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Source: APNA Primary Times Summer 2021 (Volume 21, Issue 2)
Intrauterine devices (IUDs), contraceptive implants and early medical abortion (EMA) are safe and effective. So why aren’t they being utilised more by primary care clinicians?
The use of IUDs and contraceptive implants among Australian women remains low, despite being safe and effective methods of contraception. Early medical abortion is also underutilised in primary health care, despite it being an effective and acceptable method of pregnancy termination. These inequities are magnified in rural and regional areas of Australia.
To address this gap and to provide clinicians with support, access to training opportunities and a national database of long-acting reversible contraception (LARC) and EMA providers and suppliers, the National Health and Medical Research Council’s Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care (SPHERE) has launched the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network.
The AusCAPPS Network is the first of its kind in Australia. It is a national, secure and free online space that facilitates discussion and provides participants access to clinical experts from Family Planning NSW and Family Planning Victoria, who are on hand to answer questions and support discussion. Participants post questions, such as ‘What has your experience been setting up an EMA service in your practice?’, ‘What’s your approach to explaining bleeding patterns with Implanon NXT?’ and ‘What are your experiences with EMA follow-up for people in COVID-19 isolation?’. Clinical experts provide their expertise and other participants share their experiences, advice and tips.
The AusCAPPS Network also features a unique user database that has been developed for use by participants of the network, based around users’ primary health network (PHN). The database enables participants to connect with others in their local area, providing an opportunity for clinicians to connect and bolster local services, for example, by partnering with a local pharmacist to support contraceptive counselling or provide EMA in a rural area where this may not have previously been an option.
Professor Danielle Mazza, chief investigator and director of SPHERE, which is based at Monash University, describes the AusCAPPS Network as a significant step forward in improving Australian women’s sexual and reproductive health outcomes.
‘Lack of familiarity with intrauterine devices and implants among health professionals and misperceptions about their use limits women’s options. It can be difficult for GPs, practice nurses and other health professionals to get training in LARC. Lack of support following training (e.g., supervision, mentoring) are also real issues in regional and rural areas,’ Professor Mazza says.
‘Without adequate numbers of clinicians who are confident in providing LARC and EMA, especially in regional and rural primary care settings, women find it very difficult to access these essential services. This can significantly increase wait times, travel and costs, and puts women at risk of unintended pregnancy in the interim.’
‘Through the AusCAPPS Network, we want to change the landscape for Australian women seeking contraception and abortion, and dramatically increase the availability of these services in the settings where women are most likely to seek them out – their local general practice and community pharmacy.’
Preventing unintended pregnancies is an important public health imperative and a key focus of Australia’s National Women’s Health Strategy.1 One in four women experience an unintended pregnancy, with a third of those pregnancies resulting in abortion.2 Rates of unintended pregnancy are disproportionately higher among the socio-demographically disadvantaged and those living in rural areas.3 During the past 10 years, approximately 30% of women with an unintended pregnancy have had an abortion. Unintended pregnancies resulting in a live birth can have poorer outcomes for mother and child and adversely affect the social and financial wellbeing of women and their families.4
Deborah Bateson, medical director of Family Planning NSW, says that while specialised clinics, like Family Planning NSW, provide each of these services to women at low or no cost, the AusCAPPS Network is an essential tool to support fellow health workers wanting to better meet the needs of patients. Dr Bateson says the resource is more critical than ever given the increased pressure clinicians are under as a result of the COVID-19 pandemic.
‘Clinicians are relying more on online tools and communities, and it is much harder to network and meet peers organically in the current environment,’ Dr Bateson says. ‘The AusCAPPS Network has created a unique opportunity for clinicians with an interest in reproductive health to connect with others, grow their skills, access knowledge and information and stay across changes and developments in this area. It’s a fantastic tool with a growing community of clinicians from around Australia.’
AusCAPPS is supported by an extensive partner and advisory network that includes the University of British Columbia, the University of Sydney, La Trobe University, Family Planning NSW, the University of Melbourne, Marie Stopes Australia, the Centre of Excellence in Rural Sexual Health, and others.
To join the AusCAPPS Network, visit https://medcast.com.au/communities/auscapps. For more information, email email@example.com.
1. Australian Government Department of Health, National Women’s Health Strategy 2020-2030, Department of Health, Canberra, 2018.
2. H Rowe, S Holton, M Kirkman et al., ‘Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey’, Aust N Z J Public Health, 2016, 40(2):104-109.
3. H Rowe, S Holton, M Kirkman et al., ‘Abortion: Findings from women and men participating in the Understanding Fertility Management in Contemporary Australia national survey’, Sex Health, 2017, 14(6): 566–573.
4. A Taft, M Shankar, K Black, D Mazza, S Hussainy and J Lucke J, ‘Unintended and unwanted pregnancy in Australia: a crosssectional, national random telephone survey of prevalence and outcomes’, Med J Aust, 2018, 209:407–408.