Original research articleChanging patterns of contraceptive use in Australian women☆
Introduction
Contraception is one of the keystones of reproductive health [1] enabling women to control their fertility according to their desires and circumstances. A range of new products such as vaginal rings, skin patches, hormonal IUDs, implants, injectables and new types of oral contraceptive pills now allow women more choice than ever, and future technological advances promise further developments in contraceptive methods [2]. Despite the options available, around half of all pregnancies in the United States are unintended and half of unintended pregnancies occur despite contraceptive use [3].
Contraceptive use has been found to be variable [4], [5] with high rates of discontinuation of methods [6]. The United States National Survey of Family Growth [7] showed high rates of method switching with 61% of unmarried women changing their method over a period of 2 years. Detailed data are lacking for other countries, including Australia. Most empirical research examining method choice has focused narrowly on specific populations such as adolescents or clinic-based samples [8]. There is a need for wider understanding of contraceptive use among adult women [9]. The nationally representative studies of contraceptive use in developed countries have focused on broad associations between contraceptive use at one time and basic sociodemographic characteristics [4], [10], [11], [12], [13], [14].
Patterns of contraceptive use vary with age, life stage [15], ethnicity and race, marital status, fertility intentions and education [16], as well as contextual factors such as access to contraception [6], frequency and predictability of intercourse, partner characteristics [15] and risk of infection [17]. The oral contraceptive pill is consistently reported to be the most popular among women, with the male condom the second most popular method used in developed countries such as the US [18], UK [6] and Australia [14], [19]. Long-acting reversible methods such as injectables, implants and IUDs are less common and are used mainly by older, parous women [6]. Choice of method is strongly influenced by the health service provider's views and expertise, and the advice and information given to potential users as well as the availability of particular methods [6]. Sociodemographic factors associated with specific methods have been examined [8] but usually as cross-sectional analyses. It has been noted that what may appear to be demographic influences on contraceptive use may actually be markers for psychosocial influences [20].
Another limitation of previous studies has been the focus on a single method of contraception. In one of the few Australian studies to examine concurrent or dual use of methods, Parr and Siedlecky [14] examined data collected in 2005 from the Household Income and Labour Dynamics in Australia (HILDA) study. They found that use of the oral contraceptive pill as the only method of contraception was associated with age, marital status, education and birthplace, whereas use of condoms only was associated with being partnered and living in a major city.
The current study extends this knowledge by using longitudinal data to examine patterns of contraceptive use in women as they age from their late teens to early 30s, a peak period for contraceptive use. As part of a broad-based health study, the Australian Longitudinal Study on Women's Health (ALSWH) also has the capacity to examine the impact of a broad range of health and lifestyle factors on contraceptive use and method change.
The objectives of the study were:
- (1)
to examine the patterns of contraceptive use among a cohort of Australian women born 1973–1978;
- (2)
to examine patterns of change over time in use of specific contraceptive methods; and
- (3)
to compare the factors associated with use of contraception at four time points over 11 years.
Section snippets
Survey
The ALSWH is a broad-ranging longitudinal examination of reproductive, physiological and social factors, and associated impact on women's health. Participants respond to mailed surveys. In 1996, Australian women from three age cohorts (born 1921–1926, 1946–1951, 1973–1978) were selected from the Medicare database, which contains names and addresses of all Australian citizens and permanent residents. Random sampling of the population was undertaken with intentional oversampling of women from
Exploratory analysis
Cross-sectional patterns of contraceptive use and nonuse at each survey are shown in Fig. 1. The proportion of women not using contraception decreased between the first two surveys and then steadily increased from Surveys 2 to 4. Women were more likely to be pregnant or trying to conceive at later surveys.
The oral contraceptive pill was the single most commonly used method at each survey (27–44%), but its use decreased over time as women either stopped using contraception or switched to other
Discussion
This study is important because it shows that contraceptive use and associated factors changed over time. A cross-sectional examination of four waves of data showed an overall decrease in the use of contraception and a change in methods used. There was a decrease in the use of the oral contraceptive pill, steady rates of condom use and an increased reliance on other methods. Examining the women's patterns of contraception use longitudinally showed that oral contraceptive pill use was fairly
Acknowledgments
We are grateful to the Australian Government Department of Health and Ageing for funding and to the women who provided the survey data.
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Cited by (0)
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The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women's Health at the University of Newcastle and University of Queensland.