Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study

Abstract

Background Given chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor maternal and fetal outcomes, these women would benefit from effective preconception care. However, there is a lack of understanding of how these women use or don’t use contraception to inform such interventions. This study examined patterns of contraceptive use among an Australian cohort of young women and investigated the influence of chronic disease on contraceptive use over time. Methods Using data from 15,244 young women from the Australian Longitudinal Study on Women’s Health (born 1989–1995), latent transition analysis was performed to identify distinct contraceptive patterns among women who were at risk of an unintended pregnancy. Multinomial mixed-effect models were used to evaluate the relationship between contraceptive combinations and chronic disease. Results Contraceptive use for women with cardiac and autoinflammatory diseases differed to women without chronic disease over the observation period. Compared to women without chronic disease using the pill, women with cardiac disease had double the odds of using ‘other’ contraception and condoms (OR = 2.20, 95% CI 1.34, 3.59) and a modest increase in the odds of using the combined oral contraceptive pill and condoms (OR = 1.39, 95% CI 1.03, 1.89). Compared to women without chronic disease who used the pill, women with autoinflammatory disease had increased odds of using LARC and condoms (OR = 1.58, 95% CI 1.04, 2.41), using ‘other’ contraception and condoms (OR = 1.69, 95% CI 1.11, 2.57), and using the combined oral contraceptive pill and condoms (OR = 1.38, 95% CI 1.09, 1.75). No differences in contraceptive patterns over the observation period were found for women with asthma or diabetes when compared to women without chronic disease. Conclusion The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between health care providers and women with chronic disease to improve young women’s contraceptive knowledge and agency in contraceptive choice, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.

Patterns of contraceptive use through later reproductive years: A cohort study of Australian women with chronic disease

“…This is important as these methods are safe for most women with chronic disease, have low failure rates and provide additional benefits during perimenopause [ 24 ]. LARC use among women with chronic disease in this cohort however was found to be substantially lower than that reported by women with chronic disease in the 1989–95 cohort at similar ages and suggests that there may be a generational shift in the perceptions surrounding the use of LARC, including the suitability of these methods for women of reproductive age with chronic disease [ 25 ].…”

“…However, around half of the women in our study were also predicted to combine their condom use with other low efficacy methods such as withdrawal. The layering of low efficacy methods has been demonstrated among young women, including those with AICs [ 18 , 25 ]. This is particularly problematic as it has been found that 61% of women with SLE reported using these low efficacy methods and more than half reported having had an unintended pregnancy [ 31 ].…”

Patterns of contraceptive use through later reproductive years: a prospective cohort study of Australian women with chronic disease

“…This is important as these methods are safe for most women with chronic disease, have low failure rates and provide additional benefits during perimenopause [25]. LARC use among women with chronic disease in this cohort however was found to be substantially lower than that reported by women with chronic disease in the 1989-95 cohort at similar ages and suggests that there may be a generational shift in the perceptions surrounding the use of LARC, including the suitability of these methods for women of reproductive age with chronic disease [26].…”

“…However, around half of the women in our study were also predicted to combine their condom use with other low efficacy methods such as withdrawal. The layering of low efficacy methods has been demonstrated among young women, including those with AICs [18, 26]. This is particularly problematic as it has been found that 61% of women with SLE reported using these low efficacy methods and more than half reported having had an unintended pregnancy [32].…”

“…Our findings therefore point to a lack of evidence-based advice and support from GPs and specialists. This is particularly important as our recent research has demonstrated that the use of low efficacy contraception has also been found in younger women with AICs [26]. It is essential that individualised contraceptive counselling is included for women of reproductive age from the time of diagnosis and as part of their ongoing care.…”