Young women and contraceptive choices

1. Young women and contraceptive choices Understanding LARC adherence: an in-depth investigation into sub-dermal contraceptive implant removal amongst young women in London Dr Lesley Hoggart and Dr Victoria Newton Sexual Health Research and Practice Group

2. Background to the study • Commissioned by the London Sexual Health Commissioning Group • Why? • Uptake of LARC methods, including the implant, is still relatively low despite the NICE guidelines and policy push. • Anecdotal evidence suggests that implant removal rates are quite high.

3. Research Question • Why do some teenagers that have selected the implant as their contraception of choice have it removed within one year? • Qualitative methodology to examine this question in depth • Go beyond the tick-box

4. Recruitment • We recruited from four sites: • Greenwich • Haringey • Hounslow • King’s • We interviewed in total: • 20 young women • 9 practitioners

5. Inclusion Criteria • Young women aged between 16-19 • Age range extended to 24 • Had their implant removed • Had their implant for 1 year or less • Some slipped through the exclusion criteria

6. Recruitment Process • Asked by practitioner if they would like to take part in research project • Shown leaflet • If interested in taking part contact details passed to LH/VN • Contact made by telephone • Interview arranged

7. The Interview • Face-to-face interview, usually at the clinic. • Sometimes a telephone interview if this is difficult. • Expenses reimbursed and £20 voucher as thank you.

8. The Interview • We asked the young women questions about: • Reasons for choosing implant • Reasons for removal • Opinions about other forms of contraception • Experiences of local sexual health services • More general discussions about their sexual behaviour, what influences contraceptive choice, how they made their decisions.

9. Emerging Findings • Reasons for choosing the implant • Experiences of the implant • Reasons for removal • Implications for practice

10. Reasons for choosing implant • Thought of as a good method (reliability) • Difficulty using other methods • Returned to implant after trying other methods • Because of an established relationship • To control bleeding/other perceived effect on the body

11. Pros and cons • Good concept but actual experience of method unsatisfactory: It’s just the gain, the fact that you gain weight, yes, but otherwise it’s a good thing, it’s the smartest one out of all of them. I think it’s a really good idea, I've got nothing against it except for the period flows.

12. Reasons for removal

13. Attitudes post-removal • Distrust/scepticism of other hormonal methods • Trust – not being given the ‘full picture’ • Regaining bodily control

14. Implications for Practice • Understanding implant as a positive choice • Pre-warning about side effects • Helping to manage side effects • Removing and moving onto other contraception quickly • Overcoming resistance to the IUD? • Any contraindications for implant?

15. What next? • Participants can view and comment on the draft report once it is written. This helps ensure a true representation of the issues raised. • Final report and dissemination. • Further research possibilities?

16. Thank you • Any questions? • Any contributions? Lesley Hoggart l.hoggart@gre.ac.uk Victoria Newton v.l.newton@gre.ac.uk