Semin Reprod Med 2022; 40(05/06): 240-245
DOI: 10.1055/s-0042-1759554
Review Article

Opportunities for Increasing Access to Effective Contraception in Australia

Danielle Mazza
1   SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
,
Jessica R. Botfield
1   SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
› Author Affiliations

Abstract

Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.



Publication History

Article published online:
07 December 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann 2008; 39 (01) 18-38
  • 2 Crowne SS, Gonsalves K, Burrell L, McFarlane E, Duggan A. Relationship between birth spacing, child maltreatment, and child behavior and development outcomes among at-risk families. Matern Child Health J 2012; 16 (07) 1413-1420
  • 3 Qiu X, Zhang S, Sun X, Li H, Wang D. Unintended pregnancy and postpartum depression: a meta-analysis of cohort and case-control studies. J Psychosom Res 2020; 138: 110259
  • 4 Parks C, Peipert JF. Eliminating health disparities in unintended pregnancy with long-acting reversible contraception (LARC). Am J Obstet Gynecol 2016; 214 (06) 681-688
  • 5 Downing SG, Cashman C, Russell DB. Ten years on: a review of medical terminations of pregnancy performed in a sexual health clinic. Sex Health 2017; 14 (03) 208-212
  • 6 Rowe H, Holton S, Kirkman M. et al. Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey. Aust N Z J Public Health 2016; 40 (02) 104-109
  • 7 Department of Health. National Women's Health Strategy 2020–2030. Canberra: Commonwealth of Australia; 2018
  • 8 Sully EA, Biddlecom A, Darroch JE. et al. Adding It Up: Investing in Sexual and Reproductive Health 2019. New York: Guttmacher Institute; 2020
  • 9 HT ANALYSTS. Impact of Unintended Pregnancy. Macquarie Park, New South Wales: Organon; 2022
  • 10 Dixon SC, Herbert DL, Loxton D, Lucke JC. ‘As many options as there are, there are just not enough for me’: contraceptive use and barriers to access among Australian women. Eur J Contracept Reprod Health Care 2014; 19 (05) 340-351
  • 11 Dorney E, Botfield JR, Robertson S, McGeechan K, Bateson D. Acceptability of the copper intrauterine device as a form of emergency contraception in New South Wales, Australia. Eur J Contracept Reprod Health Care 2020; 25 (02) 114-119
  • 12 Goldhammer DL, Fraser C, Wigginton B. et al. What do young Australian women want (when talking to doctors about contraception)?. BMC Fam Pract 2017; 18 (01) 35
  • 13 Trussell J. Understanding contraceptive failure. Best Pract Res Clin Obstet Gynaecol 2009; 23 (02) 199-209
  • 14 Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol 2012; 120 (06) 1291-1297
  • 15 Grzeskowiak LE, Calabretto H, Amos N, Mazza D, Ilomaki J. Changes in use of hormonal long-acting reversible contraceptive methods in Australia between 2006 and 2018: a population-based study. Aust N Z J Obstet Gynaecol 2021; 61 (01) 128-134
  • 16 Hellström A, Gemzell Danielsson K, Kopp Kallner H. Trends in use and attitudes towards contraception in Sweden: results of a nationwide survey. Eur J Contracept Reprod Health Care 2019; 24 (02) 154-160
  • 17 Richters J, Fitzadam S, Yeung A. et al. Contraceptive practices among women: the second Australian study of health and relationships. Contraception 2016; 94 (05) 548-555
  • 18 Skiba MA, Islam RM, Bell RJ, Davis SR. Hormonal contraceptive use in Australian women: Who is using what?. Aust N Z J Obstet Gynaecol 2019; 59 (05) 717-724
  • 19 Harris ML, Coombe J, Forder PM, Lucke JC, Bateson D, Loxton D. Young Women's complex patterns of contraceptive use: findings from an Australian cohort study. Perspect Sex Reprod Health 2020; 52 (03) 181-190
  • 20 Rassi A, Wattimena J, Black K. Pregnancy intention in an urban Australian antenatal population. Aust N Z J Public Health 2013; 37 (06) 568-573
  • 21 Coombe J, Harris ML, Wigginton B, Lucke J, Loxton D. Contraceptive use at the time of unintended pregnancy: findings from the contraceptive use, pregnancy intention and decisions study. Aust Fam Physician 2016; 45 (11) 842-848
  • 22 Kruss J, Gridley H. ‘Country women are resilient but. …’: family planning access in rural Victoria. Aust J Rural Health 2014; 22 (06) 300-305
  • 23 Harney C, Dude A, Haider S. Factors associated with short interpregnancy interval in women who plan postpartum LARC: a retrospective study. Contraception 2017; 95 (03) 245-250
  • 24 Tocce KM, Sheeder JL, Teal SB. Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?. Am J Obstet Gynecol 2012; 206 (06) 481.e1-481.e7
  • 25 Australian Healthcare and Hospitals Association. Consensus statement: Reducing unintended pregnancy for Australian women through increased access to long-acting reversible contraceptive methods 2017. Accessed November 14, 2022 at: https://ahha.asn.au/sites/default/files/docs/policy-issue/larc_consensus_statement.pdf
  • 26 D'Souza P, Bailey JV, Stephenson J, Oliver S. Factors influencing contraception choice and use globally: a synthesis of systematic reviews. Eur J Contracept Reprod Health Care 2022; 27 (05) 364-372
  • 27 Claringbold L, Sanci L, Temple-Smith M. Factors influencing young women's contraceptive choices. Aust J Gen Pract 2019; 48 (06) 389-394
  • 28 Garrett CC, Keogh LA, Kavanagh A, Tomnay J, Hocking JS. Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study. BMC Womens Health 2015; 15: 72
  • 29 Mazza D, Harrison C, Taft A. et al. Current contraceptive management in Australian general practice: an analysis of BEACH data. Med J Aust 2012; 197 (02) 110-114
  • 30 Monester J, Fisher J, Kirkman M, Rowe H, Holton S. ‘If I had known the fertility health facts sooner…’ Knowledge gaps as a barrier to effective fertility management: findings from the understanding fertility management in contemporary Australia survey. Eur J Contracept Reprod Health Care 2019; 24 (04) 274-279
  • 31 Mazza D, Bateson D, Frearson M, Goldstone P, Kovacs G, Baber R. Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: an expert roundtable discussion. Aust N Z J Obstet Gynaecol 2017; 57 (02) 206-212
  • 32 Stewart M, Digiusto E, Bateson D, South R, Black KI. Outcomes of intrauterine device insertion training for doctors working in primary care. Aust Fam Physician 2016; 45 (11) 837-841
  • 33 Turner R, Tapley A, Sweeney S, Magin P. Barriers to prescribing of long-acting reversible contraception (LARC) by general practitioner registrars: a cross-sectional questionnaire. Aust N Z J Obstet Gynaecol 2021; 61 (03) 469-473
  • 34 Kelly M, Inoue K, Black KI. et al. Doctors' experience of the contraceptive consultation: a qualitative study in Australia. J Fam Plann Reprod Health Care 2017; 43 (02) 119-125
  • 35 Wellings K, Zhihong Z, Krentel A, Barrett G, Glasier A. Attitudes towards long-acting reversible methods of contraception in general practice in the UK. Contraception 2007; 76 (03) 208-214
  • 36 Black K, Lotke P, Buhling KJ, Zite NB. Intrauterine Contraception for Nulliparous Women: Translating Research into Action (INTRA) Group. A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women. Eur J Contracept Reprod Health Care 2012; 17 (05) 340-350
  • 37 Middleton AJ, Naish J, Singer N. General practitioners' views on the use of the levonorgestrel-releasing intrauterine system in young, nulligravid women, in London, UK. Eur J Contracept Reprod Health Care 2011; 16 (04) 311-318
  • 38 Botfield JR, Tulloch M, Contziu H. et al. Feasibility, acceptability and sustainability of postpartum contraceptive implant provision by midwives in NSW public hospitals. Women Birth 2022; 35 (05) e439-e445
  • 39 Botfield JR, Wright SM, Fenwick SE, Cheng Y. Training nurses in contraceptive implant procedures: implications for practice in Australia. Collegian 2021; 28 (01) 114-120
  • 40 Croan L, Craig A, Scott L, Cameron ST, Lakha F. Increasing access to contraceptive implants in the postnatal period via a home insertion service by community midwives. BMJ Sex Reprod Health 2018; 44 (01) 61-64
  • 41 Ministry of Health. New Zealand Aotearoa's Guidance on Contraception. Wellington: Ministry of Health; 2020
  • 42 Botfield JR, Zwi AB, Rutherford A, Newman CE. Learning about sex and relationships among migrant and refugee young people in Sydney, Australia: “I never got the talk about the birds and the bees”. Sex Educ 2018; 18 (06) 705-720
  • 43 Roth C, Cheng Y, Wilson EG, Botfield J, Stuart A, Estoesta J. Opportunities for strengthening sexual health education in schools: findings from a student needs assessment in NSW. Health Promot J Austr 2022; 33 (02) 499-508
  • 44 Mazza D, Buckingham P, McCarthy E, Enticott J. Can an online educational video broaden young women's contraceptive choice? Outcomes of the PREFER pre-post intervention study. BMJ Sex Reprod Health 2022; 48 (04) 267-274
  • 45 Dewart CM, Serpico J, Steiner MJ, Gallo MF. Electronic interventions for changing knowledge, attitudes or practices regarding contraception: a systematic review. Contraception 2019; 100 (01) 10-25
  • 46 World Health Organization. WHO Recommendations: Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions through Task shifting. Geneva, Switzerland; 2012
  • 47 Department of Health. Telehealth changes improve remote Australians' access to a doctor 2019. Accessed November 14, 2022 at: https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/telehealth-changes-improve-remote-australians-access-to-a-doctor
  • 48 Sjöström S, Kopp Kallner H, Simeonova E, Madestam A, Gemzell-Danielsson K. Medical abortion provided by nurse-midwives or physicians in a high resource setting: a cost-effectiveness analysis. PLoS One 2016; 11 (06) e0158645
  • 49 Subasinghe AK, Deb S, Mazza D. Primary care providers' knowledge, attitudes and practices of medical abortion: a systematic review. BMJ Sex Reprod Health 2019:bmjsrh-2019-200487
  • 50 Botfield JR, Tulloch M, Contziu H. et al. Contraception provision in the postpartum period: knowledge, views and practices of midwives. Women Birth 2021; 34 (01) e1-e6
  • 51 Walker SH, Hooks C, Blake D. The views of postnatal women and midwives on midwives providing contraceptive advice and methods: a mixed method concurrent study. BMC Pregnancy Childbirth 2021; 21 (01) 411
  • 52 Cameron ST, Craig A, Sim J. et al. Feasibility and acceptability of introducing routine antenatal contraceptive counselling and provision of contraception after delivery: the APPLES pilot evaluation. BJOG 2017; 124 (13) 2009-2015
  • 53 Moulton JE, Subasinghe AK, Mazza D. Practice nurse provision of early medical abortion in general practice: opportunities and limitations. Aust J Prim Health 2021; 27 (06) 427-430
  • 54 Mazza D, Watson CJ, Taft A. et al. Increasing long-acting reversible contraceptives: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomized trial. Am J Obstet Gynecol 2020; 222 (4S): 921.e1-921.e13
  • 55 Hyland P, Raymond EG, Chong E. A direct-to-patient telemedicine abortion service in Australia: retrospective analysis of the first 18 months. Aust N Z J Obstet Gynaecol 2018; 58 (03) 335-340
  • 56 LaRoche KJ, Wynn LL, Foster AM. “We've got rights and yet we don't have access”: exploring patient experiences accessing medication abortion in Australia. Contraception 2020; 101 (04) 256-260
  • 57 Grossman D, Grindlay K. Safety of medical abortion provided through telemedicine compared with in person. Obstet Gynecol 2017; 130 (04) 778-782
  • 58 Aiken A, Gomperts R, Trussell J. Experiences and characteristics of women seeking and completing at-home medical termination of pregnancy through online telemedicine in Ireland and Northern Ireland: a population-based analysis. BJOG 2017; 124 (08) 1208-1215
  • 59 Mazza D. Increasing access to women's sexual and reproductive health services: telehealth is only the start. Med J Aust 2021; 215 (08) 352-353
  • 60 Cashman C, Downing SG, Russell D. Women's experiences of accessing a medical termination of pregnancy through a Queensland regional sexual health service: a qualitative study. Sex Health 2021; 18 (03) 232-238
  • 61 Fix L, Seymour JW, Sandhu MV, Melville C, Mazza D, Thompson TA. At-home telemedicine for medical abortion in Australia: a qualitative study of patient experiences and recommendations. BMJ Sex Reprod Health 2020; 46 (03) 172-176
  • 62 Cameron ST, Glasier A, McDaid L. et al. Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial. Lancet 2020; 396 (10262): 1585-1594
  • 63 Buckingham P, Amos N, Hussainy SY, Mazza D. Pharmacy-based initiatives to reduce unintended pregnancies: a scoping review. Res Social Adm Pharm 2021; 17 (10) 1673-1684
  • 64 The Pharmacy Guild of Australia. National Rural Health Commissioner's discussion paper for consultation: rural allied health quality, access and distribution - options for Commonwealth policy reform and investment. The Pharmacy Guild of Australia; 2019