Doctor contraceptive-prescribing behaviour and women's attitudes towards contraception: two European surveys

Relationship between classic indicators of health behaviour and contraceptive choices in women in Flanders

BACKGROUND

In this study we shed light on ongoing trends in contraceptive use in Flanders (Belgium). Building on the fundamental cause theory and social diffusion of innovation theory, we examine socio-economic gradients in contraceptive use and the relationship to health behaviours.

METHODS

Using the unique and recently collected (2020) ISALA data, we used multinomial logistic regression to model the uptake of contraceptives and its association to educational level and health behaviour (N:4316 women).

RESULTS

Higher educated women, and women with a healthy lifestyle especially, tend to use non-hormonal contraceptives or perceived lower-dosage hormonal contraceptives that are still trustworthy from a medical point of view. Moreover, we identified a potentially vulnerable group in terms of health as our results indicate that women who do not engage in preventive health behaviours are more likely to use no, or no modern, contraceptive method.

DISCUSSION

The fact that higher educated women and women with a healthy lifestyle are less likely to use hormonal contraceptive methods is in line with patient empowerment, as women no longer necessarily follow recommendations by healthcare professionals, and there is a growing demand for naturalness in Western societies.

CONCLUSION

The results of this study can therefore be used to inform policy makers and reproductive healthcare professionals, since up-to-date understanding of women's contraceptive choices is clearly needed in order to develop effective strategies to prevent sexually transmitted infections and unplanned pregnancies, and in which women can take control over their sexuality and fertility in a comfortable and pleasurable way.

Evaluation of factors associated with noncompliance in users of combined hormonal contraceptive methods: a cross-sectional study: results from the MIA study

Background

Understanding contraception from the perspective of the user may help to improve compliance. The aim of this project was to determine the factors that influence the noncompliance in young women that use combined hormonal contraceptives (pill, patch or vaginal ring).

Methods

A nationwide cross-sectional multicenter epidemiology study. Physicians [obstetricians/gynecologists]) recorded socio-demographic, clinical and current contraception data of 8,762 women. Women completed a self-administered questionnaire on compliance. After the assessment of self-administrated questionnaire, the physicians reported on their recommendations on the possibility of changing the contraceptive.

Results

Fifty-two percent of women were noncompliant, mainly because of simple forgetfulness (pill, 74.9%; patch, 47.8%; vaginal ring, 69.1%). The percentage of noncompliant women was lower in vaginal ring users (26.6%) than in patch users (42.4%) or pill users (65.1%) (p < 0.0001). The most common course of action after noncompliance was to take/use the contraceptive as soon as possible. In the multiple logistic regression analysis, the use of the pill increased the probability of noncompliance compared with the patch and the vaginal ring (odds ratio [IC95%]: 2.53 (2.13-3.02) and 4.17 (3.68-4.73, respectively), and using the patch compared with the vaginal ring (1.65 (1.36-1.99)). Others factors associated with noncompliance were: high treatment duration, low degree of information on the contraceptive method, understanding of instructions on the contraceptive method, indifference to becoming pregnant, lack of partner support, not participation in selecting the method, not having a routine for taking treatment and difficulties remembering use the contraceptive method. Switching contraceptive method was proposed by the physicians to 43.2% of women (51.8% of pill users, 58.2% of patch users and 19.4% of vaginal ring users).

Conclusions

More than 50% of combined hormonal contraceptive users did not comply with the treatment regimen. The percentage of noncompliant women was lower between vaginal ring users. Understanding user’s reasons for noncompliance by the clinician and encouraging a collaborative approach can go a long way to improving compliance.

Impact of UK Medical Eligibility Criteria implementation on prescribing of combined hormonal contraceptives

Objectives

Combined hormonal contraceptives (CHCs) are the most widely prescribed contraceptive methods in the UK; however, their use is associated with significant cardiovascular risk for women with some medical conditions and risk factors. The objective of this study was to assess the potential change in CHC prescribing among higher-risk women following publication of the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) in 2006.

Methods

A cross-sectional study was conducted using the General Practice Research Database to analyse UK women aged 15–49 years who were prescribed CHCs during the period 2004–2010. Of women prescribed CHCs, those at higher risk of cardiovascular events (with UKMEC Category 3 or 4 risk factors) were identified. The percentage of higher-risk CHC users, among all CHC users, in 2005 (pre-UKMEC) was compared to that in 2010 (post-UKMEC).

Results

The percentage of higher-risk CHC users significantly decreased by 0.8% (95% CI 0.68% to 1.02%) following publication of UKMEC [8.1% (95% CI 7.98% to 8.22%) in 2005 vs 7.3% (95% CI 7.14% to 7.38%) in 2010; p<0.001]. However, an estimated 1 74 472 women in the UK were prescribed CHCs in 2010 despite having Category 3 or 4 risk factors. The most common Category 3 or 4 risk factors were body mass index ≥35 kg/m², hypertension and smoking in women aged ≥35 years.

Conclusions

Despite the observed reduction in prescribing of CHCs to higher-risk women after publication of UKMEC, a large number of women with Category 3 or 4 risk factors are still prescribed CHCs. The increased risk of cardiovascular events is unnecessary for many of these women given the availability of alternative contraceptive methods.