Young women and contraceptive choices

1
Young women and contraceptive choices

• Understanding LARC adherence
• an in-depth investigation into sub-dermal
  contraceptive
• implant removal amongst young women in London
• Dr Lesley Hoggart and Dr Victoria Newton
• Sexual Health Research and Practice Group

2
Background to the study

• Commissioned by the London Sexual Health
  Commissioning Group
• Why?
• Uptake of LARC methods, including the implant, is
  still relatively low despite the NICE guidelines
  and policy push.
• Anecdotal evidence suggests that implant removal
  rates are quite high.

3
Research Question

• Why do some teenagers that have selected the
  implant as their contraception of choice have it
  removed within one year?
• Qualitative methodology to examine this question
  in depth
• Go beyond the tick-box
•  

4
Recruitment

• We recruited from four sites
• Greenwich
• Haringey
• Hounslow
• Kings
• We interviewed in total
• 20 young women
• 9 practitioners

5
Inclusion Criteria

• Young women aged between 16-19
• Age range extended to 24
• Had their implant removed
• Had their implant for 1 year or less
• Some slipped through the exclusion criteria

6
Recruitment Process

• Asked by practitioner if they would like to take
  part in research project
• Shown leaflet
• If interested in taking part contact details
  passed to LH/VN
• Contact made by telephone
• Interview arranged

7
The Interview

• Face-to-face interview, usually at the clinic.
• Sometimes a telephone interview if this is
  difficult.
• Expenses reimbursed and 20 voucher as thank you.
  

8
The Interview

• We asked the young women questions about
• Reasons for choosing implant
• Reasons for removal
• Opinions about other forms of contraception
• Experiences of local sexual health services
• More general discussions about their sexual
  behaviour, what influences contraceptive choice,
  how they made their decisions.

9
Emerging Findings

• Reasons for choosing the implant
• Experiences of the implant
• Reasons for removal
• Implications for practice

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Reasons for choosing implant

• Thought of as a good method (reliability)
• Difficulty using other methods
• Returned to implant after trying other methods
• Because of an established relationship
• To control bleeding/other perceived effect on the
  body

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Pros and cons

• Good concept but actual experience of method
  unsatisfactory
• Its just the gain, the fact that you gain
  weight, yes, but otherwise its a good thing,
  its the smartest one out of all of them.
• I think its a really good idea, I've got
  nothing against it except for the period flows.

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Reasons for removal
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Attitudes post-removal

• Distrust/scepticism of other hormonal methods
• Trust not being given the full picture
• Regaining bodily control

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Implications for Practice

• Understanding implant as a positive choice
• Pre-warning about side effects
• Helping to manage side effects
• Removing and moving onto other contraception
  quickly
• Overcoming resistance to the IUD?
• Any contraindications for implant?

15
What next?

• Participants can view and comment on the draft
  report once it is written. This helps ensure a
  true representation of the issues raised.
• Final report and dissemination.
• Further research possibilities?

16
Thank you

• Any questions?
• Any contributions?
• Lesley Hoggart
• l.hoggart_at_gre.ac.uk
• Victoria Newton
• v.l.newton_at_gre.ac.uk