Awareness of Long Acting Reversible Contraception in General Practice Park Lane Medical Centre, Hampshire, United Kingdom Dr Anjali Bala Chandra MBBS BSc (Hons.) MRCGP (2014) Dr Birbala Dixit MBBS D(Obst) RCOG FRCOG FFRSH FIMSA Good afternoon ladies and gentlemen. I would like to thank the organising committee for inviting me to this conference. This is my first time in China. This is a very exciting opportunity and it is a privilege to be here. I will be sharing the data from this small study about Long Acting Reversible Contraception awareness in the community and I look forward to hearing your views and having a discussion about this topic. This study was due to be presented by the first author Dr Chandra however she has been unable to attend this conference. I am privileged to be presenting on her behalf.

Park Lane Medical Centre (U.K.) Number of registered patients: 8609 Number of doctors: 4 Number of nurses: 3 Number of health care assistants: 1 Administrative staff: 12 I am presenting data from a community general practice clinic in a semi-rural town in Hampshire, United Kingdom. The patient population are mainly Caucasian and there are 8609 registered patients at Park Lane Medical Centre. There are 4 full time doctors and 3 nurses at this community general practice. We designed a questionnaire and this was distributed by my colleague, nurses and administrative staff to patients. We collected 100 responses.

LARC MAYBE INTERACTIVE – can you recognise what these pictures represent? On the far left – this represents the copper coil which is known as IUCD – intra-uterine contraceptive device. There are 150 million users of IUCD worldwide. This lasts minimum 5 years. Sometimes this can cause heavy bleeding. Next is the progesterone only sub-dermal implants. This is known as Nexplanon and it lasts 3 years. Some women many have irregular spotting initially. Next is the Intrauterine System, most commonly used is Mirena coil. This is also indicated for use in heavy menstrual bleeding and as a part of hormone replacement therapy during menopause. Again this lasts for 5 years and can cause irregular bleeding initially. Finally on the far right is Depo-provera which is an intramuscular injection which provides contraception for 12 weeks. There is also Sayana Press which is a subcutaneous injection and also lasts 12 weeks. The woman can self-administer this injection if they feel confident. Again initially irregular spotting may occur. LARC methods are suitable for most women. The only main contraindication for the implant is enzyme-inducing drugs.

CONTRACEPTION FAILURE RATES Percentage of unplanned pregnancies in the 1st year Withdrawl method: 22% Condom: 18% Combined Pill / Patch / Ring: 9% Progesterone-only Pill: 9% Injection: 6% IUCD: 0.8% IUS : 0.2% Implant: 0.05% Female sterilisation: 0.5% Male sterilisation: 0.15% LARC methods have much lower failure rates than user-dependent short-acting methods. This is particularly vital in China where the number of children a couple could have are restricted.

Unplanned pregnancies 30% pregnancies are unplanned Number of Terminations in England and Wales: 1976: 101,912 1986: 147,619 1996: 167,916 2006: 193,737 2016: 185,596 Switching patients from SARC to LARC  fewer unplanned pregnancies Will save millions of pounds to NHS every year Termination of pregnancies mostly result from incorrect use of pill or condoms. Sometimes women only keep their fingers rather than keeping their legs crossed and use NO contraception!! =) Switching even <10% of patients from SARC to LARC will result in fewer unplanned pregnancies which will save the NHS (National Health Service in United Kingdom) millions of pounds every year.

Contraception Questionnaire

Data analysis

Knowledge of LARC effectiveness is still very poor Knowledge of LARC effectiveness is still very poor. In a first world country.

This is a surprising result, as I expected most people to know about copper coil as it has been longer in the market rather than implant

Analysis of knowledge of LARC at PLMC (U.K) TYPE OF RESPONSE MALE FEMALE ALL 4 CORRECT 4 (13.7%) 19 (26.7%) PARTIALLY CORRECT 16 (55.1%) 39 (54.9%) NONE CORRECT 9 (31.0%) 13 (18.3%) TOTAL 29 71

Contraception use at PLMC (U.K.) Type of contraception Number of women Percentage Combined oral contraception 301 31.99% Progesterone only contraception 250 26.57% Contraceptive patch 7 0.74% Total SARC 558 59.30% Injection 92 9.78% Sub-dermal implant 60 6.38% Copper coil 15 1.59% Hormone coil 216 22.95% Total LARC 383 40.70% Total 941 100% Type of contraception used by women at Park Lane Medical Centre The percentages are out the total 941 women who are using contraception in the surgery. Surprisingly the copper coil is not very popular in comparison to hormone coil. In the UK the hormone coil is gold standard management for heavy menstrual bleeding. As you can see SARC is

Recommendations 1 - Any male or female patients >16yrs: discuss sexual health and contraception. 2 - Request sexual health clinic, pharmacies, OOH and A&E to inform us about our patients attending for contraception and emergency contraception. 3 - Display a poster in the waiting / reception area. “Are you sexually active? If so see a doctor or nurse for advice.” In UK pharmacies can dispense emergency contraception so it would be good if they kept us informed. Poster – are you sexually active? If so see a doctor or nurse for advice.

Recommendations 2 4 - Message on the back of prescription. “Are you sexually active? If so see a doctor or nurse for advice.” 5 - Discuss at practice meeting and at meetings with local GPs to remind all members of staff. 6 - Re-audit in 6 months to see if there are any improvements. Similar message on back of prescription recommending patients seek advice about contraception if needed. If you have any other recommendations please let me know. I would appreciate your input.

Conclusion This preliminary study suggests that there is a definite need for education and training of healthcare professionals as well as the general public to improve knowledge and awareness to increase the uptake of LARC. Consequently this could lead to fewer unplanned pregnancies and termination of pregnancies in the future. CHILDREN BY CHOICE, NOT BY CHANCE!

Any questions?

Thank you. Any questions?