Predictors of choosing long-acting reversible contraceptive methods when provided free-of-charge – A prospective cohort study in Finland

Gyllenberg, Frida; Saloranta, Tuire; But, Anna; Gissler, Mika; Heikinheimo, Oskari

doi:10.1016/j.contraception.2020.01.018

Cited by 8 publications

(7 citation statements)

References 29 publications

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“…However, if this were the case, it would even further support our results. Likewise, because more than 20% of women who receive free contraception opt for a LARC method such as the LNG-IUS or contraceptive implants, 21 the same bias may concern the analyses on the HC types.…”

Section: Discussionmentioning

confidence: 99%

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

et al. 2022

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ObjectivesThe relationship between the use of contraception and of psychiatric medications is understudied. We examined whether the current and past use of psychotropic medications is associated with the use and type of hormonal contraception (HC).DesignNationwide register-based matched case–control study.SettingsAll fertile-aged (15–49 years) girls and women living in Finland in 2017; data from several national registers.Participants294 356 girls and women with a redeemed prescription of HC in 2017, and their same-sized control group of non-users (n=294 356) identified through the Prescription Centre.Main outcome measuresAssociations between the use of psychotropic medications and the use of HC, and the type of HC tested in logistic regression models.ResultsAltogether 19.5% of the HC users, and 18% of the HC non-users received at least one prescription for a psychotropic medication in 2017. Among HC users, the proportions of occasional and regular users of psychotropic medications in 2013–2016 were 4.5% and 14.8%, while among HC non-users the respective figures were 4.3% and 14.6%, respectively. In multivariable logistic regression models both the use of psychotropic medications in 2017, and their occasional or regular use between 2013–2016 were associated with higher odds of HC use, although with small to very small effect sizes (ORs between 1.37 and 1.06 and 95% CIs 1.22 to 1.53, and 1.03 to 1.09, respectively). After adjustment for covariates, when fixed combinations of progestogens and oestrogens for systemic use was the reference category, women using almost any class of psychotropic medications had higher odds of using other types of HC.ConclusionsFertile-aged girls and women with current and past use of psychotropic medications have higher odds of using HC, with a specific pattern in the type of contraceptives used. Further research is warranted to examine whether our observations indicate a reduction of unwanted pregnancies in women with psychiatric disorders.

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Section: Discussionmentioning

confidence: 99%

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

et al. 2022

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“…This finding most likely reflects the high use of LARC methods among parous women. In fact, parous women were more likely to choose LARC methods than nulliparous women at the family planning clinics of Vantaa [28].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, women with a history of induced abortion were most likely to be aware of the services and had higher odds of service use across all age groups. Surprisingly, women with a history of induced abortion in Finland were found to have lower rates of hormonal contraceptive use [27], whereas, young women with a history of induced abortion were especially likely to choose LARC methods, which could explain the discrepancy in the studies [28].…”

Section: Discussionmentioning

confidence: 99%

Use of universally offered family planning services – a cohort study in the city of Vantaa, Helsinki metropolitan area, Finland

Saloranta

Gyllenberg

But

et al. 2021

Scand J Public Health

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Aims: Knowledge about the women reached by public family planning services is scarce. The means for provision of these services that are pivotal for women’s health and empowerment varies globally. In Finland, family planning services are offered free of charge, but often separately for different age groups. City of Vantaa offers these services for all female residents without age limit. The aim of this study was to describe the characteristics of the women using public family planning services. Methods: We assessed the sociodemographic and reproductive characteristics of women aged 15–44 using ( n = 11,790) and not using ( n = 42,931) these services in 2013–2014. We obtained adjusted odds ratios (AORs) and 95% confidence intervals (95%CIs) for service use by multivariate logistic regression. Results: Women under 35 years of age had higher odds of service use compared with those over 35 (AORs ranging from 2.79 [95%CI 2.54–3.07] for 15–19 year-olds to 1.81 [95%CI 1.69–1.95] for 30–34 year-olds). Women speaking a foreign native language used services less when aged under 30 and more when aged 35–44 compared with women speaking the national languages. Women with a history of delivery, induced abortion or sexually transmitted infections, or with a lower socioeconomic or educational status were more likely to use the services. Conclusions: Young women in general were more likely to use free-of-charge family planning services. In contrast, young women speaking a foreign native language were underrepresented among service users. It is important to recognise and actively reach underrepresented groups, such as young women with a foreign background, to optimise equal access to family planning services.

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“…45 Poor accessibility disproportionally impacts adolescents and, in support of this concern, researchers have found that the uptake of LARC methods (including post-abortion) increases when financial barriers are removed. [46][47][48] However, researchers are concurrently attempting to understand adolescent decision-making and document the practices of healthcare professionals in the context of LARC provision, particularly to "high-risk" groups such as adolescents. 49 In a preliminary search of the literature we identified a relative lack of research on acceptability and personcentered outcomes despite increasing emphasis on IPP/IPA LARC.…”

Section: Introductionmentioning

confidence: 99%

“…As LARC have similarly high rates of continuation across postpartum and nulliparous adolescents, 44 IPP provision of LARC is perceived by researchers, clinicians and advocates as being an accepted or preferred method to adolescent mothers 45 . Poor accessibility disproportionally impacts adolescents and, in support of this concern, researchers have found that the uptake of LARC methods (including post‐abortion) increases when financial barriers are removed 46‐48 . However, researchers are concurrently attempting to understand adolescent decision‐making and document the practices of healthcare professionals in the context of LARC provision, particularly to “high‐risk” groups such as adolescents 49 .…”

Section: Introductionmentioning

confidence: 99%

Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

Buckingham

Moulton

Subasinghe

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Long‐acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post‐abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents’ preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10–19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision‐making to use, not use or discontinue IPP/IPA LARC. Material and methods In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively. Results We identified 10 relevant articles, four of which were entirely adolescent‐focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents’ sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor‐quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision‐making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do. Conclusions Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents’ lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person‐centered care when assisting adolescents’ contraceptive choice following pregnancy.

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Predictors of choosing long-acting reversible contraceptive methods when provided free-of-charge – A prospective cohort study in Finland

Cited by 8 publications

References 29 publications

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

Use of universally offered family planning services – a cohort study in the city of Vantaa, Helsinki metropolitan area, Finland

Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

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