Australian women hesitant to use long-acting reversible contraception despite benefits

Alice Gibney is not sure what could convince her to try a long-acting reversible contraception (LARC), such as an IUD or Implanon.

The 37-year-old mother of two struggled with mood stability issues while on the contraceptive pill when she was younger.

That was part of the reason she never properly looked into using a LARC.

"I have a bit of a personal reluctance, I guess," she said.

Ms Gibney also has ADHD and is on the autism spectrum, so she is worried about how the hormones could affect her.

"I've not once looked into it just because, knowing myself well, I strongly assume that I would have a similar kind of sensitivity to the hormones in a LARC," she said.

"I'm scared of what the cost would be for me personally, just from an emotional perspective."

Yasmine Cumming was also hesitant about using a long-acting contraceptive.

The 25-year-old was on the contraceptive pill for six years, but said it was "mucking around" with her mood.

After trialling different pills, doctors recommended she consider LARCs.

"I was a little bit hesitant."

"Only because I didn't know anyone that had had it, so I didn't have any advice from friends or any experiences to go off."

Ms Cumming has now had a LARC for three or four years.

While she said the first month or so was "quite rough", she now says it was the "best decision" she ever made.

"I've had no problems. Wouldn't even know it's there."

"I used to get really, really painful periods as well, and now I don't even get a period, which is nice [because] I don't have this intense pain every month."

"It's very much out of sight, out of mind".

'Worldwide trend' away from hormonal contraception

Yasmine and Alice's stories probably resonate with many women's experiences, but there are far more people in Alice's camp than Yasmine's.

Just over one in ten Australian women are using LARCs.

That is well below comparable countries such as the UK and other European countries where more than 30 per cent of women use LARCs.

The reasons why the take-up is lower in Australia range from access issues — financial or finding someone to do the procedure — to a preference for the contraceptive pill.

The federal government is working to make them more accessible and affordable for Australian women, including through $25.6 million in funding to set up bulk-billed specialist LARC centres in each state and territory.

Monash University women's health professor Danielle Mazza said one of the big issues around LARCs was misconceptions.

"There is both misinformation … inaccurate stuff that's out there and online, but there's also active disinformation," Dr Mazza said.

Dr Mazza is the head of general practice at Monash University and the director of the Sphere Centre of Research Excellence in Women's Sexual and Reproductive Health in Primary Care.

She said there was a worldwide trend away from the use of hormonal contraception among younger women.

"There's this sense amongst younger women that they don't want to put something foreign in their bodies, that they don't want to use hormones,"

"But I think they're often forming those opinions without really talking through the range of benefits."

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Australian Women's Health Alliance deputy chair Bonnie Corbin said the way Australia had approached information about LARCs had been "very patchy" and that had left the door open for misinformation.

"Social media feeds, algorithms will just pick up like reams of misinformation, and whether it be from just like fake kind of like anti-choice sites or whether it be from pharmaceutical companies that have a particular influence," Ms Corbin said.

"There's just so many things out there that can direct people in the wrong direction around LARC."

At more than 99 per cent effectiveness, LARCs are the most effective reversible form of contraception.

The pill also has an effectiveness of 99 per cent, but only if it is used correctly. In reality, experts say the pill's effectiveness is more like 93 per cent.

LARCs also have non-contraceptive benefits, from reducing blood loss to decreasing heavy menstrual bleeding, and can even help with endometriosis.

That is not to say they work for everyone.

But experts say it is important women can see through the misinformation and understand their options.

A 2020 study that Dr Mazza was involved in found that by offering women contraceptive counselling and better access to LARC insertion, there was a "massive" uptake in LARCs.

"We were also able to demonstrate reductions in unplanned pregnancy and abortions in this group."

Access to services to increase

But misinformation and access to counselling is only one part of the problem.

Finding someone to perform the procedure is not always easy, particularly in rural and regional areas.

"Different practitioners will specialise in different types of LARC and so … it all depends on which practitioners you have in your area or within your reach," Ms Corbin said.

Dr Mazza said healthcare practitioners who offered LARC insertions and removals were "very limited in number" because it was difficult for them to access training.

"Our message to government has been, 'Help GPs to provide these services, offer more training, offer more support, increase the rebates, and then we'll have more GPs providing and we'll have more women taking up these products,'"

It is a message the federal government appears to have taken on board.

In the past year, the government has introduced a 40 per cent bulk-billing incentive for healthcare professionals, increased the Medicare rebate for certain contraceptives, and announced funding to set up bulk-billed LARC "centres of excellence".

The centres, which were informed by the 2020 study, will allow women, girls and gender diverse people to access contraceptive counselling as well as LARC insertion and removal services.

They will also train health professionals who want to be able to insert and remove LARCs.

Assistant Minister for Health and Women Rebecca White said it was about giving more choice to women so they could "decide for themselves what's in their best interest when it comes to managing their sexual and reproductive health".

"These centres of excellence will not only be places where women can go to actually receive this service directly, but also a place where other health professionals can learn,"

"And there'll be outreach support to centres in our regional rural communities too, because we want to remove some of those access barriers."

It is still unclear exactly where in each jurisdiction the centres will be, but the providers have now been announced, and the centres are expected to open in the next six months.

"By removing barriers around cost, by removing barriers around the lack of information and … having a trained health professional who can perform the procedure … we hope that more Australian women will choose this as their contraception of choice," she said.

Ms White also acknowledged broader concerns around misinformation and said the government was in "conversation" with the sexual and reproductive sector about the issue, but she hoped the centres would help in the battle against misinformation.

The centres are expected to be operating within the next six months.