March 2014

How to better inform women about the benefits of long-acting reversible contraception? Here is a counseling tool based on the lessons learned from the St. Louis Contraceptive CHOICE Project.

In the Contraceptive CHOICE Project, women were offered free contraception for three years if they switched contraceptive methods—from nothing to something or from one method to another—and read a brief introductory script that emphasized the effectiveness of intrauterine contraceptives (IUCs) and implants. The investigators hoped that use of intrauterine contraception would reach 6% to 10% and implants would reach 3%. The results were simply stunning. Of the 9,250 participants, 75% chose these methods: Mirena (46%), ParaGard (12%), and Implanon (17%). In the United Kingdom, women pay nothing for contraception, but the proportion choosing these methods falls far short of 75%. In Hull, England, we launched our own initiative. We developed a simple double-sided A4 hand-out. On one side was a script with pictures of copper and levonorgestrel IUCs next to a 20-pence coin and of an implant next to a hair grip. On the other side was the three-tiered effectiveness chart from Contraceptive Technology. The goal was to have the receptionist give the hand-out to every woman and ask her to read it before seeing a clinician. Then the clinician would ask the woman if she had read it and if she had any questions. Although we implemented the project in family planning, abortion, and antenatal clinics and selected GP practices, we planned to evaluate it only in family planning clinics and GP practices because electronic records were available.

There was no overall impact in family planning clinics. However, only one, the service hub (Conifer House) is open daily (except Sunday) and has permanent sexual health staff on the reception desk. In Conifer house the proportion of women receiving IUCs or implants increased 15% from October 2012-April 2012 to May 2012-November 2012 (from 30.7% to 35.2%, p=0.0002), indicating that the project was highly effective. The proportion returned to baseline in December 2012-November 2013. Reasons for this decline are being investigated. Data from GPs will become available in late March. This simple, extremely low-cost intervention was highly effective, by far the most cost effective on record. It can easily be replicated.

Feel free to adapt the materials below for your own counseling tool.

James Trussell and Kate Guthrie

Download this chart here: Hull LARC Initiative Effectiveness Chart

Download this script here: Hull LARC Initiative Handout Script