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Your contraception questions answered

9 Dec 2022

The new Australian Contraception and Abortion Primary Care Practitioner Community of Practice (AusCAPPS) is designed to support your clinical practice in women’s sexual and reproductive health care, writes Dr Sharon James, Research Fellow/Project Manager, AusCAPPS Network, Monash University.

One-quar­ter of Aus­tralian women expe­ri­ence an unin­tend­ed preg­nan­cy in their life­time, with rates 1.4 times high­er in rur­al and remote com­mu­ni­ties¹. About a third of these unin­tend­ed preg­nan­cies end in abor­tion¹. Com­pared to some forms of con­tra­cep­tion which rely on reg­u­lar user com­pli­ance to be effec­tive, long-act­ing reversible con­tra­cep­tion (LARC) is high­ly effec­tive, has high­er con­sumer sat­is­fac­tion and longer con­tin­u­a­tion rates². 

Pre­vent­ing unin­tend­ed preg­nan­cy is an impor­tant ini­tia­tive in the Aus­tralian Nation­al Women’s Health Strat­e­gy 2020 – 2030³. LARC and ear­ly med­ical abor­tion (EMA) (using mifepri­s­tone fol­lowed by miso­pros­tol up to nine weeks ges­ta­tion) are safe and effec­tive but few pri­ma­ry care clin­i­cians pro­vide either of these ser­vices. Bet­ter clin­i­cian access to LARC and EMA edu­ca­tion, train­ing and ongo­ing sup­port would assist clin­i­cians pro­vid­ing this care⁴⁺⁵.

To sup­port clin­i­cians in pro­vid­ing LARC and EMA care to com­mu­ni­ties, the SPHERE NHM­RC Cen­tre of Research Excel­lence in Sex­u­al and Repro­duc­tive Health for Women in Pri­ma­ry Care launched the Aus­tralian Con­tra­cep­tion and Abor­tion Pri­ma­ry Care Prac­ti­tion­er Sup­port (Aus­CAPPS) Net­work in July 2021 for prac­tice nurs­es, gen­er­al prac­ti­tion­ers, and com­mu­ni­ty phar­ma­cists work­ing in women’s health. 

The devel­op­ment of Aus­CAPPS is sup­port­ed by an exten­sive part­ner and advi­so­ry net­work that includes Aus­tralian Pri­ma­ry Health Care Nurs­es’ Asso­ci­a­tion, Phar­ma­cy Soci­ety of Aus­tralia, Roy­al Aus­tralian Col­lege of Gen­er­al Prac­ti­tion­ers, Roy­al Aus­tralian and New Zealand Col­lege of Obste­tri­cians and Gynae­col­o­gists, and oth­er key stake­hold­ers in women’s health. AHPRA ver­i­fied clin­i­cians can join Aus­CAPPS and access net­work­ing oppor­tu­ni­ties with peers and experts, a data­base of providers of LARC and EMA ser­vices, a resource library, access to webi­na­rs and pod­casts, and links to LARC and EMA train­ing providers.

Aus­CAPPS will assist in answer­ing clin­i­cian ques­tions about pro­vid­ing LARC and EMA care and pro­vide week­ly expert clin­i­cian post­ing on the dis­cus­sion forum, with sup­port by med­ical direc­tors in fam­i­ly plan­ning. Exam­ples of Aus­CAPPS mem­ber post­ing includes Can any­one direct me to evi­dence sur­round­ing safe tim­ing of tam­pon use after EMA?” and I have today received a refer­ral from a GP for assess­ment for implanon NXT for an 11 year old. Haven’t spo­ken to her or par­ent as yet, but won­der­ing what oth­ers think of this…” Addi­tion­al­ly, exam­ples of the week­ly expert clin­i­cian post­ing includes top­ics such as Mire­na use in per­i­menopause” and In addi­tion to a clin­i­cal his­to­ry, what do you use to con­firm suc­cess of an ear­ly med­ical abor­tion?” as well as many oth­er key issues relat­ed to women’s sex­u­al and repro­duc­tive health.

Nurse-led LARC and EMA care is safe and an afford­able way to enhance pri­ma­ry care access for these ser­vices in rur­al com­mu­ni­ties⁶. To sup­port your clin­i­cal prac­tice in women’s sex­u­al and repro­duc­tive health care, you can join the Aus­CAPPS Net­work by vis­it­ing the Aus­CAPPS | Med­cast web­site at med​cast​.com​.au/​c​o​m​m​u​n​i​t​i​e​s​/​a​u​s​capps. It takes five min­utes to reg­is­ter. We now have over 1100 mem­bers! For more infor­ma­tion, email auscapps.​trial@​monash.​edu

Ref­er­ences

1. Taft AJ, Shankar M, Black KI, et al. Unin­tend­ed and unwant­ed preg­nan­cy in Aus­tralia: a cross-sec­tion­al, nation­al ran­dom tele­phone sur­vey of preva­lence and out­comes. The Med­ical jour­nal of Aus­tralia 2018;209(9):407 – 08. doi: 10.5694/mja17.01094

2. Black KI, McGeechan K, Wat­son CJ, et al. Women’s sat­is­fac­tion with and ongo­ing use of hor­mon­al long-act­ing meth­ods com­pared to the oral con­tra­cep­tive pill: Find­ings from an Aus­tralian gen­er­al prac­tice clus­ter ran­domised tri­al (ACCORd). Aus­tralian and New Zealand Jour­nal of Obstet­rics and Gynae­col­o­gy 2021;61(3):448 – 53. doi: 10.1111/ajo.13319

3. Aus­tralian Gov­ern­ment Depart­ment of Health. Nation­al Wom­en’s Health Strat­e­gy 2020 – 20302018.

4. Aus­tralian Health­care and Hos­pi­tals Asso­ci­a­tion. Con­sen­sus State­ment: Reduc­ing unin­tend­ed preg­nan­cy for Aus­tralian women through increased access to long-act­ing reversible con­tra­cep­tive meth­ods, 2017.

5. Devane C, Ren­ner RM, Munro S, et al. Imple­men­ta­tion of mifepri­s­tone med­ical abor­tion in Cana­da: pilot and fea­si­bil­i­ty test­ing of a sur­vey to assess facil­i­ta­tors and bar­ri­ers. Pilot Fea­si­bil­i­ty Stud 2019;5:126. doi: 10.1186/s40814-01905208 [pub­lished Online First: 20191108]

6. Tom­nay JE, Coel­li L, David­son A, et al. Pro­vid­ing acces­si­ble med­ical abor­tion ser­vices in a Vic­to­ri­an rur­al com­mu­ni­ty: a descrip­tion and audit of ser­vice deliv­ery and con­tra­cep­tion fol­low up. Sex­u­al & Repro­duc­tive Health­care 2018: 16175