Contraceptives and Unintended Pregnancy Among Australian Women [transcript][audio]

Guest: Alison Verhoeven

Presenter: Tabetha Moreto

Guests Bio: Alison Verhoeven is Chief Executive of the Australian Healthcare and Hospitals Association. Alison has broad experience in health, education, corporate governance and communications, and has worked in both the private and public sectors in Australia, the Asia-Pacific region, and Europe. She is a Graduate of the Australian Institute of Company Directors, holds a Masters in Business Administration, and previously was the Senior Executive, Governance and Communications for the Australian Institute of Health and Welfare.

 Segment overview: Unintended pregnancy in Australia remains prevalent. About 50-60% of Australian women who had an unintended pregnancy were actually using contraception. In fact, the number of abortions amongst Australian women aged under 30 years old is more than double the number of women aged 30 years or above. Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association, talks about the issues encountered by women with birth control methods and how to get access with other contraceptive methods.

TRANSCRIPT – AHHA

Tabetha Moreto: Hello everyone, welcome to Health Professional Radio. I’m your host for today, Tabetha Moreto. Our guest today is Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association. Alison has broad experience in health, education, corporate governance and communications and has worked in both the public and private sectors in Australia. Today we’re going to talk about a very interesting topic about birth control and unintended pregnancy among Australian women. Without further ado, welcome to the show Alison. I’m so happy you can join us today.

Alison Verhoeven: Thank you very much for including me in the discussion.

T: Yes, it’s my pleasure. So Alison can you please tell our audience more about yourself please and what you do exactly?

A: Sure. I’m Chief Executive of the Australian Healthcare and Hospitals Association. We are a not-for-profit organisation that represents public hospital and primary health networks and primary care providers across Australia. And generally our focus is on ensuring that Australians have access to a high quality, safe affordable and equitable health system.

T: That’s wonderful. This is very interesting Alison, it looks like that unintended pregnancy remains to be a significant health issue in Australia. Can you please explain why?

A: Yes. Look, there are many reasons why and one of the reasons we identified in the work we’ve done with a broad range of stakeholders with an interest in contraception and reproduction is that there is comparatively a fairly low use in Australia of long-acting reversible contraceptive method. And so we undertook a piece of work with the range of stakeholders to identify what might be causing that and what we might do to change that.

T: Okay. Because I find it very interesting because with a country like Australia that’s considered to be very progressive and first world, unintended pregnancy to some people – a lot of people would think this is not an issue in Australia but it looks like it is.

A: Well there’s a range of reasons for that. So one of the things we know about the contraceptive methods that some people use is that they fail. Not everybody adheres to guidelines for use, for example around the contraceptive pill as well as they might there are reasons in their lifestyle that don’t support good use of contraception. And so that’s one of the reasons why long-acting reversible contraceptive methods have generally been favored not only in Australia but in the guidelines internationally because it does overcome some of the social and individual issues associated with use of contraception. So again another reason why we would look at it but what we now found in Australia in the research we did around that 60% of women who’ve had an unintended pregnancy were actually using contraception but generally they’ve missed a dose for example with the contraceptive pill and that’s a reason why they have resulted in an unintended pregnancy. Having said that, not every unintended pregnancy is an unwanted pregnancy and I think we just need to be fairly clear on the difference between unintended pregnancy and unwanted pregnancy as well.

T: Yes. Thank you so much for explaining the difference between unwanted and unintended pregnancies. I really appreciate that.

A: No, we’re certainly not making any judgments in the piece of work that we’ve done around unwanted pregnancies. We’re talking about unintended pregnancies, so an unplanned pregnancy.

T: Okay. So can you tell us what is the Australian Healthcare and Hospitals Association doing in order to tackle this issue?

A: So what we did last year was to undertake some research which is related to some of the barriers to using our long-acting reversible contraceptive method. And we did that because we know that internationally the guideline around this practice, the contraception support, the use of long-acting reversible contraceptives. And what we found was that there were several barriers to best practice contraceptive management and they ranged from areas related to individuals like lack of knowledge and lack of support system through to things like financial barriers. So as a result of that work we then subsequently held a workshop with key stakeholders. So representing various organizations, clinical organization but also organizations that provide contraceptive services to women in Australia. And we talked about some of the steps that we might do to address the variation in best practice in Australia and as a result of that we published yesterday a consensus statement which suggested some ways forward for our health system to better respond in this space. That includes some goals and actions which we think health leaders, health professionals and clinicians and their professional colleges might take. But also some steps that our Commonwealth government needs to take around some of the funding mechanisms both for our reimbursement and the practitioners who provide long-acting reversible contraceptives to their patients. But also for some of the training programs that are required to support that as well.

T: Very fascinating. You mentioned earlier Allison that sometimes even if women take pills they still get pregnant which is the result of an unwanted or rather unintended pregnancy. So can you tell us what are the best methods of birth control?

A: Look, I’m not able to specify what’s best generically because different women have different health needs. And they really need to discuss what’s best for them with their health professional, because every woman is different, has different needs, has different health and they need to discuss that with the health professional. But generally what we know is that long-acting reversible contraceptives are the most effective reversible contraceptive, if they’re offered within a context of informed choice. So that we’re talking about things like progestogen only implant and hormonal and copper IUD. So those we know are very effective, they’re reversible, they’re cost-effective and furthermore their rate of efficacy is very high. So for that reason in Australia and internationally, guidelines suggest that they should be among the contraceptive choices offered to women. And they’re not always offered and as I said for a number of reasons. One of those is the training required to insert them and secondly is the cost and who pays for them and how they’re paid for and the third thing is actually around education and awareness. And not only for people, women who are choosing to use them but also for clinicians who are offering them.

T: Yes, I agree with you Alison. That’s true because not all women are the same because for example the birth control method that works for me may not work for another woman so that is something that we really have to consider.

A: That’s right, yes. And so our statement isn’t about saying one methodology is better than another. What it’s saying is that for a range of reasons in Australia, long-acting reversible contraceptives aren’t used as widely as we would expect them to be because they are regarded here and internationally has the most effective reversible contraceptive method. And we explore some of the barriers and what might be done about that.

T: Yes, very interesting. So Alison how can Australian women can access a birth control more easily and how can we educate them more about their choices?

A: Well there’s a range of ways in which Australian women access birth control, it’s generally through attending their general practitioner or a family planning clinic or it may be when they’re in hospital after having had a child. And so there’s a range of opportunities of interaction with health professionals to be able to access contraception. So some of that surround the questions that they are might ask their health professional and some of it’s about the information that the health professional might offer to them. We think that there’s a little bit of work to be done including through mechanisms such as education programs in schools to make sure women are actually aware of the choices that might be available to them and help with their health literacy such that when they do see their doctor or other health professional that they are able to ask questions and feel about the contraceptive choices that are being offered to them.

T: That sounds excellent, I hope that these strategies will work in order to decrease the number of unintended pregnancies in Australia.

A: Well we hope so too and I think there’s a real opportunity for the Australian Government to look at the mechanisms for funding in particular because that is a very significant barrier to their use at the moment.

T: So Alison if you don’t mind me asking, do you know how many unintended pregnancies occur in Australia every year?

A: Look, it’s very hard to have really informative data about that because obviously the definition of an unintended pregnancy varies depending on people’s perspective about intention and want. But what has been estimated is that around 40 to 50 percent of Australian women have had an unintended pregnancy at least once during their reproductive life. So up to half of all women will become pregnant at least once during their reproductive life at a time when they haven’t necessarily planned for that to happen.

T: Thank you for sharing that data. Now Alison I want to ask you a personal question if you don’t mind. Why are you passionate about helping women in particular in order to decrease the number of unintended pregnancies? Why are you so passionate about this particular topic?

A: Well this is an important topic for all Australians. It’s about women in Australia having access to information to be able to make good choices about their health. It’s about them being able to access affordable services and affordable health care, safe and high-quality health care when they want it. And this is an important reproductive life. It’s an important aspect of a woman’s life and indeed our overall population in terms of the way we live our lives so that’s why it’s important. And it’s certainly important and we really value the opportunity to have worked with so many of our colleagues across health sector, some clinical colleagues, other colleagues who are providing services to women. Really a broad range of stakeholders have participated in this work together because overall as a group of organisations we are committed to good choices and affordable safe, healthcare.

T: Wonderful. Now what are the misconceptions about birth control that you would like to clear up on the show today?

A: Well look I think I’ve probably covered most of the research that we’ve undertaken here fairly well today. So probably not many other misconceptions that I would want to talk about, but other than to refer interested parties to our consensus statement which is available on our website if they would like to know more about it.

T: That’s wonderful, thank you so much. Now what is your main takeaway message to all of our listeners?

A: Well the main takeaway message is that organisations like my organization and others who’ve signed to the consensus statement have listened to Australian women. We’ve looked at the barriers to uptake of long-acting reversible contraceptive and we’re working to encourage government to ensure that they actually fund at the health system in a way which aligns well with the health needs and interests of Australian women.

T: Thank you very much Alison. I really appreciate your message and I’m sure that all of our listeners out there will be more educated about this particular topic.

A: Thank you so much.

T: Yes. So now Allison how can people get in touch with you guys at the Australian Healthcare and Hospitals Association?

A: Yes. So our website is www.ahha.asn.au. And also, you can follow us on Twitter at #@AusHealthcare.

T: Thank you very much Alison for all of that information. And I appreciate you coming on the show today. It was such a pleasure.

A: Thank you, no problem. Thank you for your interest in the topic.

T: And that was Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association. We’ve just been talking about unintended pregnancies in Australia and the different methods of birth control. If you liked this interview, transcripts and archives are available at www.hpr.fm. We’re on all social media platforms so don’t forget to follow, like and subscribe. We’re also available for download on SoundCloud and iTunes. I’m Tabetha Moreto and you’re listening to Health Professional Radio.

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