6.4.2 Why do women prefer sterilisation to long-term reversible contraception?
Roslyn Kane, Senior Lecturer, School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom Co authors: Gwen Irving, Sally Brown, Neal Parkes, Martin Walling & Stephen Killick rkane@lincoln.ac.uk
Abstract:
Despite widely available, reliable and cost effective reversible long-acting methods of contraception, there is still a heavy reliance on sterilisation. Previous research has shown relatively high rates of regret associated with sterilisation and, given the difficulties of its reversal, a move towards the increasing use of other reversible methods would appear to be desirable.
Methods:
A survey was conducted among 386 women, recruited from three general practices in Lincolnshire, who had either recently been sterilised or opted for a long acting reversible method (either Mirena or Implanon). Case note analysis and in-depth qualitative interviews were also conducted amongst a sub-sample to explore their reasons behind their choice of method and their experiences of its use.
Results:
The study revealed incidences of regret amongst those women who had opted for sterilisation and this was the case even among some who initially seemed certain that this was the appropriate option for them. Women often chose sterilisation specifically because of its irreversibility when they did not wish to retain their choice of future fertility. There were reports of positive experiences of both Implanon and Mirena although significant side effects of both were also experienced. There was evidence of limited awareness of long acting reversible methods, despite the women being recruited from specialist family planning GP practices.
Conclusion:
There is room for improvement in knowledge of long acting reversible methods amongst women requesting contraception. Ways in which awareness can be increased need to be explored in order to maximise informed choice in line with the current NICE Guidelines. Care should be taken when agreeing to a request for sterilisation, even in women who seem certain of their decision.
Source of Funding: No funding
Amount in Funding: N/A
Recommended reading list:
- NICE. Long-acting reversible contraception. The effective and appropriate use of long-acting reversible contraception. National Collaborating Centre for Women’s and Children’s Health. Commissioned by the National Institute for Health and Clinical Excellence. October 2005 RCOG Press
- FFPRHC Guidance. The levonorgestrel-releasing intrauterine system (LNG-IUS) in contraception and reproductive health. Journal of Family Planning and Reproductive Health Care 2004; 30(2):99-109
- French R, Van Vliet H, Cowan F, Mansour D, Morris S, Hughes D, Robinson A, Proctor T, Summerbell C, Logan S, Helmerhorst F, Guillebaud J. Hormonally impregnated intrauterine systems (IUSs) versus other forms of reversible contraceptives as effective methods of preventing pregnancy. Cochrane Database Syst Rev. 2004;(3):CD001776
Biography:
Ros Kane is currently a senior lecturer in the Faculty of Health Life and Social Sciences at the University of Lincoln. She is involved in teaching on the Nursing and Health studies degree programmes. Ros originally qualified as a nurse (RGN) in 1989 and then worked for some years in women’s health, mainly at the Elizabeth Garrett Hospital for Women in London. After this time Ros went back to university and gained a BSc in Anthropology and Geography from University College London and later a Masters degree in Medical Demography from the London School of Hygiene and Tropical Medicine. Ros then took up employment at LSHTM where she worked on a number of different research projects from 1996 to 2006. She gained her PhD at LSHTM: Providing sexual health services in England: meeting the needs of young people. A qualitative and quantitative study exploring the optimal mode of delivering sexual health services to young people.