The uptake of long acting reversible contraceptives (LARCs) is higher among Aboriginal women in the Western Desert communities of Western Australia than at a national level, research published in Medical Journal of Australia has found.
Of the women who were using contraception in the region, 77% were using the etonogestrel implant and 7% were using depot medroxyprogesterone.
The high uptake of LARCs is in line with international recommendations about contraceptive use.
Dr Emma Griffiths and colleagues from the Kimberley Aboriginal Medical Services Ltd and The University of Western Australia wrote that good local access to a dedicated sexual health coordinator and trained inserters could have influenced the popularity of the implant.
"Ready availability of the etonogestrel implant may predispose prescribers to recommend it; in comparison, the 900km journey required for inserting an [intra-uterine contraceptive device] probably contributes to their low use in these communities," the authors wrote.
Although the social acceptance of LARCs was high, teenage pregnancy rates among Indigenous girls are still higher than for non-Indigenous girls, an accompanying MJA editorial argued.
Griffiths and her colleagues concluded that their findings support "a model of service delivery that promotes the reproductive health of Aboriginal women through community engagement and capacity building," broadening sexual health care "above and beyond the detection and management of sexually transmissible infections." Professor Sarah Larkins and Ms Priscilla Page (James Cook University) agree that more needs to be done to reduce the rates of unintended pregnancy, and that access to contraception is just one part of comprehensive sexual and reproductive health (SRH) care.
"This care needs to be embedded in a holistic primary health care system providing culturally appropriate support, and must include attention to the broader social determinants of health," they wrote.
They also pointed out that although LARC is highly effective against pregnancy, it doesn't protect against sexually transmitted infection, "so that a wider range of strategies, grounded in the empowerment of young women, is critical".
They wrote that part of the process is educating young people about their aspirations and life choices so they can make their own informed decisions about contraception.
"Only when all young women have access to quality SRH care provided by non-judgemental and culturally safe health staff, and they are empowered in terms of their own reproductive decision making (as well as decisions about educational and employment options), will we be on track to closing the gap," the authors concluded.
Article: Access to contraception for remote Aboriginal and Torres Strait Islander women: necessary but not sufficient, Sarah L Larkins and Priscilla Page, Medical Journal of Australia, doi: 10.5694/mja16.00431, published 4 July 2016.