title: Uptake of long-acting, reversible contraception in three remote Aboriginal communities: a population-based study.
abstract: OBJECTIVE
  To assess the use, effectiveness and acceptance of prescribed contraception in three remote Western Australian Aboriginal communities.
  
  
  METHODS
  Mixed method study, including retrospective file review of contraception methods for 566 regular female Aboriginal patients, 1 November 2010 - 1 September 2014, and semi-structured interviews with 20 Aboriginal women.
  
  
  METHODS
  Primary care clinics in three remote Aboriginal communities.
  
  
  METHODS
  Number of episodes of contraceptive use, effectiveness and continuation rates of prescribed contraceptive use; personal experiences, attitudes towards and beliefs about contraception options.
  
  
  RESULTS
  34% of women had used contraception, ranging from 15% of women aged younger than 15 years to 55% of women aged 15-19 years. The most common forms of contraception at the census date were long-acting reversible contraceptives (LARCs): 77% of women using contraception had an etonogestrel implant and 7% had depot medroxyprogesterone. Etonogestrel continuation rates at 1, 2 and 3 years were 87% (95% CI, 81-92%), 72% (95% CI, 64-78%) and 51% (95% CI, 41-60%) respectively. Medroxyprogesterone depot continuation at one year was only 14% (95% CI, 8-22%). Social acceptance of the etonogestrel implant was high; no concerns were raised about stigma or unwanted attention related to implant use.
  
  
  CONCLUSIONS
  The high uptake of LARCs in these communities is consistent with international recommendations about contraception use. High acceptability was reflected in excellent continuation rates. Service delivery models that use community engagement and capacity building are recommended for broadening the focus of sexual health beyond sexually transmitted disease detection and management, giving priority to the reproductive rights and unmet needs of Aboriginal women.
authors.affiliation: Kimberley Aboriginal Medical Services Council, Broome, WA emmag@kamsc.org.au.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Griffiths
authors.affiliation: Kimberley Aboriginal Medical Services Council, Broome, WA.
authors.forename: Julia V
authors.initials: JV
authors.lastname: Marley
authors.affiliation: Kimberley Aboriginal Medical Services Council, Broome, WA.
authors.forename: Domenica
authors.initials: D
authors.lastname: Friello
authors.affiliation: University of Western Australia, Broome, WA.
authors.forename: David N
authors.initials: DN
authors.lastname: Atkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002648:Child; D003271:Contraceptive Agents, Female; D004343:Drug Implants; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants