Changes in use of hormonal long‐acting reversible contraceptive methods in Australia between 2006 and 2018: A population‐based study

Abstract

Background Long‐acting reversible contraceptives (LARCs) are promoted internationally as a key strategy for reducing unintended pregnancy and abortion rates. Aims To examine trends in use of hormonal LARCs among reproductive‐aged women in Australia between 2006 and 2018 and explore trends according to age groups and state/territory of dispensing. Materials and Methods Retrospective population‐based study using Pharmaceutical Benefits Scheme (PBS) dispensing claims of a 10% random sample of females aged 15–44. We investigated rates and annual trends in dispensing claims of etonorgestrel implant and levonorgestrel intrauterine systems (IUS). Results Between 2006 and 2018, annual PBS claims for LARCs increased approximately two‐fold from 21.7 to 41.5 per 1000 women, with a plateau observed from 2015 onward. Absolute rate increases were similar for the implant (9.0/1000) and IUS (10.8/1000), with increases observed across all age groups and states/territories. Overall dispensing rates varied by two‐fold according to state/territory of dispensing and four‐fold according to age groups. Rate increases for the implant were highest among the 15–19 and 20–24 age groups, while rate increases for the IUS were highest among the 35–39 and 40–44 age groups. It is estimated that in 2018, 10.8% of women aged 15–44 were using a LARC; 4.5% for the implant and 6.3% for the IUS. Conclusions Rates of hormonal LARC use have doubled over the past decade. Investigating underlying reasons for the large observed differences in rates of use according to age and state/territory could help further improve uptake for these most effective methods of contraception.

Contraceptive use among women through their later reproductive years: Findings from an Australian prospective cohort study

“…These strategies appear to have had some success. An analysis of the Pharmaceutical Benefits Scheme (PBS) data suggests that rates of hormonal LARC use doubled between 2006 to 2018, with the highest uptake among women aged 35–44 [ 31 ]. Given that women are deferring pregnancy to later ages and the interval between family completion and menopause is becoming shorter, LARC may be a more favoured option than sterilisation, with IUDs presenting few contraindications for perimenopausal women [ 32 , 33 ].…”

Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study

“…In contrast, high efficacy contraceptive use in our study was attributed to the use of hormonal LARC. This finding is important given that LARC use has previously been reported as low among young women in Australia [ 10 , 15 , 22 ] although more recent evidence suggests that hormonal LARC use is much higher among young women [ 23 ]. Our finding may be reflective of increased awareness in Australia around the acceptability of LARC across the reproductive life course and in particular the suitability of LARC for young nulliparous women.…”

Identifying gaps in dual protection from sexually transmissible infections and unintended pregnancies among Australian women: an observational study

“…33 Conversely, the later study excluded copper IUDs, which were used by approxi mately 8% of IUD users in our study. 33 Second, the crosssectional study design assessed dual protection at one point in time and was unable to assess whether initiating LARC resulted in reduced condom use due to behavioural risk compensation. Third, although a strength of this study was the whole-of-population denominator, it is important to recognise that women choose contraception for a variety of reasons, and those in more enduring relationships may not place the same emphasis on STI prevention.…”

“…First, the ASHR2 data collection occurred in 2012-13; a recent analysis of Australian Pharmaceutical Benefits Scheme dispensing data from women aged 15-44 years estimated that in 2018, uptake of hormonal LARCs was 10.8%, which is slightly higher than our study (8.3%). 33 The recent study included women aged 35-44 years, who tend to have higher use of IUDs than younger women. 33 Conversely, the later study excluded copper IUDs, which were used by approxi mately 8% of IUD users in our study.…”

“…33 The recent study included women aged 35-44 years, who tend to have higher use of IUDs than younger women. 33 Conversely, the later study excluded copper IUDs, which were used by approxi mately 8% of IUD users in our study. 33 Second, the crosssectional study design assessed dual protection at one point in time and was unable to assess whether initiating LARC resulted in reduced condom use due to behavioural risk compensation.…”