Update on contraception.

• Jurisdiction: Australia
• Date: 01 October 2012
• Author: Garad, Rhonda

Much has changed in the array of contraception options available to women which can be challenging for nurses to keep up with. This article provides an overview of key areas such as: population trends in contraception use; data on the safety of the oral contraceptive pill (OCP); and specific information for population groups such as young people, breastfeeding mothers, older women and disabled women.

Women's changing contraception needs

Women's contraception needs are changing with population trends showing women are having less children, resulting in a greater reliance on contraception and for longer periods. A marked change in contraception options is the availability of long acting contraception (LAC) with increased benefits such as low cost, reversibility and improved compliance. Many countries such as the United Kingdom (UK) have used LAC in younger populations of women for many years, while Australian health professionals have shown a reluctance to follow this trend.

Bigger picture

Worldwide the demand for contraception is expected to grow by 40% in the next 15 years with an estimated 731 million users by 2015, a growth pattern which is outstripping available services and supplies.

Is the pill safe?

The OCP has now been used for over 50 years and persistent questions about the safety of long term pill use have now been answered. Data shows use of the OCP is not associated with an increased risk of death according to a long term UK study (Hannaford et al 2010). In fact, in the absence of background disease risk, a net health benefit was apparent (12% lower mortality rate). For example, the study confirmed users of the OCP had a reduced overall risk of cancers such as large bowel/rectum, uterine body, ovarian, gynaecoiogical cancers combined, and circulatory disease.

Four facts about the OCP

* To work effectively the OCP must be taken regularly and if missed for more than 24 hours after the usual time, additional protection must be used for seven days.

* It is perfectly safe to run active OCP packets together to avoid a period for a month or a number of months if desired.

* If experiencing troublesome side effects discuss appropriate alternatives with a medical practitioner.

* Long acting contraceptives such as IUDs are safe and appropriate for young women (with or without children).

The principles of contraceptive choice include a number of social, cultural, and economic considerations. In addition to this the Medical Eligibility Criteria (MEC) system is a useful tool that allows health professionals to safely match a woman's medical and personal history with her preferred methods of contraception. Australian guidance on MEC uses both the Faculty of Sexual and Reproductive Health (FSRH) and World Health Organization (WHO). MEC 1-4 will be used throughout this paper as defined in Table 1.

Contraception for young people

A request for contraception is the second most common general practice presentation for 14-17 year old females (Harrison et al 2011).

Contraceptive choices for younger women are in general no different to other age groups. Medical contraindications are uncommon although eliciting a family history may sometimes be difficult. The clinical issues are usually focused on establishing rapport, assessing maturity in decision making, capacity to consent to clinical management and child protection considerations. Confidentiality is highly valued by young people (Baxter et al 2011; Reddy et al 2002; Jones et al 2005) and it is important to be explicit about rights. Other relevant issues include: ability to pay for ongoing supplies; privacy of method; increased risk of sexually transmissible infections (STIs); and high fertility.

From a medical perspective there is no lower age limit for prescribing hormonal contraception if the young woman has started menstruating (Faculty of Sexual and Reproductive Healthcare Clinical Guidance 2010). The age of consent to medical treatment is 18. However the common law position in most states and territories is that a younger person can consent to their own treatment if they are judged as a mature minor. Check your local laws (Bird 2011).

A discussion about parental involvement should occur with those aged 15 or younger. Parental involvement removes the burden of keeping contraception secret, surreptitious borrowing of health care or Medicare cards and may assist with costs. While there are proven benefits of good parental communication the young person is in the best position to judge whether or not this is in his or her best interest and should not be pressured.

Condoms

While...