Immediate Postpartum Long Acting Reversible Contraception

Project Status: In Sustainment

This project was published by the American Journal of Obstetrics and Gynecology on December 12, 2019.

Years Active: 2018-2019

Project Aim

To improve the health of infants as well as eligible, desiring mothers in Tennessee by increasing access to contraception through systematically promoting and supporting immediate postpartum LARC in the birth setting in Tennessee, thus reducing unplanned pregnancies, improving pregnancy spacing, and potentially reducing NAS births.

IMMEDIATE AIM: To increase access to immediate postpartum LARC to 50 % of participating institutions by March 2019. Once an institution’s supporting structure is complete, to increase placement in eligible women desiring immediate postpartum LARC to 70% by March 2019.

Key Driver Diagram

Project Narrative

Approximately 45% of all pregnancies and 75% of U.S. teen pregnancies are unintended. In 2013, around 57.5% of women who gave birth stated that they had not been trying to get pregnant but only 43.4% of these women were actively using contraception (TDH Data, 2016). Additionally, of the deliveries in 2014, 22.7% were defined as short-interval pregnancies (TDH Data, 2016). These data indicate for women in Tennessee, there is an overall lack of access to effective, long-acting reversible contraception (LARC). Immediate postpartum placement of long-acting reversible contraception (IPP LARC) is safe, effective, and provides a window of opportunity for women to gain access to contraception. (Committee Opinion No. 642)

As of November 2nd, 2017, a policy change has allowed postpartum women with TennCare coverage to receive IPP LARC as a means to address the gap in contraceptive access. The Tennessee Initiative for Perinatal Quality Care (TIPQC) launched IPP LARC as the Maternal Quality Improvement Project under the direction of the TIPQC Medical Director, Nikki Zite, MD, MPH. The goal is to increase access to IPP LARC for all women in Tennessee by working with providers, hospitals, pharmacies, nurses, lactation consultants, and commercial insurance providers to decrease barriers and extend IPP LARC access across the state of Tennessee. Ultimately, this goal will help women have control over their reproductive choice while improving the health of infants through the lowering of unintended and short-interval pregnancy rates as well as rates of neonatal abstinence syndrome across the state.

Patient Resources (English)

Patient Resources (Spanish)

Project Resources

TIPQC Immediate Postpartum LARC Toolkit
Project Application
TN Department of Health PPLARC Letter
PPLARC IRB Approval Letter
Private Pay Letter PPLARC
TIPQC Immediate Postpartum LARC Toolkit
Article: Role of Bridge Contraception in Postpartum
PPLARC Guidelines
PPLARC Nursing Care Presentation
All health care providers performing LARC insertions must complete appropriate training. Providers performing implant insertions and removals must complete manufacturer training. ACOG’s LARC Program provides a list of clinical training for each of these devices. For information on training sessions, visit: https://pcainitiative.org/
American College of Obstetricians & Gynecologists. (2017) Counseling adolescents about contraception. Committee Opinion No. 710. Obstetrics and Gynecology, 130, e74-80.
American College of Obstetricians & Gynecologists. (2016a) Optimizing postpartum care. Committee Opinion No. 666. Obstetrics and Gynecology, 127, e187-192.
American College of Obstetricians & Gynecologists. (2016b) Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670. Obstetrics and Gynecology, 128, e32-37.
American College of Obstetricians & Gynecologists. (2016c). Clinical challenges of long-acting reversible contraceptive methods. Committee Opinion No. 672. Obstetrics and Gynecology, 128, e69-77.
American College of Obstetricians & Gynecologists. (2015a) Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Committee Opinion No. 642. Obstetrics & Gynecology, 126, e44-48.
American College of Obstetricians & Gynecologists. (2015). Access to contraception. Committee Opinion No. 615. Obstetrics and Gynecology, 125, 250-255.
American College of Obstetricians & Gynecologists. (2012). Adolescents and long-acting reversible contraception: implants and intrauterine devices. Committee Opinion No. 539. Obstetrics and Gynecology, 120, 983-988.
American College of Obstetricians & Gynecologists. (2011, reaffirmed 2015) Long-acting reversible contraception; implants and intrauterine devices. Committee Opinion No. 121. Obstetrics & Gynecology, 118, 184-196.

Project State Leader

The PPLARC project is headed by Nikki Zite, MD.

Nikki received her MD from Northwestern University in 1998. She got her introduction to Tennessee in OB/GYN residency at The University of Tennessee Health Science Center in Memphis from 1998-2002 before she went back home to Chicago for a Family Planning Fellowship and earning her MPH at the University of Illinois School of Public Health. Marriage brought her back to Tennessee, this time for her husband’s residency in Urology at The University of Tennessee Graduate School of Medicine in Knoxville, where she joined the faculty in 2004. They took a one year leave to complete his fellowship at the Cleveland Clinic, and then returned to Knoxville and have been there since 2009. She is currently Program Director and Professor in the OB/GYN department. Her research focuses on contraceptive counseling, access and barriers to female sterilization and long acting reversible contraception. Nikki is excited to be part of TIPQC and to work with this amazing organization to work to improve the health of women and infants in Tennessee.