Teens’ contraception needs left wanting in regional areas: Study

Informed decision-making, better access to all contraception methods, and updating some GPs on suitable intrauterine device (IUD) recipients are among recommendations in a new study examining high rates of teenage pregnancies in rural and regional Australia.
 
The study, published this week in the Australian Journal of Primary Health, was conducted by Monash University’s SPHERE Centre of Research Excellence.
 
A qualitative descriptive interview study, it features interviews with 18 regional GPs from seven Victorian local government areas where the teenage pregnancy rate is higher than the state average – at 18.3 or more live pregnancies per 1000 teenage women, compared to the state average of 9.5.
 
One in four women in Australia have experienced an unintended pregnancy, with rates even higher in rural areas and among younger women.
 
Two key themes emerged from the SPHERE study’s interview data: GPs’ approaches to contraceptive counselling with teenagers, and considerations given to contraceptive options.
 
Most GPs in the study said they most discussed and prescribed the oral contraceptive pill and contraceptive implant for teenagers, with IUDs less discussed.
 
While most of the GPs inserted contraceptive implants as part of their practice, only four routinely inserted IUDs.
 
The study authors noted that some GPs in the study demonstrated ‘misunderstanding’ around the suitability of long-acting reversable contraception (LARC) for teenagers, particularly IUDs due to ‘out-dated teaching’ around the suitability and safety of modern IUDs for women who had never given birth.
 
‘Misinformation regarding LARC held by healthcare professionals are important to consider, as they impact contraceptive counselling practices, and in turn teenagers’ contraceptive choices,’ wrote the study authors.
 
The GPs interviewed for the study were all deidentified, instead each given a number.
 
GP 12 said their reluctance to recommend IUDs is ‘probably [due to] old-fashioned concerns, just about damage to the cervix and the insertion of [an IUD]’.
 
‘I feel more comfortable with women who have gone through a pregnancy and having that inserted,’ they said.
 
GP 18 said they were ‘brought up in the age’ where IUDs weren’t recommended for young women because of the higher risk of sexually transmissible diseases, and therefore they ‘still stumble a little bit at recommending an IUD for a teenager’, except as a last option.
 
While GP 5 said ‘I will sometimes talk about Mirena if there are special circumstances, but I don’t really like using Mirena in women who haven’t had children’.
 
GPs who took part in the study recognised there are unmet needs for contraception information and care among teenagers in their respective regions.
 
While several GPs reported that, where appropriate, they try to include contraception in the discussion for most teenage consultations, most describe contraceptive discussions occurring opportunistically during appointments, or when initiated by the teenager.
 
Most GPs reported that a parent, often a mother, commonly attend consultations with their child, and that this often facilitated contraception discussions.
 
They said the parent often led the discussion or had a strong influence on the chosen contraceptive method, based on their own preferences or personal experiences.
 
GP 4 said ‘mums will often come in with their daughter to arrange the pill’, while GP 7 said their teenage patients often want to talk the options over with their parents, to make the right choice for themselves.
 
Most GPs highlighted the importance of supporting teenagers to make their own informed contraceptive choices.
 
‘That’s my philosophy, that adolescents are pretty capable, and if 99% of the time if you give them the right environment, the right information and enough time, they’ll make the best decisions for themselves,’ said GP 6.
 
Most GPs in the study suggested teenagers had limited knowledge of, and access to, contraception due to reasons including lower socioeconomic status, costs associated with some contraceptive methods, and a lack of providers of LARC insertion in their region.
 
The study authors recommended GPs, particularly in high-need areas, be incentivised to undertake LARC insertion and removal training.
 
‘[This] may increase the number of IUD inserters in primary care and subsequently reduce costs for patients,’ they wrote.
 
The study’s lead author, SPHERE Senior Research Fellow Dr Jessica Botfield, said the findings show GPs could better support teenagers in learning about contraception options.
 
‘Ensuring teenagers feel general practice is a safe place to discuss sexual and reproductive health issues was seen as important, to put them at ease and improve engagement in contraception discussions,’ Dr Botfield said.
 
‘Building on GPs’ current efforts to provide contraception information and support to young people and discussing contraception as part of routine care for teenagers, will further support these endeavours.’
 
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