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How to better reduce unintended pregnancies

Despite the widespread use of contraceptives, unintended pregnancies remains a significant health issue that needs to be addressed by both clinicians and patients, the Australian Healthcare and Hospitals Association (AHHA) says.

Chief executive Alison Verhoeven said long acting reversible contraceptive methods (LARCs) could be the answer, and to discuss this possibility, the AHHA held a workshop and released a Consensus Statement on the topic.

"When we talk of LARCs we mean progestogen-only implant and hormonal and copper intrauterine devices (IUDs)," Ms Verhoeven said.

"The uptake of LARCs is low in Australia — yet clinical and other experts, both here and internationally, recommend them as the most effective reversible contraceptive, within the context of informed choice.

"The release of the contraceptive pill in 1961 led to huge changes in women’s lives as they assumed control over their reproductive future. The pill continues to be used widely — estimates for primary contraceptive method for Australian women are that 33 per cent use oral contraceptives, 30 per cent condoms, and 19 per cent sterilisation.

"But despite this, unintended pregnancy remains a significant health issue. Around 60 per cent of Australian women who have had an unintended pregnancy were using contraception — most notably the pill (43 per cent) and condoms (22 per cent). The problem with the pill was usually a missed dose.

"Although they will not suit everyone, LARCs are a more effective less user-dependent method of contraception."

Ms Verhoeven said there was still some way to go before LARCs could be used as a genuine contraception alternative, and healthcare providers needed to take great care to help consumers understand their options.

"There are several barriers to best-practice contraceptive management for women in Australia, ranging from lack of knowledge and support systems among consumers and professionals to financial barriers," she said.

"Participants at our workshop felt that all levels of government across the health, social and education sectors, as well as consumers, health professionals, and professional colleges and associations, had roles and responsibilities in reducing unintended pregnancies.

"As a first step, women must be supported to make an informed choice about contraception. This starts from secondary school age onwards, through mechanisms such as education programs in schools and national clinical guidelines.

"Then, changes to financing and models of care are needed to ensure equitable access to LARCs. This includes MBS items for insertions and removals that adequately reflect the cost of providing the service, as well as taking into account the public health benefit."

Ms Verhoeven said training programs in implant and IUD insertion and removal needed to made readily available for health professionals.

She said she would also like to see better national data sources on contraceptive use and pregnancy outcomes.

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