Low use and awareness of long-acting reversible contraception in women attending a South London genitourinary medicine clinic

Abstract

Sirs: Samuel et al. describe how long-acting reversible contraception (LARC) in the form of a Mirena coil was useful for a woman with HIV. It improved her heavy periods and also provided effective contraception. National Institute for Health and Clinical Excellence (NICE) guidelines recommend LARC be promoted among sexually active teenagers a group who may have difficulties with consistent use of condoms and oral contraceptives. In January 2009 we conducted a cross-sectional survey to look at usage and awareness of LARC among women attending a genitourinary medicine clinic in southwest London. During a one-week period 122 women who attended the clinic were approached of whom 120 (98%) consented to filling in the questionnaire. The mean age of responders was 22 years (range 13-35) and 49 (41%) were teenagers. Most participants (57%) were from ethnic minorities. Thewomen described their ethnicity as white -43% black -42% (black-Caribbean black-African and black other) Indian -4% Pakistani -2% Chinese -2% any other ethnic group -7%. Current usage of LARC (defined as ?Depo provera injection implant or coil?) among the responders was 10% (11/120). This comprised 6% intrauterine contraceptive device (IUCD) 3% Depo provera injection and 1% contraceptive implant. Only four (8%) of the 49 teenagers were using LARC as their contraceptive method: three had an IUCD and one had an implant. Of all the participants 21% (24/120) said they had used LARC in the past. However more than half the women (54% [65/120]) including 59% (29/49) of teenagers said that they had never received any information about LARC. Over half the teenagers (57% 28/49) said their reason for not using LARC was ?insufficient information/knowledge?. We found that current usage of LARC (8%) among the teenagers in our study was much lower than other methods of contraception such as condoms (44%) and the contraceptive pill (34%). Samuel et al. point out the benefit of LARC in preventing pregnancy while preserving fertility. We agree that LARC should be more widely promoted especially among vulnerable teenagers. (full-text)