Colorado learned valuable lessons as a leader in the effort to expand access to the most effective forms of contraception. Here are few tips and key learnings.

Partner with existing systems

Start by reaching out to partners and clinics that are well-versed in family planning. Advantages of working with existing family planning partners includes ease in start-up, existing clinical guidelines and protocols, access to an existing client population, ease in funding distribution, access to experienced staff and opportunities to work with a 340B Federal Drug recipient that receives lower-cost pharmaceuticals. Consider taking a planning year, if possible, with your partners to build trust and a common implementation timeline.

Organize your data

Ensure you have the “before” data to help show the impact of the LARC investment. Examples include birth rate, age, income, county, abortion, Title X program. Colorado also collected additional LARC insertion and removal data points. Data was tracked annually to show impact and build a case for support moving forward. Births averted and cost avoidance (to other state programs) was calculated from this baseline data.

Build a network of LARC champions

A network of champions for the effort is essential to build both high-level and local-level support. These champions should be distributed across the medical, civic and political communities to ensure widespread implementation for the program as well as ongoing support for its continuation.

Offer low cost LARC and train providers and clinic staff

Evidence shows the high cost of LARC is a primary barrier to receiving it as a contraceptive method. When that barrier is removed, clients are more likely to choose a LARC method.  Cost barriers can be addressed in a number of ways:

  • Providing LARCsPut LARC devices on the same sliding fee scale as other contraceptive methods. Do not provide LARC devices for free and charge for other methods. Ensure LARC removal is on the same sliding fee scale 

  • Make certain all LARC methods are included in state Medicaid benefits and reimbursed adequately. Medicaid waiver/state plan amendment options offer expanded eligibility for family planning services

  • Make certain all LARC methods are included in private insurance benefits

  • Partner with 340B health center to ensure lower price devices

  • Use federal funding (Title X, MCH, TANF, others), state and county funding

  • Utilize patient/payment assistance programs

  • Other funding – seek gifts, grants, donations to supplement

Provide training for all clinical providers and clinic staff including:

  • Offer on-going LARC insertion training for new providers

  • Offer on-going LARC removal for providers

  • Offer on-going Motivational Interviewing and Patient Centered Counseling training

  • Debunk old myths about LARCs for teens

  • Offer refresher courses for existing providers

  • Solicit pharmaceutical companies for various LARC training kits and support for training activities

  • Provide hands-on training using models or actual patients, if possible

  • Offer training on side effects and counseling techniques that ensure clients understand options and what to expect

  • As providers become more competent, offer advanced training topics

Provide training to clinic staff including:

  • General LARC overview

  • Negotiating Insurance contracting

  • Annual billing and coding training

  • Clinic efficiency

  • Same day insertions

Analyze Data

Key data that help to prove the value of expanded access to LARC include:

Unintended pregnancy: The ultimate measure is unintended pregnancy data. This data is collected in many states through the Pregnancy Risk Assessment Monitoring System (PRAMS).

Fertility rates and birth data: If the number of births is going down, there are likely fewer unintended pregnancies. Birth data or fertility rates (particularly for demographic groups you are targeting) can be a leading indicator of success and are usually available much sooner than PRAMS data. Fertility rates are usually obtained through birth data collected by a state’s vital records authority.

Patient demographics: Patient demographics are important, especially when looking at overall population changes and understanding program impact on health disparities. Minimum data elements ideally include: age, county of residence, income, and race and ethnicity.

Abortion data: If this data is collected and accessible, it may be helpful to show program impact. If possible, try to breakdown data by demographics of target populations.

Insertion and clinic visit data: This type of information is helpful in terms of process measures and what level of impact to expect. Insertion and clinic visit data immediately showcase what your program has done.

Education, Outreach and Marketing

An important and powerful communication strategy is simply word-of-mouth. A satisfied client telling friends and family, particularly among teens, has more clout than other advertisements and is often more effective than a provider’s recommendations. Other helpful and effective marketing strategies include bus benches, ads in newspapers, including school newspapers, community events and social media.

Key Lessons Learned

  1. Do not advertise your program as “free LARCs”. You must offer all FDA approved methods, including LARC, on the same sliding fee scale. You cannot offer LARCs free of costs and other methods at a charge

  2. To debunk the notion of coercion, ensure you include LARC removals, motivational interviewing and patient-centered counseling in all of your talking points

  3. Follow best practices in patient counseling and having set clinical guidance help to address concerns regarding coercion

  4. Build a funding sustainability plan that includes a variety of funding streams and strategies

  5. Know all of the Medicaid and private insurance challenges in your state

  6. Supportive minor consent laws are imperative

  7. Be prepared to encounter and respond to opponents with evidence-based information

Reach out for additional help

Family Planning Program Prevention Services Division, Colorado Department of Public Health and Environment

LARC4CO Coalition

Colorado’s success is a direct result of broad community support and bi-partisan support among lawmakers. Continued access to LARCs ensure that Colorado remains a national leader, reducing unintended pregnancy, saving the state money, and securing a healthy future for thousands of Colorado women and their families.

LARC4CO is a broad coalition of over 60 organizations and groups statewide who support Colorado’s continued success in improving the health and well-being of Colorado’s children and families. To learn more contact Erin Miller at Erin@coloradokids.org or 303.620.4560.

Coalition Members

  • Alamosa County Public Health Department

  • American Academy of Pediatrics, Colorado Chapter

  • Boulder County Board of Commissioners

  • Boulder County Public Health

  • Center for Biological Diversity

  • Children’s Hospital Colorado

  • City of Commerce City

  • ClinicNET

  • Colorado Academy of Family Physicians

  • Colorado Access

  • Colorado Affiliate, American College of Nurse Midwives

  • Colorado Association for School-Based Health Care

  • Colorado Association of Infant Mental Health (CoAIMH)

  • Colorado Association of Local Public Health Officials (CALPHO)

  • Colorado Center on Law and Policy

  • Colorado Chapter, American Congress of Obstetricians and Gynecologists

  • Colorado Children’s Campaign

  • Colorado Community Health Network

  • Colorado Consumer Health Initiative

  • Colorado Counseling Association

  • Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR)

  • Colorado Public Health Association

  • Colorado Religious Coalition for Reproductive Choice

  • Colorado School Medicaid Consortium

  • Colorado Women’s Bar Association

  • Colorado Youth Matter

  • Delta County Health Department

  • Denver Health

  • Denver Public Health

  • Dolores County Public Health

  • Eagle County Commissioners

  • Eagle County Public Health & Environment

  • Early Childhood Partnership of Adams County

  • Fostering Colorado

  • Having Kids

  • Health District of Northern Larimer County

  • Healthier Colorado

  • Interfaith Alliance of Colorado

  • Jefferson County Public Health

  • Kaiser Permanente

  • Kids First Health Care

  • Lake County Public Health Agency

  • Lincoln County Public Health Department

  • March of Dimes

  • Montrose County Health and Human Services

  • Mountain Family Health Centers

  • NARAL Pro-Choice Colorado

  • National Association of Social Workers, Colorado Chapter

  • Northwest Colorado Visiting Nurse Association

  • Otero County Public Health Department

  • Ouray County Public Health

  • Pitkin County Board of County Commissioners

  • Pitkin County Public Health

  • Planned Parenthood of the Rocky Mountains

  • Public Health Nurses Association of Colorado

  • Pueblo-City County Public Health

  • Rio Grande County Public Health

  • Saguache County Public Health

  • San Juan Basin Health Department

  • San Miguel County Board of Commissioners

  • Summit County Board of Commissioners

  • The Aspen to Parachute Dental Health Alliance

  • The Consortium

  • Tri-County Health Department

  • Valley Wide Health Services

  • Women’s Foundation of Colorado

  • Women’s Lobby of Colorado