Multilevel Barriers to Long-Acting Reversible Contraceptive Uptake: A Narrative Review.

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice.

Operationalizing antiracism in health systems: Strategies state government administrative organizations use towards racial and ethnic mental health equity.

Although a growing body of literature recommends strategies for improving racial equity in organizations and populations, little is known about how racial equity goals are operationalized in actuality, particularly in the context of state health and mental health authorities (SH/MHAs) attempting to promote population wellness while navigating bureaucratic and political constraints. This article seeks to examine the number of states engaging in racial equity work in mental health care, what strategies SH/MHAs use to improve their state's racial equity in mental health care, and how the workforce understands these strategies. A brief survey of 47 states found that all but one state (98%) is enacting racial equity interventions in mental health care. Through qualitative interviews with 58 SH/MHA employees in 31 states, I created a taxonomy of activities within six overarching strategies: 1) running a racial equity group; 2) gathering information and data about racial equity; 3) facilitating training and learning for staff and providers; 4) collaborating with partners and engaging with communities; 5) offering information or services to communities and organizations of color; and 6) promoting workforce diversity. I describe specific tactics within each of the strategies as well as the perceived benefits and challenges of the strategies. I argue that strategies bifurcate into development activities, which are activities creating higher-quality racial equity plans, and equity-advancing activities, which are actions directly impacting racial equity. The results have implications for how government reform efforts can impact mental health equity.