Women and reproductive health

Time trends in contraceptive prescribing in UK primary care 2000– 2018: a repeated cross-sectional study

author list

Thomas Joshua Pasvol,

Thomas Joshua Pasvol

Institution: The Research Department of Primary Care and Population Health, University College London,

Email: thomas.pasvol@nhs.net

E Anne Macgregor,

E Anne Macgregor

Institution: Centre for Reproductive Medicine, Barts and the London School of Medicine and Dentistry Centre for Neuroscience and Trauma,

Email: thomas.pasvol@nhs.net

Greta Rait,

Greta Rait

Institution: The Research Department of Primary Care and Population Health, University College London,

Email: thomas.pasvol@nhs.net

Laura Horsfall

Institution: The Research Department of Primary Care and Population Health, University College London,

Email: thomas.pasvol@nhs.net

Background Over the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000–2018. Methods A repeated cross-sectional study using patient data from the IQVIA Medical Research Data (IMRD) database. The proportion (95% CI) of women prescribed non-barrier contraception per year was captured. Results A total of 2 705 638 women aged 15–49 years were included. Between 2000 and 2018, the proportion of women prescribed combined hormonal contraception (CHC) fell from 26.2% (26.0%–26.3%) to 14.3% (14.2%–14.3%). Prescriptions for progestogen-only pills (POPs) and long-acting reversible contraception (LARC) rose from 4.3% (4.3%–4.4%) to 10.8% (10.7%–10.9%) and 4.2% (4.1%–4.2%) to 6.5% (6.5%–6.6%), respectively. Comparing 2018 data for most deprived versus least deprived areas, women from the most deprived areas were more likely to be prescribed LARC (7.7% (7.5%–7.9%) vs 5.6% (5.4%–5.8%)) while women from the least deprived areas were more likely to be prescribed contraceptive pills (20.8% (21.1%–21.5%) vs 26.2% (26.5%–26.9%)). In 2009, LARC prescriptions increased irrespective of age and social deprivation in line with a pay-for-performance incentive. However, following the incentive's withdrawal in 2014, LARC prescriptions for adolescents aged 15–19 years fell from 6.8% (6.6%–7.0%) in 2013 to 5.6% (5.4%–5.8%) in 2018. Conclusions CHC prescribing fell by 46% while POP prescribing more than doubled. The type of contraception prescribed was influenced by social deprivation. Withdrawal of a pay for-performance incentive may have adversely affected adolescent LARC uptake, highlighting the need for further intervention to target this at-risk group.
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1 year ago

Predictors associated with low-risk women’s pre-labour intention for intrapartum pain relief: a cross-sectional study

author list

Yvonne Kuipers,

Yvonne Kuipers

Institution: Rotterdam University of Applied Sciences, Institute of Healthcare,

Email: y.kuipers@napier.ac.uk

Elise van Beeck

Institution: Edinburgh Napier University, School of Health and Social Care,

Email: y.kuipers@napier.ac.uk

Background Pregnant women have preferences about how they intend to manage labour pain. Unmet intentions can result in negative emotions and/or birth experiences. Objective To examine the antenatal level of intention for intrapartum pain relief and the factors that might predict this intention. Design A cross-sectional online survey-based study. Setting and participants 414 healthy pregnant women in the Netherlands, predominantly receiving antenatal care from the community-based midwife who were recruited via maternity healthcare professionals and social media platforms. Methods The attitude towards intrapartum pain relief was measured with the Labour Pain Relief Attitude Questionnaire for pregnant women. Personality traits with the HEXACO-60 questionnaire, general psychological health with the Mental Health Inventory-5 and labour and birth anxiety with the Tilburg Pregnancy Distress Scale. Multiple linear regression was performed with the intention for pain relief as the dependant variable. Results The obstetrician as birth companion (p<.001), the perception that because of the impact of pregnancy on the woman’s body, using pain relief during labour is self-evident (p<.001), feeling convinced that pain relief contributes to self-confidence during labour (p=.023), and fear of the forthcoming birth (p=.003) predicted women were more likely to use pain relief. The midwife as birth companion (p=.047) and considering the partner in requesting pain relief (p=.045) predicted women were less likely to use pain relief. Conclusion: Understanding the reasons predicting women’s intention of pain management during labour, provides insight in low-risk women’s supportive needs prior to labour and are worth paying attention to during the antenatal period.
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1 year ago

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