Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, P.O. Box 140, 00029 HUS Helsinki, Finland.
Department of General Practice and Primary Care, University of Helsinki, Finland.
Contraception. 2020 Jun;101(6):370-375. doi: 10.1016/j.contraception.2020.01.018. Epub 2020 Feb 13.
To identify factors associated with choosing long-acting reversible contraception (LARC) (intrauterine device or contraceptive implant), when provided free-of-charge.
This register-based cohort study comprises all women living in the city of Vantaa in the Helsinki metropolitan area during 2013-2014, with information on LARC initiations retrieved from electronic health records. Since January 2013, women in Vantaa can receive their first LARC method free-of-charge at public contraceptive clinics. We performed multivariable regression to assess seven predictors based on literature and four predictors based on gynecological history for association with choosing LARC in this population.
In 2013-2014, 9669 women entitled to a free-of-charge method visited a public clinic and 2035 (21.0%) women initiated LARC. Factors most associated with LARC initiation included history of delivery (odds ratio [OR] 5.4, 95% confidence intervals [CI] 4.7-6.2) and induced abortion (OR 1.4, 95%CI 1.2-1.6), and no previous visit at the clinic (OR 1.3, 95%CI 1.2-1.5). Previous delivery was associated with LARC initiation in all age-groups (OR, 95%CI by age-group; 15-19 years: 10.8, 5.1-23.4; 20-24 years: 6.4, 4.9-8.3; 25-29 years: 6.7, 5.2-8.6; 30-44 years: 3.6, 2.9-4.6).
History of delivery and induced abortion were strongly associated with choosing a LARC method, even though all women in the population were entitled to their first free-of-charge LARC method. The association was particularly strong among women less than 25 years of age.
Untargeted provision of free-of-charge LARC in public contraceptive services reached women with previous delivery or abortion well during the programs first years. However, as LARCs are recommended to all women, future research should focus on how uptake evolves and how to reach all women in need of long-term, effective contraception.
确定与选择长效可逆避孕措施（宫内节育器或避孕植入物）相关的因素，这些措施是免费提供的。
本注册队列研究包括 2013-2014 年居住在赫尔辛基大都市区万塔市的所有女性，其宫内节育器起始使用信息从电子健康记录中检索。自 2013 年 1 月以来，万塔市的女性可以在公共避孕药具诊所免费获得她们的第一种宫内节育器方法。我们进行了多变量回归分析，根据文献评估了七个预测因素，并根据妇科病史评估了四个预测因素，以评估该人群中选择宫内节育器的相关性。
2013-2014 年，有 9669 名符合免费方法条件的女性到公共诊所就诊，其中 2035 名（21.0%）女性开始使用宫内节育器。与宫内节育器起始使用最相关的因素包括分娩史（比值比[OR]5.4，95%置信区间[CI]4.7-6.2）和人工流产史（OR 1.4，95%CI 1.2-1.6），以及之前未到诊所就诊（OR 1.3，95%CI 1.2-1.5）。所有年龄组的既往分娩均与宫内节育器起始使用相关（年龄组比值比[OR]，95%CI；15-19 岁：10.8，5.1-23.4；20-24 岁：6.4，4.9-8.3；25-29 岁：6.7，5.2-8.6；30-44 岁：3.6，2.9-4.6）。
尽管该人群中的所有女性都有权获得第一次免费宫内节育器方法，但分娩和人工流产史与选择宫内节育器方法密切相关，即使所有女性都有权获得免费的宫内节育器方法。这种关联在年龄小于 25 岁的女性中尤为强烈。
公共避孕药具服务中免费提供的无针对性宫内节育器在项目的最初几年很好地覆盖了有既往分娩或流产史的女性。然而，由于宫内节育器推荐给所有女性，因此未来的研究应侧重于如何发展使用情况以及如何为所有需要长期、有效避孕的女性提供服务。
