conclusions: The multi-level contexts and nuances we illuminate in our study currently fall outside the purview of well-intentioned, large-scale initiatives such as Del-CAN, that attempt to address and ameliorate oft-researched barriers. Thus, these barriers persist within provider-patient interactions and clinic/practice policies and structures.

Implications: The evaluated LARC-based intervention, Del-CAN, cannot fully address issues around provider autonomy, inadequate provider-patient communication, or practice-specific policies and criteria. In order for this intervention, and others like it, to be successful, they must be aware of and prepared to address such dimensions in their efforts.