Issue 27 / 16 July 2012

AN expanded skill-set and improved knowledge of long-acting reversible contraception among GPs could help curb high rates of unplanned pregnancy in Australia, according to family planning experts.

Research published in the MJA this week reveals a low uptake of long-acting reversible contraception (LARC) among Australian women, which the authors say provides important insights into high rates of unplanned pregnancy. (1)

The researchers found that despite clinical guidelines recommending promotion of LARC, such as intrauterine devices (IUDs) or long-acting subcutaneous devices, the combined oral contraceptive pill was still the most frequently prescribed method of contraception. There had been only “moderate” prescription of LARCs, especially in younger women.

Dr Caroline Harvey, medical director at Family Planning Queensland, said the findings confirmed the anecdotal impression that use of LARCs in Australia, particularly by younger women, was suboptimal.

“Available international evidence suggests that unintended pregnancy rates could be reduced by increased use of LARCs. Increased awareness plus ready and affordable access is the key to increasing use”, she said.

She said this was likely to have the biggest impact on younger women who were the most fertile and sexually active yet were currently less likely to use the most effective methods.

Sexual health physician Dr Terri Foran said LARCs had the potential to cut unintended pregnancy rates because they reduced the human error component of contraception.

The study was based on data from the Bettering the Evaluation and Care of Health (BEACH) program — a national study of GP activity in Australia — which found a shift towards prescribing LARC, as recommended in clinical guidelines, was yet to occur in Australian general practice.

Unlike in the US and the UK, there was no clear policy on increasing access to LARC in Australia, the authors said. More research was needed to determine why GPs and/or their patients were reluctant to use LARCs, they wrote.

Dr Foran said Australia’s unintended pregnancy rate is one of the highest in the developed world.

“I do think increased training, education and increased access to good affordable referral systems — if GPs are reluctant to do IUD insertions themselves — would make a huge difference”, she said.

Dr Harvey said some GPs lacked either confidence or training in the insertion of implants and IUDs, and could face time constraints for discussing the benefits of LARC with patients.

“There is a need for coordinated approaches to training, especially IUD insertion. While it is a skill which is within the scope of GPs, it does require supervised clinical training, considerable experience in pelvic examination and regular ongoing insertions to maintain skills.”

Dr Deborah Bateson, medical director of Family Planning NSW, agreed that increasing GP access to training would be an important part of any strategy to increase use of LARCs.

However, she said IUD insertion was a complex procedure, so appropriate training and ongoing support were important in order to develop and maintain skills.

“This skill may not be one that all GPs would necessarily wish to take up, so referral of women choosing an IUD to other providers is important in this context”, Dr Bateson said.

She said other ways to deliver implants could be considered, including training other health professionals such as nurses, a strategy that has proved successful in other countries.

– Amanda Bryan

1. MJA 2012; 197: 110-114

Posted 16 July 2012

This article was corrected on 16 July 2012.

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