Young women and contraceptive choices
Understanding LARC adherence:
an in-depth investigation into sub-dermal contraceptive
implant removal amongst young women in London
Dr Lesley Hoggart and Dr Victoria Newton
Sexual Health Research and Practice Group
Background to the study
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Commissioned by the London Sexual
Health Commissioning Group
Why?
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Uptake of LARC methods, including the
implant, is still relatively low despite the NICE
guidelines and policy push.
Anecdotal evidence suggests that implant
removal rates are quite high.
Research Question
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Why do some teenagers that have
selected the implant as their
contraception of choice have it removed
within one year?
Qualitative methodology to examine this
question in depth
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Go beyond the tick-box
Recruitment
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We recruited from four sites:
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Greenwich
Haringey
Hounslow
King’s
We interviewed in total:
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20 young women
9 practitioners
Inclusion Criteria
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Young women aged between 16-19
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Age range extended to 24
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Had their implant removed
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Had their implant for 1 year or less
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Some slipped through the exclusion criteria
Recruitment Process
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Asked by practitioner if they would like to take
part in research project
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Shown leaflet
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If interested in taking part contact details
passed to LH/VN
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Contact made by telephone
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Interview arranged
The Interview
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Face-to-face interview, usually at the
clinic.
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Sometimes a telephone interview if this is
difficult.
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Expenses reimbursed and £20 voucher
as thank you.
The Interview
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We asked the young women questions
about:
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Reasons for choosing implant
Reasons for removal
Opinions about other forms of contraception
Experiences of local sexual health services
More general discussions about their sexual
behaviour, what influences contraceptive
choice, how they made their decisions.
Emerging Findings
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Reasons for choosing the implant
Experiences of the implant
Reasons for removal
Implications for practice
Reasons for choosing implant
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Thought of as a good method
(reliability)
Difficulty using other methods
Returned to implant after trying
other methods
Because of an established
relationship
To control bleeding/other perceived
effect on the body
Pros and cons
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Good concept but actual experience
of method unsatisfactory:
It’s just the gain, the fact that you gain weight, yes, but
otherwise it’s a good thing, it’s the smartest one out of all
of them.
I think it’s a really good idea, I've got nothing against it
except for the period flows.
Reasons for removal
main side
effects
• Bleeding
• weight gain
• moody
other side
effects
• headaches
• skin
problems
• implant
discomfort
other
concerns
• bodily
control
• fertility
concerns
• relationship
changes
Attitudes post-removal
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Distrust/scepticism of other hormonal
methods
Trust – not being given the ‘full
picture’
Regaining bodily control
Implications for Practice
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Understanding implant as a positive
choice
Pre-warning about side effects
Helping to manage side effects
Removing and moving onto other
contraception quickly
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Overcoming resistance to the IUD?
Any contraindications for implant?
What next?
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Participants can view and comment on
the draft report once it is written. This
helps ensure a true representation of the
issues raised.
Final report and dissemination.
Further research possibilities?
Thank you
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Any questions?
Any contributions?
Lesley Hoggart
l.hoggart@gre.ac.uk
Victoria Newton