Use of contraceptive methods and contraceptive recommendations among health care providers actively involved in contraceptive counseling — results of an international survey in 10 countries

Abstract

Background

This study was conducted to determine the personal choices of contraceptive methods among an international sample of contraception health care professionals (HCPs) and to determine if these choices are concordant with their recommendations to women.

Study Design

In an anonymous online survey, 1001 HCPs actively involved in contraceptive counseling [obstetrician/gynecologists (OB/GYNs), general practitioners (GPs) and midwives (only in Sweden)] from 10 countries (Australia, Brazil, Canada, France, Germany, Korea, Mexico, Spain, Sweden and the United Kingdom) were asked about their personal use of contraceptive methods and their recommendations to women in two different clinical scenarios: for spacing between children (Group A) and after completion of the family (Group B).

Results

The largest HCP group was OB/GYNs (67.1%), followed by GPs (31.4%) and midwives (1.5%). A total of 42.7% of respondents were male, and 57.3% were female. The majority of respondents were aged 36–45 years (38.9%) or 46–55 years (42.8%), 79.7% had children, and 53.9% were currently using contraception (by themselves or by their partners). Among 540 contraceptive users, the three most common methods were the levonorgestrel-releasing intrauterine system (LNG-IUS; 29.3%), combined oral contraceptives (COCs; 20.0%) and condoms (17.0%). OB/GYNs were more likely to be using the LNG-IUS than GPs (p=.014). Gender did not seem to influence contraceptive preference. Reasons for these choices were largely influenced by family situation and high contraceptive efficacy (for the LNG-IUS) or side effects caused by other methods (for condoms). The top contraceptive recommendation was COCs for Group A and the LNG-IUS for Group B. HCPs currently using COCs and the LNG-IUS were more likely to recommend these methods than other contraceptive methods for Group A and Group B, respectively.

Conclusions

The most popular contraceptive method in this sample of HCPs was the LNG-IUS. Choice of contraceptive method was driven by family situation, age and profession. It appears that, in this sample, personal contraceptive use influences contraceptive recommendations.

Introduction

Women currently enjoy a range of contraceptive options. How they choose the method most suited to them and their life situation is still not completely understood. Preferred methods differ significantly in different countries, and while this may reflect cultural influences, cost and accessibility, availability or perceived risk to benefit ratios of different methods may also influence contraceptive choice. Just how much health care providers’ (HCPs’) personal experience with contraceptive methods influences the dialogue is little known. We were able to identify only two studies which explore this topic in the literature, both from the United States. The first, a recent study on postabortion contraception, reported that personal intrauterine contraceptive (IUC) use by clinic staff members was independently associated with the decision to use an IUC [1]. In an earlier study, physicians' personal oral contraceptive or postmenopausal hormone therapy (HT) use was shown to affect their patient counseling practices [2]. Postmenopausal physicians who took HT and premenopausal OC-using physicians intending to take HT were significantly more likely to counsel their patients to use HT [2]. Thus, presently, there are little data to address whether personal contraceptive choices and experience of HCPs could influence contraceptive counseling.

In other clinical encounters, physicians’ personal behaviors have been found to influence their counseling practices. Patients seen by a physician who is a cigarette smoker were less likely to report stop-smoking advice than patients seen by a nonsmoking physician [3]. Physically active internists were more likely to counsel about the importance of physical activity than those not physically active, and nonsmoking internists were more likely to counsel about smoking cessation than those who smoked [4]. Primary care physicians who ate a low-fat diet and had had their cholesterol checked were more likely to recommend dietary modification to patients with mild cholesterol elevation than those who did not do so [5]. Each of these examples shows that the personal practices of HCPs influence their advice and prescription to patients.

Due to the paucity of data regarding this issue, the present survey was designed to examine current contraceptive choices and recommendations in a diverse international population of HCPs and to see if personal choices were concordant with practice recommendations.