Predictors of choosing long-acting reversible contraceptive methods when provided free-of-charge - A prospective cohort study in Finland

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Gyllenberg , F , Saloranta , T , But , A , Gissler , M & Heikinheimo , O 2020 , ' Predictors of choosing long-acting reversible contraceptive methods when provided free-of-charge - A prospective cohort study in Finland ' , Contraception , vol. 101 , no. 6 , pp. 370-375 . https://doi.org/10.1016/j.contraception.2020.01.018

Title: Predictors of choosing long-acting reversible contraceptive methods when provided free-of-charge - A prospective cohort study in Finland
Author: Gyllenberg, Frida; Saloranta, Tuire; But, Anna; Gissler, Mika; Heikinheimo, Oskari
Contributor: University of Helsinki, University of Helsinki
University of Helsinki, Department of General Practice and Primary Health Care
University of Helsinki, Department of Public Health
University of Helsinki, Department of Obstetrics and Gynecology
Date: 2020-06
Language: eng
Number of pages: 6
Belongs to series: Contraception
ISSN: 0010-7824
URI: http://hdl.handle.net/10138/316045
Abstract: Objective: To identify factors associated with choosing long-acting reversible contraception (LARC) (intrauterine device or contraceptive implant), when provided free-of-charge. Study design: This register-based cohort study comprises all women living in the city of Vantaa in the Helsinki metropolitan area during 2013-2014, with information on LARC initiations retrieved from electronic health records. Since January 2013, women in Vantaa can receive their first LARC method free-of-charge at public contraceptive clinics. We performed multivariable regression to assess seven predictors based on literature and four predictors based on gynecological history for association with choosing LARC in this population. Results: In 2013-2014, 9669 women entitled to a free-of-charge method visited a public clinic and 2035 (21.0%) women initiated LARC. Factors most associated with LARC initiation included history of delivery (odds ratio [OR] 5.4, 95% confidence intervals [CI] 4.7-6.2) and induced abortion (OR 1.4, 95%CI 1.2-1.6), and no previous visit at the clinic (OR 1.3, 95%CI 1.2-1.5). Previous delivery was associated with LARC initiation in all age-groups (OR, 95%CI by age-group; 15-19 years: 10.8, 5.1-23.4; 20-24 years: 6.4, 4.9-8.3; 25-29 years: 6.7, 5.2-8.6; 30-44 years: 3.6, 2.9-4.6). Conclusion: History of delivery and induced abortion were strongly associated with choosing a LARC method, even though all women in the population were entitled to their first free-of-charge LARC method. The association was particularly strong among women less than 25 years of age. Implications statement: Untargeted provision of free-of-charge LARC in public contraceptive services reached women with previous delivery or abortion well during the programs first years. However, as LARCs are recommended to all women, future research should focus on how uptake evolves and how to reach all women in need of long-term, effective contraception. (C) 2020 Elsevier Inc. All rights reserved.
Subject: Long-acting reversible contraception
LARC
Intrauterine device
Contraceptive implant
Free-of-charge
UNINTENDED PREGNANCY
UNITED-STATES
WOMEN
QUALITY
YOUNG
3123 Gynaecology and paediatrics
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