A network of dedicated IUD insertion clinics could present a solution to one of the key challenges in the federal government’s national women’s health strategy.
Key points:
- IUDs, which are more effective to prevent pregnancy than the pill and condoms, have a low uptake in Australia
- Increasing use of long acting reversible contraception is a key benchmark in the government’s women’s health strategy
- A member of the federal government’s women’s health advisory group says incentives for doctors are also part of the solution
Intra uterine devices, or IUDs, are small T-shaped contraceptive devices inserted in the uterus to prevent pregnancy.
They’re more than 99 per cent effective, significantly more failsafe than the two most common forms of contraception in Australia — the pill and condoms — which are effective around 91 per cent of the time and 88 per cent of the time.
In the long run, they’re also one of the cheapest options. Yet in Australia, uptake of IUDs is low compared to other countries.
New analysis from a group of respected doctors specialising in reproductive and sexual health shows dedicated insertion clinics help increase use of IUDs.
Increasing use of long-acting reversible contraceptives (LARCs) such as IUDs and contraceptive implants is a key benchmark in the federal government’s National Women’s Health Strategy.
Analysis co-author Danielle Mazza — chair of general practice at Monash University — said IUD insertion clinics could also help solve the significant workforce shortages in sexual and reproductive health by increasing training opportunities for doctors.
Professor Mazza, who is a member of the federal government’s Women’s Health Advisory Council, also wants the federal government to consider providing incentives for doctors to provide sexual and reproductive health services.
How the clinics work
The new analysis from Professor Mazza and her colleagues published in the Australian Journal of Primary Health looked specifically at two ‘rapid referral’ insertion clinics set up for the Australian Contraceptive Choice Project study.
GPs were able to directly book their patients in online, with just over half of GPs taking part in the study opting to do so.
Around three quarters of IUD insertions in the study took place at the clinic when it was made available for GPs to refer their patients to.
The study also included education for GPs so they could be more aware of a wider range of contraceptive options.
Professor Mazza said the option of a rapid referral clinic saw greater uptake of IUDs in particular.
“The GP could book [the patient] directly into an appointment with one of these gynaecologists in a very rapid way so that they could get access within a couple of weeks to that service instead of sending a blind referral into local public hospital that then had to be triaged and put on a waitlist and all of that.”
Professor Mazza said the clinics could help achieve multiple outcomes.
“Not only will they be well utilised, but they will also have the potential to serve as a good training ground for trainees to learn more about these kinds of procedures.”
Is it time to provide a financial incentive?
Professor Mazza said it’s time for something similar to be considered not only for contraception insertions but for other sexual and reproductive health care such as pregnancy terminations.
“We could put in place training incentives for LARC insertion, for medical abortion,” she said.
“We have the precedence of these kinds of initiatives to fill gaps in service provision at a regional level and we could use that precedence and just do the same for sexual and reproductive health.
“The importance of a paper like this is that it’s clearly demonstrating the need.”
The ABC asked if the federal government would consider incentives for doctors to provide such services.
In a statement, Assistant Minister for Health Ged Kearney, who is responsible for women’s health, said the government was “delighted” to have Professor Mazza as a special adviser on the women’s health advisory council.
“The council will advise government on avenues to improve women’s health in Australia,” she said.
In recent times, the federal government has responded to other questions about contraception and abortion by stating they’re awaiting the recommendations of a senate inquiry into reproductive healthcare access before making any firm decisions.
Workforce gaps leaving patients without options
The study found only a third of doctors trained to insert IUDs actually did so.
“That I think is a demonstration of how difficult it is for GPs to do this kind of procedure in routine practice,” Professor Mazza said.
Even with more training provided there are still many barriers to insertion of IUDs.
Other options like the contraceptive pill are more well known and the costs of getting an IUD inserted can be prohibitive for patients particularly for non-hormonal options that don’t get any government subsidies.
Alongside those issues, pain during insertion can also be a major hurdle.
An ABC investigation found many patients were having painful and traumatic experiences getting their IUDs inserted, saying they were not given enough information about available pain relief options and when they were, those options were not actually accessible.
On the practitioner side, doctors say the rebate for the procedure is too low to cover the costs of training, consultation, specialised equipment and the assistant (usually a nurse) they need on hand during the insertion.
New pelvic pain clinics could help
Professor Mazza, who is also on the federal government’s endometriosis advisory group, said recently opened pelvic pain and endometriosis clinics could provide an avenue for increasing IUD access as well.
“I’ve been arguing very strongly that the progestogen-containing IUDs and in fact hormonal contraception is first line management of endometriosis,” she said.
“These clinics that have been established to help diagnose and manage endometriosis, they are going to be doing a lot of LARC.
“My argument is that if they are being funded to provide services, then they should also be funded to provide training because they are delivering the LARCs.
“They could be the rapid referral clinics for IUD insertion, they could be the clinics where our GP trainees are going and learning these skills.”