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.