Details of Publication 616 for Project A297A:

Lucke J & Herbert D. Area of residence is associated with Australian women’s uptake of long-acting contraception. , 2013; : 18(Supp 1)

Objective: Several new types of contraception have become available in Australia over the last 12 years (the implant in 2001, progestogen intra-uterine device (IUD) in 2003, and vaginal contraceptive ring in 2007). Most methods of contraception require access to health services. Permanent sterilisation and the insertion of an implant or IUD involve a surgical procedure. Access to health professionals providing these specialised services may be more difficult in rural areas. This paper examines uptake of permanent or long-acting reversible contraception (LARCs) among Australian women in rural areas compared to women in urban areas.Method: Participants in the Australian Longitudinal Study on Women ’ s Health born between 1973 and 1978 reported on their contraceptive use at three surveys: 2003, 2006 and 2009. Contraceptive methods included permanent sterilisation (tubal ligation, vasectomy), non-daily or LARC methods (implant, IUD, injection, vaginal ring), and other methods including daily, barrier or ‘ natural ’ methods (oral contraceptive pills, condoms, withdrawal, safe period). Sociodemographic, reproductive history and health service use factors associated with using permanent, LARC or other methods were examined using a multivariable logistic regression analysis.Results:Of 9081 women aged 25 to 30 in 2003, 3% used permanent methods and 4% used LARCs. Six years later in 2009, of 8200 women (aged 31 to 36), 11% used permanent methods and 9% used LARCs. The fully adjusted parsimonious regression model showed that the likelihood of a woman using LARCs and permanent methods increased with number of children. Women whose youngest child was school-age were more likely to use LARCs (OR 1.83,95%CI 1.43 – 2.33) or permanent methods (OR 4.39,95%CI 3.54 – 5.46) compared to women with preschool children. Compared to women living in major cities, women in inner regional areas were more likely to use LARCs (OR 1.26, 95%CI 1.03 – 1.55) or permanentmethods (OR 1.43, 95%CI 1.17 – 1.76).Women living in outer regional and remote areas weremore likely than women living in cities to use LARCs (OR 1.65, 95%CI 1.31 – 2.08) or permanent methods(OR 1.69, 95%CI 1.43 – 2.14). Women withpoorer access to GPs were more likely to use permanent methods (OR 1.27, 95%CI 1.07 – 1.52).Conclusions: Location of residence and access to health services are important factors in women ’ s choices about long-acting contraception in addition to the number and age of their children. There is a low level of uptake of non-daily, long-acting methods of contraception among Australian women in their mid-thirties.