Cheaper, better access needed for long-acting contraception
New data highlights low use of long-acting reversible contraception (LARC). The data is part of the new Atlas of Healthcare Variation domain on contraceptive use by women, released by the Health Quality & Safety Commission. Despite their effectiveness and high levels of patient satisfaction, LARC uptake is low in New Zealand compared with Australia and most European countries.
‘Availability, affordability, acceptability and access to contraception information and services is a human right,’ says Dr Orna McGinn, chair of the expert advisory group that developed the Atlas. ‘In New Zealand, access to contraception is impacted by the costs associated with LARC insertion and removal, lack of access to trained providers and poor availability of accessible information which enable women to make an informed choice.’
A 2016 study into contraception access for indigenous Māori teenage mothers found some of the major barriers for these young women also include fragmented services, negative perception of side effects and transport difficulties. This particularly impacts on women living in rural areas.
Dr McGinn says that LARCs are the most effective and reliable form of contraception, recommended as first line methods by the World Health Organization, the Royal Australian and New Zealand College of Obstetricians and Gynecologists as well as other professional bodies across the world.
‘LARC users are 22 times less likely to experience an unintended pregnancy compared to those who use pills,’ she says.
‘Information about LARCs and contraception in general needs to be made widely available in a variety of settings accessible to women. Barriers to access such as cost, punitive eligibility criteria and the lack of trained inserters need to be addressed.’
The most common contraceptive method, despite its higher failure rate, is still the oral contraceptive pill (‘the pill’), with 8.2 percent of women aged 10-54 years regularly dispensed the pill in 2018. The data highlights equity issues; in women aged 15 - 19 years, European / other women were 8.3 times more likely to regularly receive oral contraception than Pacific women, 6.4 times more than Asian women and 2.9 times more than Māori women.
‘The oral contraceptive pill requires regular visits to get prescriptions renewed and medicine dispensed. Our health service access Atlas domain shows that 39 percent of 15-24-year-old women did not visit their GP or nurse at some point in 2019 due to cost.
‘There may be many reasons why a woman prefers one contraceptive method over another, or it may be that she is not aware that other choices are available. Research shows that practitioners who are not themselves trained in LARC are less likely to mention them when talking to a patient about contraception. It is important consumers have all the available information to help them make an informed decision.’
Dr McGinn encourages district health boards, primary health care providers to use the Atlas and explore their local data.
She recommends each area conducts further local analysis to address any obvious disparities. ‘The Atlas highlights variation but not the reason for this variation or what would be an appropriate level of prescribing in each setting.’