OBJECTIVES: Improving timely same-day access to long-acting reversible contraception (LARC) for everyone who is medically eligible and desires to do so is a key component of reproductive healthcare. This study aimed to synthesize the literature investigating the impact of same-day LARC insertion as well as barriers and facilitators to same-day LARC access in the US.

METHODS: A systematic literature review was conducted in January 2023 to identify relevant literature from 2010 onwards using Medline, EMBASE, CINAHL, and ScienceDirect databases. Studies reporting on the health and economic benefits, as well as studies commenting on factors affecting access of same-day LARC insertion were included.

RESULTS: Thirty-three studies investigating same-day LARC insertion across 21 states, 1,472 clinics, and 9,040 practitioners were included. Sixteen initiatives aimed at increasing same-day LARC uptake were captured, with provider training / education, patient-centered counseling, cost support, increased LARC availability, and implementation of evidence-based best practices as common features. All seven studies that reported same-day LARC placement-related outcomes before and after program implementation showed an increase in the number of same-day placements after program implementation. Facility practices being not amenable to same-day insertion (e.g., lack of time and/or on-site availability of devices, scheduling challenges, and a lack of walk-in and same-day appointments) were identified as the most common barrier. Other barriers include insurance-related hurdles (e.g., select or partial device coverage, inadequate reimbursement, and/or preapproval required) and a lack of training / education on LARC. Same-day LARC placement was associated with cost savings of $2,117 USD per adolescent per year in one study when compared to requiring a second visit.

CONCLUSIONS: Programs aimed at increasing same-day LARC insertion were associated with increases in same-day LARC uptake and cost savings. Opportunities to ensure same-day LARC access include promoting user and provider awareness, extending funding, decreasing insurance-related administrative hurdles, and building trust in contraceptive care.