Contraceptive method use among women and its association with age, relationship status and duration: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Firman, Nicola; Palmer, Melissa; Timæus, Ian M.; Wellings, Kaye

doi:10.1136/bmjsrh-2017-200037

Cited by 18 publications

(17 citation statements)

References 29 publications

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“…Such bias can result in under or over-reporting of sensitive sexual behaviours [13,20,21] but will not have affected estimates of prescribed contraceptive use based on dispensed prescription records. In keeping with GB and Ireland, we found that just over a quarter of women of reproductive age were dispensed prescribed contraceptives in any one year [9,[22][23][24].…”

Section: Findings and Interpretationsupporting

confidence: 64%

Use of prescribed contraception in Northern Ireland 2010–2016

Given

Gray

Dolk

2020

The European Journal of Contraception & Reproductive Health

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Objective: To describe the use of prescribed contraceptives in Northern Ireland (NI) and how this varies with a woman's age, the deprivation in the area in which she lives and characteristics of her General Practice (GP). Method: A population-based cohort study was conducted including 560,074 females, aged 12-49 registered with a GP (2010-2016), contributing 3,255,500 woman-years of follow-up. Dispensed contraceptive prescriptions were linked to demographic details. Results: A contraceptive prescription was dispensed in 26.2% of woman-years with women aged 20-24 most likely to have a contraceptive dispensed (45.7% of woman-years). After adjusting for patient and other practice characteristics, practices in the least deprived quintile prescribed 6% more contraception than those in the most deprived quintile. The combined oral contraceptives (16.6% of woman-years) and progesterone only pill (8.0% of woman-years) were the most commonly dispensed methods. Patient and practice level characteristics were found to be related to the specific contraceptive methods dispensed which also changed during the time frame of the study. Conclusions: This is the first population-based assessment of contraceptive prescription in NI. It is useful for health service planning and to inform broader reproductive policy debates. The impact of practice area-based deprivation, above that of the woman's residence, on contraceptive dispensing is a new finding that deserves more exploration.

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Section: Findings and Interpretationsupporting

confidence: 64%

Use of prescribed contraception in Northern Ireland 2010–2016

Given

Gray

Dolk

2020

The European Journal of Contraception & Reproductive Health

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“…The prevalence of oral contraceptive pill use in 2008/2009 was 54% in women aged 20–24 years and 10% in 40–49 years in one survey, compared with 44% (442 per 1,000 women) using NLHC among women aged 20–24 years and 11% (106 per 1,000 women) in women aged 35–54 years, respectively, in our study ( S6 Fig ) [ 21 ]. In a large probability sample survey conducted in 2010 to 2012, 26% of women aged 16 to 24 were using hormonal methods (defined in the study as patches, pills, and injections), and 11% used LARC (implant, IUD, IUS) [ 22 ]. In our study, age-specific NLHC rates in 2011/2012 were 21% for women aged 13 to 19 and 41% for women aged 20 to 24.…”

Section: Discussionmentioning

confidence: 99%

Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study

Cecil

Bottle

et al. 2020

PLoS Med

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Background Long-acting reversible contraception (LARC) is among the most effective contraceptive methods, but uptake remains low even in high-income settings. In 2009/2010, a target-based pay-for-performance (P4P) scheme in Britain was introduced for primary care physicians (PCPs) to offer advice about LARC methods to a specified proportion of women attending for contraceptive care to improve contraceptive choice. We examined the impact and equity of this scheme on LARC uptake and abortions. Methods and findings We examined records of 3,281,667 women aged 13 to 54 years registered with a primary care clinic in Britain (England, Wales, and Scotland) using Clinical Practice Research Datalink (CPRD) from 2004/2005 to 2013/2014. We used interrupted time series (ITS) analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age and deprivation groups, before and after the P4P was introduced in 2009/2010. Between 2004/2005 and 2013/2014, crude LARC uptake rates increased by 32.0% from 29.6 per 1,000 women to 39.0 per 1,000 women, compared with 18.0% decrease in NLHC uptake. LARC uptake among women of all ages increased immediately after the P4P with step change of 5.36 per 1,000 women (all values are per 1,000 women unless stated, 95% CI 5.26–5.45, p < 0.001). Women aged 20 to 24 years had the largest step change (8.40, 8.34–8.47, p < 0.001) and sustained trend increase (3.14, 3.08–3.19, p < 0.001) compared with other age groups. NLHC uptake fell in all women with a step change of −22.8 (−24.5 to −21.2, p < 0.001), largely due to fall in combined hormonal contraception (CHC; −15.0, −15.5 to −14.5, p < 0.001). Abortion rates in all women fell immediately after the P4P with a step change of −2.28 (−2.98 to −1.57, p = 0.002) and sustained decrease in trend of −0.88 (−1.12 to −0.63, p < 0.001). The largest falls occurred in women aged 13 to 19 years (step change −5.04, −7.56 to −2.51, p = 0.011), women aged 20 to 24 years (step change −4.52, −7.48 to −1.57, p = 0.030), and women from the most deprived group (step change −4.40, −6.89 to −1.91, p = 0.018). We estimate that by 2013/2014, the P4P scheme resulted in an additional 4.53 LARC prescriptions per 1,000 women (relative increase of 13.4%) more than would have been expected without the scheme. There was a concurrent absolute reduction of −5.31 abortions per 1,000 women, or −38.3% relative reduction. Despite universal coverage of healthcare, some women might have obtained contraception elsewhere or had abortion procedure that was not recorded on CPRD. Other policies aiming to increase LARC use or reduce unplanned pregnancies around the same time could also explain the findings. ...

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“…Trip et al found that younger users may be less likely to use regular contraception due to a lack of ability to find suitable contraception 21. Firman et al explored the impact of nature and duration of relationship on preferred method of contraception and established that barrier methods were higher in short-term relationships among younger population 22. Pregnancy ‘risk’ perception and personal invulnerability may be potential factors influencing the use/non-use of contraception during sexual intercourse 23 24.…”

Section: Discussionmentioning

confidence: 99%

A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales

Mantzourani

Hodson

Evans

et al. 2019

BMJ Sex Reprod Health

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BackgroundAccess to emergency contraception (EC) has been a core component of attempts to address high teenage pregnancy rates in Wales. A national service was commissioned in 2011, allowing supply of EC free of charge from community pharmacies (CPs). This study investigated 5 years of the EC service, to describe its use and investigate changes in the pattern of use over time.MethodsSecondary analyses of data from all National Health Service funded CP EC consultations in Wales between 1 August 2012 and 31 July 2017 (n=181 359). Data comprised standardised clinical and demographic information, in the form of predefined service user responses, submitted for reimbursement by CPs.ResultsOverall service provision remained relatively consistent over the study period, with women aged between 13 and 59 years accessing the service. An association was observed between the time since unprotected sexual intercourse and the day on which the service was accessed (Χ2(18)=16 292.327, p<0.001). Almost half (47.9%) of requests were because no contraception had been used, with a strong and positive association for teenagers and women aged 40+ years. A statistically significant and increasing percentage of consultations were accompanied by further sexual health advice (r=0.7, p<0.01).ConclusionsAccess to EC through CPs is contributing to reducing teenage conceptions and termination rates. However, action is needed to increase contraception use in all age groups. Reduced availability of CP services on Sundays is a barrier to timely EC access. Findings support an expanded role for community pharmacists in provision of regular contraception.

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Contraceptive method use among women and its association with age, relationship status and duration: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Cited by 18 publications

References 29 publications

Use of prescribed contraception in Northern Ireland 2010–2016

Use of prescribed contraception in Northern Ireland 2010–2016

Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study

A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales

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