Long-acting reversible contraception free-of-charge - who chooses it?
ESC Congress Library. Saloranta T. May 10, 2018; 208241; ESC177 Disclosure(s): Consultant work (lectures on contraception) for Novartis/Sandoz
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Abstract
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Objective: To describe characteristics associated with selection of long-acting reversible contraceptive (LARC) methods, when offered free-of-charge in a primary health care setting. Design and methods: The City of Vantaa in the Helsinki metropolitan area, Finland, offers family planning services at no-cost for all women of fertile age. In a public program launched in 2013, all women in Vantaa have been entitled to their first LARC method free-of-charge. We gathered a population cohort of all non-sterilised women aged 15-45 in Vantaa during 2013 and 2014 (n=55,500), and obtained background information from registers of the National Institute of Health and Welfare, Statistics Finland, and the Vantaa Population Register. At the start of follow-up, 50,308 women were entitled to a LARC method free-of-charge. During 2013, altogether 5,930 of them visited one of Vantaa's public family planning clinics, and altogether 1,307 women initiated a LARC method. Of these LARC methods 800 were provided free-of charge, 63 (7.8%) were copper-IUDs, 308 (38.5%) implants, and 429 (53.6%) LNG-IUDs. We describe the characteristics of women who chose a LARC method when provided free-of-charge by age, parity, prior abortions, and marital status. We analysed the differences between women choosing LARC and not choosing LARC using T-test for age, Fisher's exact test and Chi-squared test for parity, abortions, and marital status. Results:  Of the women using the services, 13.5% chose a free-of-charge LARC. Comparison of women choosing vs. not-choosing LARC revealed that the women choosing LARC were older (mean age 28.1 [SD 7.05] vs. 24.9 [6.8] years, p Moreover, parous women were more likely to choose LARC (31.3%) than nulliparous women (9.1%) (RR=3.4 [95%CI 3.0;3.9]). Also, women with history of abortion (1.3 [1.1;1.6]) and married women (2.4 [2.1;2.7]) were more likely to choose LARC.   Conclusions:  Young women would benefit most from LARCs and nulliparity is no barrier for any LARC methods. Yet in the present material - treated in 2013 - older, married and parous women were more likely to choose a LARC method. These results are parallel with recent studies from elsewhere. As the public programme continues, we shall continue to assess how the profile of LARC user evolves and which group benefits most from the provision of free-of-charge LARC. 
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