Mazza Danielle, Bateson Deborah, Frearson Meredith, Goldstone Philip, Kovacs Gab, Baber Rod
Department of General Practice, Monash University, Notting Hill, Victoria, Australia.
Family Planning NSW, Ashfield, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):206-212. doi: 10.1111/ajo.12587. Epub 2017 Mar 10.
Australia's abortion rates are among the highest in the developed world. Efficacy of the most commonly used form of contraception (oral contraceptives and condoms) relies on regular user compliance. Long-acting reversible contraception (LARC) virtually eradicates contraceptive failure as it is not user-dependent; however, its uptake has been low.
To provide an overview of barriers to LARC use in Australia and potential strategies to overcome these barriers.
A roundtable of Australian experts was convened to share clinical perspectives and to explore the barriers and potential strategies to increase LARC use.
Three broad barriers to LARC uptake were identified. (i) A paucity of Australian research exists that impedes closure of evidence gaps regarding contraceptive prescription and use. Systematic data collection is required. (ii) Within primary care, lack of familiarity with LARC and misperceptions about its use, lack of access to general practitioners (GPs) trained in LARC insertion/removal and affordability impede LARC uptake. Potential strategies to encourage LARC use include, GP education to promote informed choice by women, training in LARC insertions/removals, effective funding models for nurses to perform LARC insertions/removals, and rapid referral pathways. (iii) At the health system level, primary care incentives to provide LARC to women and health economic analyses to inform government policy changes are required.
Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low in Australia. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce Australia's high unintended pregnancy rate.
澳大利亚的堕胎率在发达国家中位居前列。最常用的避孕方式（口服避孕药和避孕套）的有效性依赖于使用者的定期依从性。长效可逆避孕法（LARC）由于不依赖使用者，实际上消除了避孕失败的情况；然而，其使用率一直很低。
概述澳大利亚长效可逆避孕法使用的障碍以及克服这些障碍的潜在策略。
召集了一个澳大利亚专家圆桌会议，以分享临床观点并探讨增加长效可逆避孕法使用的障碍和潜在策略。
确定了长效可逆避孕法使用方面的三大障碍。（i）澳大利亚的研究匮乏，这阻碍了消除避孕处方和使用方面的证据差距。需要进行系统的数据收集。（ii）在初级保健领域，对长效可逆避孕法缺乏了解以及对其使用存在误解，缺乏接受长效可逆避孕法植入/取出培训的全科医生，以及费用可承受性问题阻碍了长效可逆避孕法的使用。鼓励使用长效可逆避孕法的潜在策略包括，对全科医生进行教育以促进女性做出明智选择，提供长效可逆避孕法植入/取出培训，为护士实施长效可逆避孕法植入/取出建立有效的资助模式，以及快速转诊途径。（iii）在卫生系统层面，需要有向女性提供长效可逆避孕法的初级保健激励措施以及进行卫生经济分析以为政府政策变革提供依据。
尽管长效可逆避孕法通过消除使用者依从性问题减少了意外怀孕，但在澳大利亚其使用率很低。针对特定障碍促进长效可逆避孕法使用的策略可能有效降低澳大利亚较高的意外怀孕率。
