Jayne Lucke Pre-conception care and contraception for the generation

Contraception available in Australia Bateson et al., Contraception: a practice-based update. Australian Doctor, 4 May 2012

What do we know? Effective contraception reduces risk of unintended pregnancy Promote long-acting methods for greater effectiveness Minimise barriers to access and risk of adverse events Provide access to a wide range of methods for changing individual needs

Aims To examine... Patterns of contraception use among young women in Australia Use of contraception before an unintended pregnancy Differences between rural and urban areas

Methods Three online surveys – baseline, +6 months, +12 months – mixed methods – survey questions and free-text Sample – year old women across Australia Recruitment – through social media and other avenues

Sample characteristics Comparison of CUPID sample characteristics with Census data from the Australian Bureau of Statistics (2011) Census N=847,042 % CUPID N=3,810 % Marital statusMarried Never married Highest educationSchool Certificate/diploma University Area of residenceMajor city Inner regional Outer regional Remote Very remote0.91.0

Sex, contraception and pregnancy 3810 recruited 3412 ever had sex 2534 never pregnant 720 ever pregnant 93 intended 609 unintended 159 not using contraception 440 using contraception 85% of the women who had been pregnant 72% of the women who had an unintended pregnancy

Contraception at last sex Method (N=3810)% Pill only25 Pill and condom11 Condoms only18 Long-acting method16 Other15

... and before unintended pregnancy Method (N=609)% Pill only28 Condoms only11 Withdrawal only 9 Pill and condoms 7 Condoms and withdrawal 4 Pill and withdrawal 2 Other methods24 No contraception26

“I want to know if the pill reduces your chances of falling pregnant in the future. I have heard from girls who have been on the pill for over 10 years and are now trying to get pregnant and find it very difficult. I believe this is because your body is so used to being on the pill, it must have something to do with it...

... Fingers crossed I don’t fall pregnant soon. I know the pull out method is not the best form of contraception (obviously) but I’d rather stay away from any other drug related forms for in the future when I want children”

“I don’t feel comfortable telling the doctor what I’m REALLY doing so I will create a similar (but more respectable) situation to get advice for, and then compare that with online advice. I’d rather if I could get advice from a pharmacist and didn’t need an (ongoing) script to get the pill”

“I have had two experiences where I have gone to a male doctor to talk about contraception and they have nearly known nothing about the matter. I think male doctors should be aware of different contraceptive options in this day and age”

What do you think? How can we best help young women understand their fertility? How should we approach pre-conception care when many pregnancies are unintended? How can we respond to the perception that hormonal contraception is “unnatural”? Does it matter if a young woman doesn’t tell her doctor what she’s REALLY doing? Are male doctors letting down the side when it comes to contraceptive counseling?