"I never went to see that doctor again": A qualitative study examining Australian women's experiences requesting removal of LARC within 12 months of insertion.

OBJECTIVES

Removal or discontinuation of long-acting reversible contraception (LARC) requires cooperation of healthcare providers. The objective of this study was to explore young women's experiences when they request removal of LARC within 12 months of insertion.

STUDY DESIGN

We conducted a qualitative study using individual semi-structured telephone interviews with women living in Victoria, Australia. We recruited participants using physical and online advertising flyers. We audio-recorded and transcribed interviews and thematically analyzed the data.

RESULTS

Fifteen women participated in an interview. The experience of unacceptable side effects prompted "early" LARC removal in all cases. The non-autonomous nature of LARC removal was not considered by women pre-insertion and participants reported confidence in their ability to access LARC removal when requested. Although satisfaction was reported when LARC was removed on request, participants reported negative feelings towards their healthcare provider when there was perceived pressure to continue with LARC for longer than desired. This had implications for the patient-clinician relationship. Women experienced resistance to removal as a challenge to their bodily autonomy and this resulted in a loss of trust in health services.

CONCLUSION

Resistance to removal of LARC can damage the patient-clinician relationship and be experienced as a challenge to women's autonomy and reproductive rights.

IMPLICATIONS

Patients have confidence in their ability to get their LARC removed on request and autonomy is not largely considered prior to LARC initiation. Supportive removal services should be emphasized for women who request removal of LARC at any point after insertion in order to maintain trust in healthcare providers and health services.