Long acting reversible contraceptives

The term LARC usually refers to contraceptive implants (in Australia available as Implanon NXT®) which are inserted under the skin and provide contraceptive coverage for up to 3 years, and copper and hormonal intrauterine devices (IUDs) inserted into the uterus, which can be effective for up to 5-10 years.

LARC methods have few contraindications, are cost effective over time, and are generally appropriate for use by women of all ages. IUDs and implants are among the most effective forms of reversible contraception available.

Other benefits are associated with the use of LARC, especially for young women and those experiencing sexual and/or reproductive coercion. These include that following insertion, it is harder (though not impossible) for someone else to tell if you are using LARC methods. In addition, these contraceptives can be inserted immediately after an abortion or miscarriage, or while breastfeeding. The copper IUD is also extremely effective as emergency contraception. However, no form of contraception is 100 per cent effective or free from side-effects. While LARC methods are extremely effective in preventing pregnancy, unlike condoms they do not prevent sexually transmissible infections (STIs).

Despite the benefits of LARC methods compared with other forms of contraception, current uptake in Australia remains low (with recent studies indicating that less than 10 per cent of women in Australia use LARC methods). A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Doctors may be reluctant to prescribe these types of contraceptives because of uncertainty about their suitability, or due to a lack of training on insertion. Additional barriers for women accessing LARC methods include concerns around possible side-effects, and the initial cost. Greater understanding by GPs of the attitudes, experiences and concerns of women in relation to LARC methods could lead to more effective contraceptive use and more meaningful choice for women.

Additional research is required relating to the uptake and experiences of LARC methods by women with disabilities and Aboriginal women, acknowledging that contraceptive interventions occur within a social and historical context which has included state-sanctioned reproductive coercion, including forced contraception. Strategies for increasing LARC access should ensure that options for specific populations are not restricted, and that reproductive choice for all women is promoted.