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Improve GP training for greater use of LARCs: study

Research 16 Mar 2020
Contraception choices2

They are one of the most effective way of preventing pregnancies, yet only 11% of women in Australia are currently using long-acting reversible contraception (LARC).

However, a new Melbourne study may encourage more women to use this form of contraception.

LARCs will stop women getting pregnant for several years, depending on the type used, and include:

  • a contraceptive implant, which is placed under the skin of a woman’s arm and lasts for three years
  • an IUD (intra uterine device). This is a small device that is placed inside the uterus and lasts for 5-10 years.

The case for using LARC is compelling. They are the most effective reversible methods of contraception. Their failure rates in the first year are 0.05-0.08% compared with 9% for the oral contraceptive pill and 18% for male condoms. Their use, however, is low.

So, researchers at Monash University in Melbourne did a randomised controlled trial to see if family doctors would promote LARCs more if they were:

  1. provided with training in effectiveness-based contraceptive counselling
  2. given access to rapid referrals to LARC insertion clinics.

The researchers – from Monash’s SPHERE NHMRC Centre for Excellence in Women’s Sexual and Reproductive Health in Primary Care – found that when these two practices were put in place, there was a significant increase in LARC uptake.

The trial involved 57 GPs and 740 women across Melbourne. Nearly 47% of the women who attended the GPs who had received the training and access to rapid referral to the insertion clinics opted for LARCs, compared with nearly 33% of women who received usual care.

The finding is significant, as national and international bodies – including the World Health Organization, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Family Planning Alliance Australia and the American College of Obstetricians and Gynecologists – endorse the use of LARCs as the most effective form of contraception.

The role of the family doctor in a woman’s choice of contraception is critical, says Professor Danielle Mazza, lead researcher and Director of SPHERE.

“If GPs don’t offer an implant or an IUD as an option, then women are unlikely to consider them,”

says Prof Mazza.

She says that empowering GPs with the tools to provide evidence-based information about LARCs, as well as fast access to LARC insertion, is “extremely important” because they are a trusted source of information for patients.

“These findings show the government could increase LARC uptake in Australia by investing in contraceptive training for GPs, so that they can support women in making an informed choice and establishing LARC insertion clinics so that women can get their LARC inserted easily and don’t experience long delays,” Prof Mazza says.

Specialist women’s health GP at Jean Hailes for Women’s Health, Dr Amanda Newman, says there is low awareness in women and health professionals in general about the place of LARC in women’s reproductive health management, but that anything that can be done to help women avoid unintended pregnancies is important.

“The study’s findings will lift awareness of LARCs. Hormonal IUDs and implants are the most effective method of reversible contraception, and more effective than the Pill.”

says Dr Newman.

Dr Newman says the use of LARCs is appropriate in young women as well as women who have already had children. They can also be helpful in reducing the amount of menstrual bleeding. And because their duration of action is so long, they can be very cost-effective.

Find more information on contraception.