title: Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: An expert roundtable discussion.
abstract: BACKGROUND
  Australia's abortion rates are among the highest in the developed world. Efficacy of the most commonly used form of contraception (oral contraceptives and condoms) relies on regular user compliance. Long-acting reversible contraception (LARC) virtually eradicates contraceptive failure as it is not user-dependent; however, its uptake has been low.
  
  
  OBJECTIVE
  To provide an overview of barriers to LARC use in Australia and potential strategies to overcome these barriers.
  
  
  METHODS
  A roundtable of Australian experts was convened to share clinical perspectives and to explore the barriers and potential strategies to increase LARC use.
  
  
  RESULTS
  Three broad barriers to LARC uptake were identified. (i) A paucity of Australian research exists that impedes closure of evidence gaps regarding contraceptive prescription and use. Systematic data collection is required. (ii) Within primary care, lack of familiarity with LARC and misperceptions about its use, lack of access to general practitioners (GPs) trained in LARC insertion/removal and affordability impede LARC uptake. Potential strategies to encourage LARC use include, GP education to promote informed choice by women, training in LARC insertions/removals, effective funding models for nurses to perform LARC insertions/removals, and rapid referral pathways. (iii) At the health system level, primary care incentives to provide LARC to women and health economic analyses to inform government policy changes are required.
  
  
  CONCLUSIONS
  Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low in Australia. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce Australia's high unintended pregnancy rate.
authors.affiliation: Department of General Practice, Monash University, Notting Hill, Victoria, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
authors.affiliation: Family Planning NSW, Ashfield, New South Wales, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bateson
authors.affiliation: Australasian Menopause Society, Melbourne, Victoria, Australia.
authors.forename: Meredith
authors.initials: M
authors.lastname: Frearson
authors.affiliation: Marie Stopes International Australia, Melbourne, Victoria, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Goldstone
authors.affiliation: Department of Obstetrics and Gynaecology, Monash Medical Centre, Clayton, Victoria, Australia.
authors.forename: Gab
authors.initials: G
authors.lastname: Kovacs
authors.affiliation: Sydney Medical School, University of Sydney, New South Wales, Australia.
authors.forename: Rod
authors.initials: R
authors.lastname: Baber
mesh_terms: D001315:Australia; D035843:Biomedical Research; D002983:Clinical Competence; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003692:Delayed-Action Preparations / Q000191:economics / Q000627:therapeutic use; D020878:Device Removal; D005260:Female; D058006:General Practice / Q000193:education*; D006266:Health Education; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007434:Intrauterine Devices; D009042:Motivation; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011320:Primary Health Care; D012017:Referral and Consultation
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations
keywords: Australia; contraception; unwanted pregnancy