Just one method among others: examining long-acting reversible contraception (non-)use

Over the past few years, interest in long-acting reversible contraception (LARC; including intrauterine devices, contraceptive implants and contraceptive injections) as a way to reduce rates of unintended pregnancy has grown. Despite increasing advocacy for these highly effective and long-lasting methods, rates of use in Australia, particularly among young women, remains low. While the body of literature in this area is developing, the reasons why young women choose to use less effective, short term methods rather than LARC remains unclear. Using data from the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) Study, this thesis develops an understanding of LARC (non-)use among a cohort of young Australian women. This work employs a mixed-method approach, and is comprised of four components, spanning a systematic review, quantitative analysis, and two qualitative analyses (the first utilises free-text comments, the second semi-structured interviews). Key findings include the importance of pregnancy (actual, or future intentions); results from the quantitative analysis demonstrated that women with a history of pregnancy were more likely to use LARC, while results from the semi-structured interviews showed that women with unclear or ambivalent attitudes towards pregnancy were reluctant to use these methods. Furthermore, non-contraceptive effects (for example, menstrual cycle control) were found to play a significant role in contraceptive decision making. Findings from the systematic review suggest that the contraceptive benefits of LARC are generally perceived positively by women. However, findings from both sets of qualitative data reveal that women make decisions based on more than contraceptive effectiveness, prioritising certain characteristics over others. The qualitative analysis of free-text comments also showed that contraceptive needs can change over relatively short periods of time, thus making the ‘temporarily permanent’ nature of LARC unappealing to some. On the other hand, findings from the semi-structured interviews demonstrated that women who desire LARC still face difficulties to use, including a general lack of awareness regarding these methods, as well as misperceptions held by their health care providers. In summary, findings from this thesis demonstrate the existence of some very real challenges to LARC use for those who would benefit or desire them. However, these methods are not the only options available to women, who will continue to choose whichever method best suits their needs, often irrespective of effectiveness.