Misplaced concerns and myths about long-acting reversible contraceptives have prompted medical experts to release Australia’s first consensus statement, saying they are more reliable and effective than condoms or the pill.

Despite their safety, efficacy and widespread use internationally, the uptake of long-acting reversible contraceptives (Larcs) is low in Australia. On Tuesday the Australian Healthcare and Hospitals Association released a consensus statement on the use of Larcs in an attempt to educate women and their doctors about the devices available.

The medical director of Family Planning New South Wales, Deborah Bateson, said Larcs such as the progestogen-only implant and hormonal and copper intrauterine devices were more reliable and effective than condoms or the pill, and had benefits for women unrelated to preventing pregnancy, such as reducing menstrual bleeding.

“But women I see sometimes go on Google and read misinformation including that Larcs are not suitable for young women, or that they have a lasting effect on future fertility,” Bateson said.

“There are also misplaced concerns about infection risk, and I think some women also feel concerned about the procedure itself, whether it’s one of the devices placed under the skin under the arm or an IUD being implanted into the uterus. So this consensus statement is about women and doctors having access to good, reliable information.”

But doctors’ clinics were often not equipped to perform the procedure, or were not providing enough information to women about the different kinds of Larcs and their pros and cons, she said. Women wary of hormonal contraceptives might wish to consider the copper IUD, for example, but weren’t necessarily being given this information.

“There is a bit of a move away from the pill and we need to get into the mindset of being aware of these other methods, which have benefits beyond reliably providing long-term contraception,” Bateson said.

“Women who have heavy bleeding and who can become anaemic because of this might benefits from Larcs, and the hormonal IUD can cut down on blood loss during periods by up to 90%. The copper IUD can be used as a form of emergency contraception if inserted within five days of unprotected intercourse but many women don’t know they have this alternative to the emergency contraceptive pill [sometimes referred to as the morning-after pill].”

It has been estimated that 33% of women are using oral contraceptives, 30% condoms and 19% sterilisation as their primary contraceptive method. A study by Monash University researchers found that around one in seven sexually active Australians use no contraception, and a further one in seven use “natural” contraceptive methods, such as withdrawal or fertility awareness-based methods.

According to the consensus statement, 60% of Australian women who have had an unintended pregnancy were using at least one form of contraception, with the oral contraceptive pill the form most frequently cited (43%), followed by condoms (22%). Failure of contraception with oral contraceptive pills is largely attributable to not taking the pill as prescribed, for example missing a day.



“A key way to reduce unintended pregnancy is to use more effective, less user-dependent methods of contraception, such as the long-acting reversible contraceptive,” the statement says.

“However, when women are provided with comprehensive, accurate, unbiased counselling, Larc methods are preferred and have been shown to have the highest rates of satisfaction and 12-month continuation compared with other combined hormonal methods.”

The chief executive of the Australian Healthcare and Hospitals Association, Alison Verhoeven, said this did not mean that Larcs were for everyone or that women should be pressured to use them.

But women had a right to good quality information about all of the available contraceptive methods, she said.

“Part of the issue is insertion of a Larc can sometimes require more than one visit to a GP, which becomes expensive if doctors don’t bulk bill, but also there is a geographic barrier in that some regional and rural clinics may not have the facilities to insert the devices,” Verhoeven said.

The federal government needed to ensure Medicare benefits schedule items for insertions and removals reflected the cost of providing the service, and took into account the wider public health benefit.

“Training programs for health professionals in implant and IUD insertion and removal should be made easily available,” she said. In particular, nurses, midwives and nurse practitioners can and should have increased involvement in Larc procedures.”

Women should also receive education about Larcs in school, she added.

The development of the consensus statement was supported by funding from Merck Sharp & Dohme, and followed consultation with consumers, leading health professionals and experts.