Jayne Lucke Pre-conception care and contraception for the generation

Jayne Lucke

Pre-conception careand contraception

for the generation

Contraception available in Australia

Bateson et al., Contraception: a practice-based update. Australian Doctor, 4 May 2012

What do we know?

• Effective contraception reduces risk of unintended pregnancy

• Promote long-acting methods for greater effectiveness

• Minimise barriers to access and risk of adverse events

• Provide access to a wide range of methods for changing individual needs

www.uqccr.edu.au/cupid

Aims

To examine... • Patterns of contraception use among young

women in Australia• Use of contraception before an unintended

pregnancy• Differences between rural and urban areas

Methods

• Three online surveys– baseline, +6 months, +12 months– mixed methods – survey questions and free-text

• Sample– 18-23 year old women across Australia

• Recruitment– through social media and other avenues

Sample characteristicsComparison of CUPID sample characteristics with Census data from the Australian Bureau of Statistics (2011)

CensusN=847,042

%

CUPIDN=3,810

%Marital status Married 4.9 4.5

Never married 94.5 91.1Highest education School 61.0 53.0

Certificate/diploma 21.7 26.0University 9.4 18.7

Area of residence Major city 74.5 62.6Inner regional 16.0 21.5Outer regional 7.2 8.5Remote 1.1 1.9Very remote 0.9 1.0

Sex, contraception and pregnancy

3810 recruited

3412ever had sex

2534never pregnant

720ever pregnant

93 intended

609unintended159

not usin

g contraceptio

n

440

using

contraceptio

n

85% of the women who

had been pregnant

72% of the women who had an unintended

pregnancy

Contraception at last sex

Method (N=3810) %Pill only 25Pill and condom 11Condoms only 18Long-acting method 16Other 15

... and before unintended pregnancy

Method (N=609) %Pill only 28Condoms only 11Withdrawal only 9Pill and condoms 7Condoms and withdrawal 4Pill and withdrawal 2Other methods 24No contraception 26

“I want to know if the pill reduces your chances of falling pregnant in the future. I have heard from girls who have been on the pill for over 10 years and are now trying to get pregnant and find it very difficult. I believe this is because your body is so used to being on the pill, it must have something to do with it...

... Fingers crossed I don’t fall pregnant soon. I know the pull out method is not the best form of contraception (obviously) but I’d rather stay away from any other drug related forms for in the future when I want children”

“I don’t feel comfortable telling the doctor what I’m REALLY doing so I will create a similar (but more respectable) situation to get advice for, and then compare that with online advice. I’d rather if I could get advice from a pharmacist and didn’t need an (ongoing) script to get the pill”

“I have had two experiences where I have gone to a male doctor to talk about contraception and they have nearly known nothing about the matter. I think male doctors should be aware of different contraceptive options in this day and age”

What do you think?

• How can we best help young women understand their fertility?

• How should we approach pre-conception care when many pregnancies are unintended?

• How can we respond to the perception that hormonal contraception is “unnatural”?

• Does it matter if a young woman doesn’t tell her doctor what she’s REALLY doing?

• Are male doctors letting down the side when it comes to contraceptive counseling?