What qualities of long-acting reversible contraception do women perceive as desirable or undesirable? A systematic review

Abstract

Little research examining qualities of contraception that make them attractive or unattractive to users, particularly young women, exists. The aim of this study is to systemically review the evidence regarding desirable and undesirable qualities of long-acting reversible contraception (LARC), including intrauterine devices, the implant and the injection, as perceived by women. Five electronic databases were searched in May 2015 using terms related to LARC and method preference or decision-making. Studies were included if they concerned women aged 18-23 years from developed countries and reported on perceived positive or negative qualities of LARC. Thirty articles were deemed relevant. Five key themes emerged under which qualities were categorised; including: (1) impact on bleeding; (2) impact on the body; (3) device-specific characteristics; (4) general characteristics; and (5) perceptions and misbeliefs. Fit and forget, high efficacy and long-term protection were considered the top desirable qualities of LARC. Undesirable qualities varied among the LARC methods; however, irregular bleeding, painful insertion and removal procedure, weight gain and location in the body were among those most commonly reported. The contraceptive benefits of LARC, including their high efficacy and longevity, are generally considered to be positive qualities by women, while the potential impact of side-effects on the body are considered as negative qualities. This information is crucial in the clinical setting as it provides practitioners with a greater understanding of the qualities women do and do not like about LARC methods. Discussion about these qualities, positive and negative, during consultations about contraception may increase rates of uptake.

“I think maybe 10 years seems a bit long.” Beliefs and attitudes of women who had never used intrauterine contraception

“…Although a systematic review by Coombe et al 34 found that longevity was reported by women as one of the top positive characteristics of IUC, our research shows that the long-acting nature of the method is not seen as an advantage by all women. This is a finding echoed in previous research 8 12.…”

Not seeking yet trying long-acting reversible contraception: a 24-month randomized trial on continuation, unintended pregnancy and satisfaction

“…The most commonly cited negative aspects attributed to LARC are irregular bleeding, painful insertion/removal, weight gain, and general aversion to having a device inserted into the body. [6]…”

Long‐acting reversible contraception: conflicting perspectives of advocates and potential users

“…Some Australian women describe the implant as weird, bizarre, creepy, or even akin to being microchipped . There are also misconceptions about risks and feelings that LARC methods would only be appropriate in a later phase of their lives . Some fear needles or pain .…”

“…In this regard, LARC methods are remarkable agents as they provide high effectiveness without the permanency of sterilisation. Many women value the ‘fit and forget’ property that gives them peace of mind . The contribution that LARC has made to allowing women to play a full part in society cannot be overstated.…”

“…A public health approach supports less personal control over contraception, so there is reduced room for error and therefore greater effectiveness and continuation. In contrast, women themselves often prefer to retain control over their contraceptive method . Many women are more comfortable using oral contraception because it is under their control, despite its lower effectiveness.…”