Few Australian women use long-acting contraceptives, despite their advantages

Few Australian women use long-acting reversible contraception, despite its advantages over other methods. These contraceptives offer women long-term, cost-effective, “fit-and-forget” contraception.

Long-acting reversible contraception (LARC) includes intrauterine devices (IUDs) and implants that are usually inserted in the upper arm. In contrast to other commonly used contraceptives, such as the pill and condoms, LARC don’t require women who use them to do something to prevent pregnancy daily or every time they have sex.

Intervention is required only when a decision is made to stop their use, and fertility is restored when the contraception is removed.

Good but under-used

This type of contraception is highly effective for between three and ten years. Women using these methods have less chance of unintended pregnancy compared to women using other contraceptives.

In fact, along with sterilisation, these are the most effective means of contraception. This is because unlike other methods – such as the oral contraceptive pill, diaphragm, rings and condoms – whose effectiveness depends on correct and consistent use, compliance isn’t an issue.

Long-acting contraception is suitable for most women including the young, those who’ve never given birth, are breastfeeding or have recently given birth, and those with chronic health conditions. It’s also suitable for use just before menopause, and appropriate for women who should avoid oestrogen.

Despite these apparent benefits, our research shows Australian women don’t use these contraceptive methods very much when compared to women in other high-income countries.

Even though most of the 1,131 Australian women we surveyed had heard of IUD and implants, only 4% to 8% reported using these methods compared with 10% to 32% in Europe and 10% in the United States.

On the whole, our respondents thought these contraceptive methods were unreliable and said they were unlikely to consider using them. The findings of our study suggest women in Australia may not be using LARC due to misperceptions about side effects, suitability and cost.

Possible misunderstandings

Concerns about the side effects and safety of LARC may reflect women’s understanding of the risks of infection and infertility associated with older intrauterine devices. But modern long-acting contraception has been developed to overcome these early problems. They’re safe and US studies show they have higher rates of continuation and satisfaction than other contraceptive methods.

The effectiveness of long-acting contraceptive methods doesn’t depend on correct and consistent use.Hey Paul Studios/Flickr, CC BY

Religious beliefs may also influence choice of contraception away from long-acting options. We found women who said religion was important in their fertility choices were less likely to consider long-acting contraceptive methods as reliable. And they were less likely to consider using them.

What’s more, UK research also shows doctors may not comply with patient requests for certain methods of contraception because of their own personal religious beliefs.

Interestingly, our research team, along with others in Australia and the United States, found women who’ve had a pregnancy or an abortion are more likely to think long-acting contraception is reliable and consider using it.

It’s likely that women who have experienced a pregnancy or, especially, an abortion are more motivated to obtain more effective contraception and avoid further unintended pregnancies. And doctors are likely to pay greater attention to these women’s contraceptive needs.

Myriad barriers

We’ve also found that men tend to have less knowledge of these contraceptive methods and to perceive them as being less reliable. This is likely due to the fact that women are the primary users of LARC and that men may receive little contraception education. Still, the attitudes of male partners are important predictors of contraceptive use.

The cost of long-acting contraception could be a barrier for some Australian women. We found women who lived in socioeconomically advantaged areas were more likely to think of these contraceptive methods as reliable and consider using them than women who lived in disadvantaged areas.

It may be that the former have better health and access to health services and products, as well as money to spend on contraception. While implants and IUDs are subsidised by the Pharmaceutical Benefits Scheme, there are high costs – paid by the patient – for the insertion procedure. But despite their high initial cost, long-acting contraceptives are not expensive over the longer term. They cost about the same as the oral contraceptive pill over equivalent periods of use.

Doctors may be reluctant to prescribe these types of contraceptives because of uncertainty about their suitability. And they may have not received training on insertion. Indeed, a 2013 Australian study concluded doctors' beliefs were the most important barrier to women using these contraceptive methods.

To help women make the right contraceptive choice for their needs, we need to provide accurate, up-to-date information to them, their male partners and their doctors. And we need to ensure that cost doesn’t prevent a woman from using the contraceptive method best suited to her.

The authors, including Sara Holton, are investigators on the 'Understanding fertility management in contemporary Australia' study which was supported by an Australian Research Council Linkage Project Grant (LP100200432) with funding and in-kind contributions from Family Planning Victoria, Melbourne IVF, The Royal Women’s Hospital, and the Victorian Department of Health

Heather Rowe receives funding from the National Health and Medical Research Council, the Australian Government, the Australian Research Council, Australian Rotary Health, not-for profit organisations and philanthropic trusts.

Jane Fisher currently receives funding from the National Health and Medical Research Council, the Australian Research Council, the Australian Department of Social Services, the Australian Department of Health, the Victorian Department of Health and Human Services, Jean Hailes for Women's Health, Family Planning Victoria, Women's Health Victoria, Monash Health, the Australian Federation of Medical Women, the Parenting Research Center, Melbourne IVF, Grand Challenges Canada, Australian Rotary Health; the L and H Hecht Trust, the Jack Brockhoff Foundation and the Prostate Cancer Foundation of Australia . Jane Fisher is President-elect of the International Marce Society for Perinatal Mental Health, she chairs the Psychosocial and Epidemiological Research in Reproduction Group for the Royal Women’s Hospital and Melbourne IVF and sits on the Royal Women’s Hospital Research Committee (2003 -), the Epworth Healthcare Human Research Ethics Committee (2009-) and the Masada Private Hospital Patient Care Review Committee (2003-). She is a member of the NHMRC Mental Health and Parenting Expert Advisory Group (2014-) and of the International Board of Advisors, Research and Training Centre for Community Development Hanoi, Vietnam. She has been an invited temporary technical adviser to WHO Departments of Reproductive Health and Research, Mental Health and Substance Use and Maternal, Newborn, Child and Adolescent Health and Development since 2005.

Maggie Kirkman receives funding from the Australian Research Council, the National Health and Medical Research Council, Jean Hailes for Women's Health, Family Planning Victoria, Women's Health Victoria, Monash Health, and the Australian Federation of Medical Women.