Is it time to reconsider the contraceptive recommendations to young women?Survey among Swedish prescribers of contraceptives
ESC Congress Library. Edlund M. May 28, 2014; 50526; A-111 Disclosure(s): Both authors are employees of Bayer HealthCare in Scandinavia
Dr. Mans Edlund
Dr. Mans Edlund
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Objective: To investigate which contraceptives Swedish prescribers recommend to women before, between and after child birth.
Methods: This study was conducted as a survey directed to prescribers of contraceptives at 13 lectures in 10 different Swedish cities between February and May 2013. The prescribers in the audience anonymously responded to 15 multiple choice questions presented on a screen by means of an audience response system (mentometer device). Participation was optional.
Results: In total, 481 prescribers of contraceptives, 435 women and 39 men, answered to the survey (7 subjects did not raise any gender). To profession, 86 % were midwives and 11 % gynecologists. Overall, 88 % of the prescribers recommended combined hormonal contraceptives, CHC (pills, patch, ring) to nulliparous women, 36 % recommended progestin-only pills between child birth and 82% recommended levonorgestrel-intrauterine systems (LNG-IUS) after child birth.
LNG-IUS was the most frequent personal contraceptive use among prescribers. However, CHC was the most commonly recommended contraceptive choice to nulliparous women irrespective of prescribers’ personal contraceptive use, represented by 92% of LNG-IUS users, 96% of CHC users and 85% of condom users.
To nulliparous women, the recommendation of CHC was 1.2 times higher (95% CI; 1.0-1.5) among prescribers aged > 35 years than younger and 1.1 times higher (95% CI; 1.0-1.3) among prescribers working at maternity center than those at outpatient clinics for gynecologists
Between child births, midwives and prescribers at maternal care centers were both above twice as prone to recommend intermediate-dose progestin-only pills as gynecologists (95% CI; 1.2-3.6) and prescribers and clinics for gynecology (95% CI; 1.5-3.8), respectively. In contrast, recommendation of CHC to women between child births was significantly higher among gynecologists than midwives (Ratio=3.5: 95% CI; 2.2-5.6) and among prescribers at outpatient clinics of gynecology than at maternal care centers (Ratio=3.0: 95% CI; 1.8-5.0).

Conclusions: The present survey showed that CHC was the most commonly recommended contraceptive to nulliparous women irrespective of the prescribers’ profession. Between child births, the recommendation of intermediate-dose progestin-only pills was higher, but CHC lower, among midwives and prescribers at maternal care centers compared to gynecologists and clinics of gynecology. Since long acting reversible contraceptives were preferably used by prescribers and recent studies support advantages of its use, there is a need for better alignment between scientific knowledge and clinical practice.

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