Original Research Article| Volume 113, P73-77, September 2022

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Comparing methods of long-acting reversible contraception: A qualitative study of Delaware women's perceptions of intrauterine devices and the implant



      To distinguish Delaware women's perceptions of the intrauterine device (IUD) relative to the subdermal arm implant (implant) as well as to compare their perceptions of various IUD types.

      Study Design

      In this qualitative study, we conducted in-depth interviews with 86 self-identified women between 16 and 44 years old who resided in the state of Delaware. We used quota sampling to ensure a diversity of perspectives using age, socioeconomic status, race/ethnicity, and county of residence to do so. We analyzed the data for content and themes using deductive and inductive techniques.


      Of the 47 participants who would use long-acting reversible contraception (LARC), 36 favored IUDs over the implant, and 11 felt more comfortable with the implant. Participants’ perceptions were primarily influenced by device side effects, body placement, and the removal process. Those favoring a specific IUD prioritized the presence of exogenous hormones, device size, and maximum duration of use. Thirty-nine women would not use IUDs or the implant, citing safety risks and the availability of "simpler" methods.


      Clinicians often use tier-based descriptions when counseling patients about contraception, particularly when emphasizing the similar efficacy levels of LARC devices. Participants in our study did not perceive LARC as a homogeneous category; rather, they consistently differentiated between IUDs and implants as well as between IUD types. Such findings demonstrate the need to understand which device features inform these distinct preferences and how providers’ contraceptive counseling practices can be adjusted in response.


      Given these findings, scholars should compare and further distinguish across methods, including IUDs, whenever possible. The findings also reinforce the benefits of stocking a variety of LARC devices at clinic and practice sites and encouraging provider counseling that emphasizes method-specific concerns and features. Doing so centers users’ needs and preferences.


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      1. Centers for Disease Control and Prevention, 2018, Accessed from:; Accessed at: March 6, 2022.

        • Bertotti AM
        • Mann ES
        • Miner SA.
        Efficacy as safety: dominant cultural assumptions and the assessment of contraceptive risk.
        Soc Sci Med. 2021; 270
        • Kramer RD
        • Higgins JA
        • Godecker AL
        • Erenthal DB.
        Racial and ethnic differences in patterns of long-acting reversible contraceptive use in the United States, 2011–2015.
        Contraception. 2018; 97: 399-404
        • Kywanna A
        • Holmes KM.
        The intersection of race and class and the use of long acting reversible contraception (LARC) a quantitative analysis.
        Obstet Gynecol. 2019; 133: 10S
      2. Guttmacher Institute. Contraceptive use in the United States by method, 2021, Accessed from:; Accessed at: March 6, 2022.

        • Grunloh DS
        • Casner T
        • Secura GM
        • Peipert JF
        • Madden T.
        Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use.
        Obstet Gynecol. 2013; 122 (10.1097%2F01.AOG.0000435452.86108.59): 1214-1221
        • McNicholas C
        • Madden T
        • Secura G
        • Peipert J.
        The contraceptive CHOICE project round up: what we did and what we learned.
        Clin Obstet Gynecol. 2014; 57 (10.1097%2FGRF.0000000000000070): 635-643
        • Borrero S
        • Nikolajski C
        • Steinberg J
        • Freedman L
        • Akers A
        • Ibrahim S
        • et al.
        ‘It just happens’: a qualitative study exploring low-income women's perspectives on pregnancy intention and planning.
        Contraception. 2015; 91: 150-156
        • Gomez AM
        • Freihart B.
        Motivations for interest, disinterest and uncertainty in intrauterine device use among young women.
        Matern Child Health J. 2017; 21: 1753-1762
        • Gomez AM
        • Mann ES
        • Torres V.
        “It would have control over me instead of me having control”: intrauterine devices and the meaning of reproductive freedom.
        Crit Public Health. 2018; 28: 190-200
        • Hall KS
        • Ela E
        • Zochowski MK
        • Caldwell A
        • Moniz M
        • McAndrew L
        • et al.
        “I don't know enough to feel comfortable using them:” women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus.
        Contraception. 2016; 93: 556-564
        • Harvey SM
        • Oakley LP
        • Washburn I
        • Agnew C.
        Contraceptive method choice among young adults: influence of individual and relationship factors.
        J Sex Res. 2018; 55: 1106-1115
        • Higgins JA.
        Pregnancy ambivalence and long-acting reversible contraceptive (LARC) use among young adult women: a qualitative study.
        Perspect Sex Reprod Health. 2017; 49: 149-156
        • Mann ES
        • White AL
        • Beavin C
        • Dys G.
        Foreign objects in college bodies: young women's feelings about long-acting reversible contraception (LARC).
        Womens Health. 2020; 60: 719-733
        • Payne JB
        • Sundstrom B
        • DeMaria AL.
        A qualitative study of young women's beliefs about intrauterine devices: fear of infertility.
        J Midwifery Womens Health. 2016; 61: 482-488
        • Pritt NM
        • Norris AH
        • Berlan ED.
        Barriers and facilitators to adolescents’ use of long-acting reversible contraceptives.
        J Pediatr Adolesc Gynecol. 2016; 30: 18-22
        • Mann ES
        • Grzanka PR.
        Agency-without-choice: the visual rhetorics of long-acting reversible contraception promotion.
        Symb Interact. 2018; 41: 334-356
        • Gomez AM
        • Fuentes L
        • Allina A
        Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods.
        Perspect Sex Reprod Health. 2014; 46 (10.1363%2F46e1614): 171-175
        • Gubrium AC
        • Mann ES
        • Borrero S
        • Dehlendorf C
        • Fields J
        • Geronimus AT
        • et al.
        Realizing reproductive health equity needs more than long-acting reversible contraception (LARC).
        Am J Public Health. 2016; 106 (10.2105%2FAJPH.2015.302900): 18-19
        • Dehlendorf C
        • Grumbach K
        • Schmittdiel JA
        • Steinauer J.
        Shared decision making in contraceptive counseling.
        Contraception. 2017; 95: 452-455
        • Berndt VK
        • Bell AV.
        “This is what the truth is”: Provider-patient interactions serving as barriers to contraception.
        Health. 2021; 25 (10.1177%2F1363459320969775): 613-629
      3. Choi YS, Rendall MS, Boudreaux M, Roby DH. Summary of the delaware contraceptive access now (DelCAN) initiative, 2020, Accessed from:; Accessed at: October 27, 2021].

        • Morse JM.
        The significance of saturation.
        Qual Health Res. 1995; 5 (10.1177%2F104973239500500201): 147-149
        • Small ML.
        How many cases do I need? On science and the logic of case selection in field-based research.
        Ethnography. 2009; 10 (10.1177%2F1466138108099586): 5-38
        • Birks M
        • Chapman Y
        • Francis K.
        Memoing in qualitative research: probing data and processes.
        J Res Nurs. 2008; 13 (10.1177%2F1744987107081254): 68-75
        • Diedrich JT
        • Zhao Q
        • Madden T
        • Secura GM
        • Peipert JF.
        Three-year continuation of reversible contraception.
        Am J Obstet Gynecol. 2015; 213: 1-8
        • Secura GM
        • Allsworth JE
        • Madden T
        • Mullersman JL
        • Peipert JF.
        The contraceptive CHOICE project: reducing barriers to long-acting reversible contraception.
        Am J of Obstet Gynecol. 2010; 203: 1-7
        • Gomez AM
        • Đỗ L
        • Ratliff GA
        • Crego PI
        • Hastings J.
        Contraceptive beliefs, needs, and care experiences among transgender and nonbinary young adults.
        J Adolesc Health. 2020; 67: 597-602