Elsevier

Contraception

Volume 76, Issue 3, September 2007, Pages 208-214
Contraception

Original research article
Attitudes towards long-acting reversible methods of contraception in general practice in the UK

https://doi.org/10.1016/j.contraception.2007.05.085Get rights and content

Abstract

Introduction

Recently published national guidance in England recommended that increased use of long-acting reversible methods of contraception could reduce unintended pregnancy rates. Usage rates of long-acting reversible methods of contraception in the UK are currently low. Since these methods require medical intervention, attitudes of professionals are important determinants of prevalence of use.

Study Design

A questionnaire survey was conducted of 321 health professionals working in general practice which sought practitioner views on safety, efficacy and acceptability of contraceptive methods, and on the feasibility and desirability of prescribing long-acting methods.

Results

A high proportion of practitioners (80.2%) endorsed the role of LARC in preventing teenage pregnancy, but fewer than half (47.1%) saw them as returning to favor. The combined oral contraceptive pill is still the mainstay of prescriptions. Lack of skill in providing was seen by 60.6% as a barrier to provision of long-acting methods of contraception. Half of respondents (50.3%) thought that irregular bleeding deterred women from using LARC and 20.6% were concerned about high discontinuation rates. Misconceptions about side effects of contraceptive methods were common.

Conclusion

Investment in professional education and training is needed for health professionals in general practice if the goal of increased provision of long-acting contraceptive methods is to be realized.

Introduction

Long-acting reversible methods of contraception [implants, injections and intrauterine devices (IUDs) and systems] are highly effective, do not interfere with intercourse and require little or no on-going attention. Implants and injections have both been shown to be associated with a lower risk of conception, particularly among young users, than pills or condoms [1], [2], and there is evidence that their increased use may have considerable potential in reducing teenage pregnancy rates [3].

The uptake of long-acting reversible methods of contraception is low in Britain; only 10% of women aged 16 to 49 were using any of these methods in 2005/2006 compared with 23% of women using the oral contraceptive pill and 21% the condom [4]. Among 16 to 17 year olds, 12% used injectables or implants compared with 61% using the pill [4]. In the past, long-acting methods of contraception have been out of favor [5], [6]. Criticism focussed on risks of inappropriate and excessive use, coercive prescribing, reports of unpleasant and adverse ‘side effects’ and women's lack of control over mode of delivery [6], [7], [8]. This reputation is increasingly seen as undeserved [9]. Guidance on LARC published by the National Institute of Clinical Health and Excellence (NICE) in England in 2005 suggested that these methods have greater potential for reducing unintended pregnancy rates than has thus far been realized [10].

The majority of women attend general practice for their contraceptive provision in the UK, and supplies are free of charge under the National Health Services. Since all long-acting contraceptive methods require medical intervention, attitudes of health care professionals are important determinants of prevalence of use. Yet, little information exists on practitioners' views on such methods [11] and what there is has been collected outside of the UK [12]. This study addresses this deficit, by exploring the reported prescribing preferences of health care professionals in general practice in the UK, and their views on the safety, efficacy and acceptability of long-acting reversible methods of contraception compared with other methods.

Section snippets

Methods

A questionnaire survey was used to investigate the prescribing preferences of health care professionals with regard to methods of contraception, with particular reference to injectables (Depo Provera®) and implants (Implanon®) since they are most likely to be used by young people. In April 2005, fully structured and scheduled, self-completion questionnaires were mailed to 215 general practitioners (GPs) and 205 practice nurses and nurse practitioners. Practices were recruited from the Medical

Results

Three hundred and twenty-one questionnaires were returned, 169 of respondents were GPs, 148 nurse practitioners and practice nurses, and four did not specify their role within general practice. Eighty-three (26%) of the respondents were male and 238 (74%) female. Two hundred and thirty-seven (74%) were aged 50 or under and 83 (26%) were aged over 50 (one did not specify age). One hundred (31%) were working in a practice situated in the most socio-economically disadvantaged quintile of the

Discussion

Long-acting methods of contraception are regarded by providers as safe and easy to use and are rated more highly than other methods on efficacy. In this last respect their views are consistent with the data on efficacy which show the prevalence of unintended pregnancy in the first year of typical use by women of a contraceptive method to be 3% for Depo Provera®; 0.1% for Mirena; and 0.05% for implants, compared with 8% for the combined pill or minipill; 21% for condoms and 16% for diaphragms

Acknowledgments

The Nuffield Foundation funded this research. The authors' work was independent of the funders and the funding source had no involvement. We are grateful to Rachael Parker for co-ordinating fieldwork and data entry, Toni Belfield and Rebecca French for their helpful advice in the design of the study, and Nicky Fasey and Kay Foulger at the MRC GPRF for their assistance in recruiting subjects. We also thank the study participants.

All authors declare they have no conflict of interest.

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