Underutilisation of long-acting reversible contraceptives (LARCs)
It has been estimated that over one half of all pregnancies in Australia are unplanned[i] and it is approximated that 1 in 5 (20-25%) women in Australia will have an abortion during their lifetime, with 80,000 induced abortions being performed annually in Australia.[ii] The current annual Australian abortion rate is approximately 19 per 1,000 women aged 15 to 44 years. This rate is high when compared to similarly developed areas, [iii] such as Western Europe with a rate of 12 per 1,000 [iv] and New Zealand with a rate of 17.3 per 1,000. [v] Many of these unplanned pregnancies could have been avoided with the appropriate and correct use of contraceptives.
Of particular note in Australia, is the underutilisation of Long Acting Reversible Contraceptives (LARCs) in primary care, with only 1.2% of women using one of these methods. Examples of these contraceptives include hormonal implants such as Implanon, the hormonal intrauterine device Mirena and the multiload copper intrauterine device. While not suitable for all women, the benefits of these contraceptives include minimal maintenance once in place, and long-term, effective contraception with very low failure rates. They are often referred to as “set and forget” methods. Increasing access to LARCs is a public health priority in the UK and US, but there is no clear policy on LARCs in Australia.[vi]
Sexual and reproductive health specialists in Australia recommend increasing the availability of LARCs because the methods are cost-effective and highly efficient, and with effective and appropriate use, have the potential to reduce the rates of unplanned pregnancies and abortions. Identified barriers to the uptake of LARCs in Australian primary care settings include: lack of familiarity amongst GPs with inserting and removing the devices, a view that it is not cost effective for GPs to do so, and a lack of appropriate technical training and medical indemnity insurance costs for nurses. Furthermore, ‘women are also poorly advised or have misconceptions that IUDs are unsuitable, even when they meet the medical eligibility criteria’.[vii]
The Medical Educators Professional Working Group (MPWG) has been the key driver of policy recommendations, in particular on unplanned pregnancies, abortion, and the underutilisation of LARCs in primary care. The MPWG is currently planning an advocacy campaign seeking to develop a national policy around the use of LARCs, with the goal of adjusting Medicare funding, establishing standards of training for GPs, and education contraception users about the availability and appropriateness of LARCs methods.
[ii]Newman P, Morrell S, Black M, Munot S, Estoesta J, Brassil A, 2011, Reproductive and sexual health needs in New South Wales an Australia: differentials, trends and assessment of data sources. Family Planning NSW: Sydney
[vi] Mazza, D., Harrison, C., Taft, A., Brijnath, B., Britt, H., Hobbs, M., Stewart, K., Hussainy, S., 2012. Current contraceptive management in Australian general practice: an analysis of BEACH data. The Medical Journal of Australia 197, 110–114
[vii]Mazza, D., Harrison, C., Taft, A., Brijnath, B., Britt, H., Hobbs, M., Stewart, K., Hussainy, S., 2012. Current contraceptive management in Australian general practice: an analysis of BEACH data. The Medical Journal of Australia 197, 110–114