New findings, published in the International Journal of Women's Health, show increased long-acting reversible contraception (LARC) usage in England was significantly associated with decreased teenage pregnancy rates (under 18 years) and abortion rates in women aged under 20 years.[i]
The research, commissioned by Merck Sharp & Dohme Limited (MSD), found that:
- Under-18 conception rates decreased significantly between 1998 and 2011, from 46.6 to 30.7 per 1,000 women.[i] A statistically significant association was observed between this decrease and increased LARC usage [i]
- Abortion rates in younger women (below 20 years of age) decreased between 1998 and 2011 and their association with increased LARC usage in this age group was statistically significant i
- The trend of LARC usage observed over the entire 1998-2011 period was an 89.7% increase [i]
- There was also evidence of increased LARC usage following the positive NICE clinical guidance which reinforced the cost effectiveness of LARC methods.[i]
In addition to increased LARC usage, the 1999 Teenage Pregnancy Strategy is likely to have significantly contributed to the reduction in teenage conceptions over the 13-year study period (1998-2011). The strategy aimed to reduce the rate of teenage conceptions with the specific aim of halving the rate of conceptions among under-18s, and to set a firmly established downward trend in the rate of conceptions among under-16s, by 2010. It also improved the awareness of and provided access to all choices of contraception. However, the recent reforms to improve healthcare provision, that moved the provision of LARC into the public health domain, have posed some challenges for providers.
Lead author Dr Anne Connolly, GP/Clinical Lead for Maternity, women's and sexual health, Bradford and Chair of the Primary Care Women's Health Forum comments: "These findings are interesting because they demonstrate that the use of LARC can make a significant impact to the rate of unplanned pregnancies. There are also US data to show that when women have full information about available contraceptive methods, many will choose intrauterine devices or implants.[ii] LARC methods have proven efficacy and there is strong evidence to demonstrate the economic benefits resulting from the use of these methods from both a health and social care point of view."
She continued: "However, Primary Care Women's Health Forum members are concerned about the future of sexual health services because of the recent commissioning changes which are putting funding for maintaining these services in both the community and in primary care settings at risk. Access in particular is key to ensure women are able to get LARC methods. If access to these contraceptive methods were to be reduced, vulnerable women may opt for more accessible and less effective methods."
In addition to the funding worries, there are also concerns that there aren't sufficient numbers of trained LARC fitters available in the UK. In a bid to address this shortage and standardise the approach to training, the Faculty of Sexual and Reproductive Health (FSRH) recently made changes to the LARC fitter accreditation process and introduced a new qualification for nurses. This means that there could be an increase in the number of fitters and fitting services provided in the community and primary care settings.
Dr Amanda Britton, Clinical Lead for Children and Maternity at North Hampshire CCG and a GP Principal commented: "The FSRH made the adaptations to the LARC training process because it recognises the importance of both maintaining fitter numbers and available training to future proof delivery and also of the on-going need for fitters to maintain their expertise. These are both important responsibilities of those commissioning services."
Whilst the recently published 2013 ONS conception statistics show a significant decline in the rate of under-18 conceptions,[iii] the UK still has the highest teenage pregnancy rates in Western Europe.[iv],[v]
Debbie Mennim, Head of Nursing, Brook said: "It is encouraging to see an increase in LARC uptake in young people. Brook endeavours to provide all young women with the information about all contraceptive methods, including LARC, to ensure they are able to make informed decisions about their contraceptive method. Effective contraception, in conjunction with information and education about relationships enables young people to develop the skills they need to form healthy and positive sexual relationships."
Teenage pregnancy has a potentially large impact on the lives of young women and represents a substantial cost to the state in terms of abortion-related care in the NHS and social care.[vi] Currently up to 50% of pregnancies are unplanned[vii] and they are estimated to cost the NHS in England £817 million a year.[viii] Health and education strategies made to reduce the number of unintended pregnancies could deliver significant cost savings to the NHS; it has been estimated that every £1 invested in contraception saves the NHS £12.50.[viii]
About Long-acting Reversible Contraception
The effectiveness of barrier methods e.g. condoms and oral contraceptive pills depends on their correct and consistent use. By contrast long-acting reversible contraception (LARC) are methods that a woman doesn't have to think about every day or every time she has sex. Their contraceptive effect is reversible after stopping or removing the method.
There are four types of LARC:
- Contraceptive injection - Injected into the buttocks, arm, leg or abdomen every 8 to 13 weeks, depending on the type. It releases the hormone progestogen which stops ovulation, thickens cervical mucus to prevent sperm reaching an egg and thins the lining of the uterus to prevent a fertilised egg implanting. Is over 99% effective.[ix],[x]
- Contraceptive implant - A flexible rod fitted just under the skin in the upper arm - lasts for up to 3 years. It releases the hormone progestogen. It stops ovulation, thickens cervical mucus to stop sperm reaching an egg, and thins the lining of the uterus (womb) to prevent a fertilised egg implanting. Is over 99% effective.[xi]
- Intrauterine device (IUD or Coil) - A small plastic and copper device fitted into the uterus and lasts for 5 or 10 years depending on the type. Its effects include preventing sperm reaching an egg, and may also stop a fertilised egg implanting in the uterus. Does not contain any hormones and is 98-99% effective.[xii]
- Intrauterine system (IUS) - A small, T-shaped plastic device, which releases the hormone progestogen, is fitted into the uterus and lasts for 3 or 5 years depending on the type. This thins the lining of the uterus to prevent a fertilised egg implanting, thickens cervical mucus to prevent sperm reaching an egg, and may stop ovulation. Is over 99% effective.[xiii],[xiv]
For further information about contraceptive choices visit www.talkchoice.co.uk