Australian women need increased access to long-acting reversible contraception

Kirsten I Black, Deborah Bateson and Caroline Harvey
Med J Aust 2013; 199 (5): . || doi: 10.5694/mja12.11832
Published online: 2 September 2013

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

  • 1 Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW.
  • 2 Marie Stopes International, London, UK.
  • 3 Family Planning Queensland, Brisbane, QLD.


Competing interests:

All three authors work in the field of contraception. Kirsten Black is a consultant on an international advisory board for Bayer Healthcare and has been supported in this capacity to attend conferences as a presenting author; she has also received payment as a speaker. She is a registered trainer in implant insertion and removal for MSD. Deborah Bateson (formerly of Family Planning NSW) and Caroline Harvey have received individual support from Bayer Healthcare and MSD to attend national and international conferences. Family Planning NSW and Family Planning Queensland have been paid by MSD and Bayer Healthcare for the development of educational materials and teaching. Family Planning NSW is involved in clinical trials sponsored by pharmaceutical companies including Bayer Healthcare and MSD.

  • 1. Chan A, Sage LC. Estimating Australia’s abortion rates 1985–2003. Med J Aust 2005; 182: 447-452. <MJA full text>
  • 2. Sedgh G, Singh S, Shah IH, et al. Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet 2012; 379: 625-632.
  • 3. Gray E, McDonald P. Using a reproductive life course approach to understand contraceptive method use in Australia. J Biosoc Sci 2010; 42: 43-57.
  • 4. United Nations, Department of Economic and Social Affairs, Population Division. World contraceptive use 2011 [wall chart]. (accessed Jun 2013).
  • 5. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006; 38: 90-96.
  • 6. Darroch JE, Singh S, Frost JJ. Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use. Fam Plann Perspect 2001; 33: 244-250.
  • 7. Monea E, Thomas A. Unintended pregnancy and taxpayer spending. Perspect Sex Reprod Health 2011; 43: 88-93.
  • 8. Trussell J. Contraceptive failure in the United States. Contraception 2011; 83: 397-404.
  • 9. Trussell J, Lalla AM, Doan QV, et al. Cost effectiveness of contraceptives in the United States. Contraception 2009; 79: 5-14.
  • 10. Mavranezouli I; LARC Guideline Development Group. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod 2008; 23: 1338-1345.
  • 11. Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol 2010; 203: 115.e1-115.e7.
  • 12. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012; 366: 1998-2007.
  • 13. 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: 110-114. <MJA full text>
  • 14. Royal College of Obstetricians and Gynaecologists, Faculty of Sexual and Reproductive Healthcare. UK medical eligibility criteria for contraceptive use. London: FSRH, 2009. (accessed Dec 2012).
  • 15. Black KI, Sakhaei T, Garland SM. A study investigating obstetricians’ and gynaecologists’ management of women requesting an intrauterine device. Aust N Z J Obstet Gynaecol 2010; 50: 184-188.
  • 16. 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: 340-350.
  • 17. Bateson D, Harvey C, Williams J, Black KI. Intrauterine contraception: why are so few Australian women using this effective method [letter]? Med J Aust 2011; 194: 324. <MJA full text>
  • 18. Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med 2001; 345: 561-567.
  • 19. Peipert JF, Zhao Q, Allsworth JE, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol 2011; 117: 1105-1113.
  • 20. National Collaborating Centre for Women’s and Children’s Health. Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception. London: RCOG Press, 2005.
  • 21. Committee on Comparative Effectiveness Research Prioritization, Institute of Medicine. Initial national priorities for comparative effectiveness research. Washington, DC: National Academies Press, 2009. (accessed Jun 2013).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.