Family planning in the Western Desert region

The availability of effective and acceptable contraception is critical to the realisation of sexual health, with an increasing shift toward promoting long-acting reversible contraception (LARC) methods at an international level. The comparatively lower rates of LARC uptake in Australia has been a trigger for research focussing on methods to improve uptake. In Aboriginal sexual health there has been a focus on high rates of STI infections, however little had been written about access to contraception in remote Aboriginal and Torres Strait Islander communities.

We aimed to find out:

  • What contraception options women are using, why, and whether they are effective
  • How they are being looked after in the area of sexual health
  • To seek community input into women’s health services to see where improvements could be made and into the development of new health practitioner resources

How was this study done?

Our mixed method study incorporated:

  • Retrospective audit of contraception prescription data, including searching all progress notes for keywords relating to contraception and review of relevant MBS billing items
  • Semi-structured interviews with women in the community (n=20)

What did we find?

  • The etonogestrel implant (Implanon ®) was the most commonly used contraceptive (77% of contraceptive users) and continuation rates were high. Rates at
    • 1 year: 87% (95% CI, 81–92%),
    • 2 years: 72% (95% CI, 64–78%)
    • 3 years: 51% (95% CI, 41–60%)
  • Medroxyprogersterone injections were the second most common contraceptive used, but were used less effectively with contraceptive effect lapsing for most women without receiving a second injection.
  • Intra-uterine contraceptive devices (IUCD) were used less commonly, probably because etonogestrel implants (but not IUCDs) can be inserted in community.
  • Tablet contraceptive medicines were not used commonly.

Most feedback from women in the communities about the etonogestrel implant was positive, although some side effects frequently reported in other populations of contraceptive implant users were mentioned (most commonly bleeding abnormalities).

Themes discussed at by community members included the need for young people to be healthy and old enough when becoming pregnant and dealing with partner pressure to cease contraception.

In this study, we did not elicit community concerns about the presence of the implant attracting unwanted attention.

What happens now?

We believe that the high uptake and continuation of a LARC method of contraception in these communities relates to an approach to sexual health that prioritises community engagement, continuity of care and integrated health promotion.

We support a holistic model of care that takes a broad approach to sexual and reproductive health, and acknowledge the importance of supporting autonomy and life opportunities for young women living in rural and remote areas.

Pre-conception counselling for young women was a priority identified by women in these communities and Kimberley Aboriginal Medical Services Ltd will be working towards improved service delivery in this area.

Publication:

Emma K Griffiths, Julia V Marley, Domenica Friello and David N Atkinson. Uptake of long-acting, reversible contraception in three remote Aboriginal communities: a population-based study. Med J Aust 2016; 205:21-25.

We would like to thank the women who participated in this project.  Without your help this research would not have been possible.