LARC

Statistical Publication Notice

27 November 2007

Key Clinical Indicators for Sexual Health:
Baseline Report on Long Acting Reversible Contraception (LARC)
Uptake in Scotland, 2003/04 – 2006/07

INTRODUCTION

“Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health” was published by the Scottish Government in 2005 in order to improve sexual health services and thus, sexual health. A key clinical indicator (KCI) on ‘long acting reversible methods of contraception (LARC)’ was developed in response to the aims of the strategy, to help monitor LARC usage within NHS boards and to increase uptake. These LARCs include intrauterine devices (IUDs), intrauterine systems (IUSs) such as Mirena and implants such as Implanon.

In typical use, long-acting methods of contraception have a lower failure rate than alternative reversible methods (for example, contraceptive pill, condoms, diaphragms). The NICE guideline on LARC for England and Wales published in October 2005 suggested that increased uptake of long-acting methods would reduce unintended pregnancy and be cost-effective for the National Health Service. Although this guideline was written for England and Wales, the findings are equally pertinent for Scotland, hence the introduction of this indicator.

KEY POINTS

Nationally, the uptake of very long acting methods (Implanon, IUD, Mirena) has increased since 2004/05.
In 2006/07, uptake for very long methods of contraception (Implanon, IUD and Mirena) was at a rate of 34 per 1000 women.
The uptake of Implanon, the contraceptive implant, has increased steadily since 2004/05 from seven per 1000 to 12 per 1000 in 2006/07.
IUD rates of uptake are lower than Implanon and do not show the same rapid increase in popularity of Implanon.
Of all the LARC methods, Mirena is showing the greatest increase in uptake, on a Board level and also nationally.

INTERPRETATION

These data have not been published before and the method of data collection is new.
The data presented looks at the proportion of women who began using a particular LARC in any one year.
Currently available data cannot tell us if the method of contraception was discontinued before the optimal time period, for example, Implanon lasts for up to three years but a woman may choose to have it removed before this time. The sexual health system, NaSH, is currently being implemented and will be able to provide these data in future.
The information in the report has been determined using two types of data.
One is the number of products dispensed from prescriptions. These are primary care data.
The second type is the number of products distributed from hospital pharmacies to community family planning clinics and to hospitals. An assumption is made that the clinics will order the products required, but that this may include a small number of ‘stock’ items.

DETAILED FINDINGS

This report looks at the uptake of Long Acting Reversible methods of Contraception (LARC) amongst women of reproductive age (which is defined as 15 – 49) in Scotland by NHS Board. These data are reported on the NHS Boards as redefined in 2006 when NHS Argyll and Clyde was incorporated into NHS Greater Glasgow and Clyde and NHS Highland.

This report is part of the key clinical indicators for sexual health programme of work. The indicators are intended to support clinical services and to help boards monitor their performance.

This report covers four financial years, 2003/04, 2004/05, 2005/06 and 2006/07.

In typical use, long-acting methods of contraception have a lower failure rate than alternative reversible methods (for example the contraceptive pill, condoms, diaphragms). The NICE guideline on LARC for England and Wales published in October 2005 suggested that increased uptake of long-acting methods would reduce unintended pregnancy and be cost-effective for the National Health Service. Although this guideline was written for England and Wales, the findings are equally pertinent for Scotland.

The data presented looks at the proportion of women that started on a particular long acting reversible method in a year.

This report publishes data on the very long acting methods of contraceptive implant (‘Implanon’), IUD (also commonly known as ‘the coil’) and IUS (‘Mirena’) by number and rates. The report also looks at usage of Depo-Provera.

Nationally, the uptake of very long acting methods (Implanon, IUD, Mirena) has increased since 2004/05. In 2006/07, uptake was at a rate of 34 per 1000 women.
The uptake of Implanon has increased steadily since 2004/05 from seven per 1000 to 12 per 1000 in 2006/07.
IUD rates of uptake are lower than Implanon and do not show the same rapid increase in popularity of Implanon. However it should be noted that that an IUD offers an alternative long acting method for those women who no longer wish to rely on hormonal methods of contraception and that although usage is not increasing nationally, neither is it decreasing.
The increase in the uptake of Mirena is the most notable of all the very long acting methods of contraception. Of all the LARC methods, Mirena is showing the greatest increase in uptake, on a board level and also nationally. The popularity of Mirena could explain, in part, the status quo in the usage of IUDs.
The data shows that Depo Provera continues to be the most used method of long acting reversible contraception. However, some would argue the necessity of an injection every 12 weeks should prevent this method being considered as ‘long acting’ as the woman has to remember to have the injection during the correct timeframe in order to remain protected against unwanted pregnancy. 92% of Boards showed a reduction in usage of Depo Provera between 2004/05 and 2006/07.

Whilst evidence suggests that increased use of LARC has the potential to reduce unintended pregnancy, barrier methods should be additionally recommended for vulnerable groups such as those outside a stable relationship or those in a relationship but who have not been tested for STIs, to stop the transmission of sexually transmitted infections.

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MAIN CONTACTS:

Felicity Naughton
Data Augmentation for Sexual health (DASH) Project Manager
0131 275 7148
felicity.naughton@isd.csa.scot.nhs.uk

Jim Chalmers
Head of Programme
Women & Childrens Health Information Programme
0131 275 6136
jim.chalmers@isd.csa.scot.nhs.uk

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GLOSSARY:

LARC – Long Acting Reversible Contraception
KCI – Key Clinical Indicator
Implanon – contraceptive implant
IUD – Intrauterine Device. Also known as ‘the coil’
IUS / ‘Mirena’ – Intrauterine System
Depo-Provera – Contraceptive injection
STI – sexually transmitted infection

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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

Although this is not a national statistics publication, it has been viewed in advance by the sexual health policy team at the SG, the National Sexual Health Advisory Committee and the Lead Clinicians for Sexual Health.

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