Women’s attitudes towards, and experience of, long-acting contraception

Women’s attitudes towards, and experience of, long-acting contraception

K. Wellings, G. Barrett, R. Kane, M. Stevens, K. Nanchahal, A. Glasier

Centre for Sexual & Reproductive Health Research, London School of

Hygiene & Tropical Medicine, London, UK

Background: In the past, long acting methods of contraception have had

little support from consumers or professionals. Despite acceptance that the

risks are similar to those associated with other hormonal methods, negative

associations have persisted, as has the charge that poorer people are

inappropriately targeted. The impetus to this study has been provided, firstly,

by evidence that use of long acting methods of contraception (injection, implant

or hormonal IUD) may have potential in reducing teenage pregnancy rates, and

secondly, from increasing awareness that attitudes towards long acting

contraception are changing. More reliable data is needed to understand the

extent of acceptance and understanding of these methods. This study addresses

this deficit, by exploring the views of both consumers and providers on their

acceptability, safety and efficacy.

Objectives: The aim of the study has been to provide data which will

facilitate an informed appraisal of the potential for long acting methods of

contraception to enhance the aims of the Teenage Pregnancy Strategy and the

Sexual Health Strategy. Qualitative and quantitative techniques of investigation

are used to examine, in relation to long acting methods of contraception,

attitudes and experience towards their adoption among young users and non-users,

and prescribing preferences and practices among health care practitioners.

Design and Methods: The study comprises four components of research.

The first consists of analysis of the second National Survey of Sexual Attitudes

and Lifestyles (Natsal 2000), with a view to providing a demographic and

behavioural profile of users of long acting contraception. The second involves

in depth interviews with 35 women recruited from the survey sample who have

either used long acting methods of contraception, or been at risk of unplanned

pregnancy. The third is a survey of 500 health care professionals, and the

fourth a qualitative study of their attitudes towards prescribing long acting

contraception. Data are presented from components 1 and 2.

Results: 24% (1440/6006) women had ever used long acting methods of

contraception, and 10% (602/6006) had used them in the last year. In terms of

demographic and classificatory variables, there were no significant differences

in prevalence of recent use (last year) by area-related deprivation, social

class, or school leaving age, but the prevalence was significantly lower among

women with A level or higher education (p=<0.0001), and significantly higher among women of African or Afro-Caribbean origin (p=0.014). Greater variation was seen in prevalence of use of long acting contraception by risk-related variables. Early age at first intercourse; motherhood before age 18; experience of abortion; ever diagnosis with STI; ever use of emergency contraception; and two or more sexual partners in the past year; were all significantly associated with recent use of long acting methods of contraception. Women interviewed in-depth could be categorised into two groups: a larger group consisting of women who had experienced dissatisfaction with, or failure of, a method, or who had had an early unplanned pregnancy and birth, and a smaller group of women with high career aspirations and demanding occupations. In both groups, levels of acceptance and satisfaction were generally high and the decision to adopt the method had been an autonomous one. Amongst non-users, knowledge and awareness of long acting methods was poor.

Conclusions: These data suggest that sexual risk factors are more

important determinants of use of long acting methods of contraception than are

demographic factors. Acceptance and tolerance of these methods is high and there

is no evidence of undue persuasion by health care practitioners for patients to

adopt them. Our data suggest that long acting contraception may have an as yet

under-exploited role to play in the prevention of teenage pregnancy. The UK

Sexual Health Strategy makes particular reference to the need to improve the

accessibility and range of contraception methods available. We hope these data

will contribute towards delivering more effective and better-tailored and

targeted contraceptive provision to young people.

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