Original research article Long-acting reversible contraception method use among Title X providers and non-Title X providers in California Hye-Youn Park, Maria I. Rodriguez, Denis Hulett, Philip D. Darney, Heike Thiel de Bocanegra ⁎ Bixby Center for Global Reproductive Health, University of California, San Francisco, P.O. Box 997420, MS8400, Sacramento, CA 95899-7420, USA Received 11 February 2012; revised 17 April 2012; accepted 17 April 2012 Abstract Background: Publicly funded family planning services play an important role in reducing unintended pregnancy by providing access to effective contraception. We assessed whether California family planning providers receiving federal Title X funds are more likely to offer on-site long-acting reversible contraception (LARC) methods than those who do not receive these funds. Study Design: Using 2009 administrative data, we examined on-site utilization of LARC by clinic type (Title X public, non-Title X public, or private) and constructed beta-binomial logistic regression models. Results: The odds of on-site LARC services in non-Title X public and private providers were decreased by 35% [Odds Ratio (OR)=0.65, 95% confidence interval (CI) 0.54–0.79] and 61% [OR=0.39, 95% CI 0.32–0.47], respectively, compared to those of Title X providers after controlling for clinic size, urban/rural location, and proportion of teen, African–American, and Latina clients. Conclusions: On-site utilization of LARC is a potential quality indicator for family planning programs. Title X resources are associated with increased use of LARC. Published by Elsevier Inc. Keywords: Long-acting reversible contraception (LARC); Title X; Contraception; Quality indicators 1. Introduction Family planning is fundamental to women's health. The average American woman desires two children and will spend 30 years contracepting [1]. Unintended pregnancy has significant consequences for the health and well-being of the woman and, if the pregnancy results in a delivery, the subsequent generation [2]. Despite a wide array of effective contraceptive methods, unintended pregnancy remains endemic in the United States [3,4]. Nationwide, nearly half of pregnancies are unintended [5]. In California, over 40% of all live births in 2006 were attributed to unintended pregnancy [6]. In addition to the adverse impact mentioned above, unplanned pregnancy continued to term is associated with delayed prenatal care, low infant birth weight and an array of infant and maternal morbidity and mortality [2,7]. From a societal perspective, unintended pregnancy has significant direct and indirect costs [8,9]. Long-acting reversible contraception (LARC) has the potential to decrease unintended pregnancy by reducing barriers to correct and consistent contraceptive use. LARC methods are highly effective and do not require daily administration, or use, at time of intercourse. LARC methods available in the United States include intrauterine contracep- tion (IUCs) and implants. Although LARC methods have many advantages over other reversible methods (oral contraceptives, condoms) [10–12], the majority of women are still using less effective methods [13]. Among US women using contraception, the use of LARC methods was only 5.6% in 2006–2008 [14]. In California, the numbers were slightly higher: 7.5 % of women using contraception in 2004–2007 were using IUCs (7.2%) and implants (0.3%) [15]. While increased use of LARC methods has the potential to reduce the high unintended pregnancy rate in the United States, systemic and logistical barriers limit increased uptake. Providing IUCs and implants requires specialized clinician training. Prior to being able to insert a contraceptive implant, clinicians must attend a training approved by the US Contraception 86 (2012) 557 – 561 ⁎ Corresponding author. Tel.: +1 916 552 8793. E-mail addresses: thielh@obgyn.ucsf.edu, heike.thiel@cdph.ca.gov (H. Thiel de Bocanegra). 0010-7824/$ – see front matter. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.contraception.2012.04.006