Australian women need increased access to long-acting reversible contraception

Increased access could decrease unintended pregnancies and their associated costs

In November 2012, an emergent theme at the first National Sexual and Reproductive Health Conference, convened by the Public Health Association of Australia and Sexual Health and Family Planning Australia, was the need to increase access to and uptake of long-acting reversible contraception (LARC) methods, particularly by younger, highly fertile women. Compared with countries in northern Europe, Australia has a relatively high rate of unintended pregnancy and abortion (19.7 per 1000 women aged 15–44 years in Australia versus 17 per 1000 in northern Europe)1,2 yet a low uptake of the most effective methods of contraception — the LARC methods (used by 6.5% of women using contraception in Australia versus 14.8% in northern Europe).3,4 These methods include: 3-monthly progestogen injections (depot medroxy-progesterone acetate); a progestogen-only (etonogestrel) subdermal implant with a duration of action of up to 3 years; and intrauterine contraceptive (IUC) methods — the hormonal levonorgestrel intrauterine system and copper intrauterine devices, which provide highly effective contraception for up to 5 and 10 years, respectively. Although data are lacking in Australia, we can learn from the situation in the United States. Population surveys have found that half of unintended pregnancies in the US are attributable to failure of contraceptive methods that, to optimise success, require women to make a daily decision to use them.5 Interventions such as enhanced counselling and instituting immediate start of the contraceptive pill have not consistently improved regularity of use and continuation rates or reduced the occurrence of unintended pregnancies. Adolescents and young women are especially vulnerable to unintended pregnancy, as they are highly fertile and may be less reliable in their contraceptive use.6