Practical problems which women encounter with available contraception in Australia

Abstract

Australian women face major difficulties with contraception because of the limited range of choices, the need for meticulous attention to compliance with most available methods and because of cost limitations for a significant minority of the population. The most commonly used methods are oral contraceptive pills and barrier methods, and each has substantial compliance problems which can be minimized with care and counselling. There is an urgent need for a wider range of options in Australia and for good information and publicity about them. Present progress in this direction gives some hope for the near future.

PIP: Australian women face compliance, availability, and cost problems with contraceptives. In reality, oral contraceptives (OCs) have a high failure rate. An abortion survey in New South Wales in 1992 found that 14.4% of women were using OCs at the time of conception. Complete compliance with OCs is uncommon (28-40%). Abrupt cessation of OC use and forgetting to use pills at either end of the pill cycle are major reasons for noncompliance. Leading reasons for abrupt cessation of OCs are concerns about OCs, poor cycle control, weight gain, and headaches. Some ways to improve OC compliance are improved packaging, uniform missed pill instructions, clearer and more readable package inserts, improved verbal and written counseling, and detailed instructions on how to take the pills and what to do when one misses a pill. The abortion survey found that 22% of women seeking an abortion were using condoms at the time of conception. Many report a broken or slipped condom, both of which are generally caused by incorrect usage. Women who use the diaphragm only when they have intercourse have a higher failure rate than those who keep it in place for 24 hours, even though the latter do not use spermicides. Women are less likely to use their contraceptive method if the instructions are difficult and complicated. The vaginal ring has potential because it does not require action every day and can be left in place. The mass media and attitudes of providers influence women's choice of contraceptives. In New South Wales, only 50% of general practitioners discuss IUDs when they talk to women about contraception. 11% of women in the abortion survey could not obtain postcoital contraception from their physicians. A postcoital contraceptive and low dose OCs should be readily available in Australia. Contraceptives are expensive in Australia. Some contraceptives which are unavailable in Australia are OCs with gestodene, postcoital contraceptives, the levonorgestrel-releasing IUD, Norplant, the vaginal sponge, the female condom, and RU-486.