Contraceptive counselling in regions of Victoria with high incidence of teenage pregnancy: general practitioners’ insights
Jessica R. Botfield A # * , Greasha Rathnasekara A # , Danielle Mazza A , Elodie Bernard A Cathy J. Watson A BA
B
Abstract
Certain regions of Australia have a higher incidence of teenage pregnancy compared to the national average. In Australia, general practitioners (GPs) are the first-line providers of contraception information and provision. However, little is known regarding GP provision of contraceptive counselling among teenagers and whether they are offering teenagers long-acting reversible contraceptive methods. We aimed to obtain GPs’ insights into how they approach contraceptive counselling with teenagers in regions of Victoria, Australia, with a high incidence of teenage pregnancy.
We conducted a qualitative descriptive study using semi-structured telephone interviews with GPs purposively sampled from regions of Victoria, Australia, with high incidence of teenage pregnancy. Interview data were analysed using a reflexive thematic analysis approach.
The 18 GPs interviewed recognised there was an unmet need for contraception information and care among teenagers in their region. Most felt that teenagers in their region had limited knowledge of and access to contraception, due in part to the lower socioeconomic status of the community, associated costs, and limited providers available to insert long-acting reversible contraceptives. Participants’ approaches to providing contraceptive counselling varied; however, most provided this opportunistically. Although they reported discussing all contraceptive options with teenagers, most were less inclined to recommend an intrauterine device (IUD). The primary reasons for this included concerns regarding suitability of IUDs for younger or nulliparous people and limited providers able to insert IUDs in their region. Participants described the importance of normalising contraception discussions to facilitate contraceptive counselling and decision-making.
Supporting informed decision-making and facilitating access to all methods of contraception for teenagers will require addressing misunderstandings among GPs regarding IUD suitability for teenage and nulliparous people and increasing the number of IUD-inserting GPs. Discussing contraception as part of routine care for teenagers will further support these endeavours.
Keywords: adolescents, contraception, contraceptive counselling, general practitioners, long-acting reversible contraception, qualitative, teenage pregnancy.
Introduction
In Australia, one-quarter of women have experienced an unintended pregnancy (Taft et al. 2018), with rates even higher in rural areas (Rowe et al. 2016) and among younger women (Rassi et al. 2013; Rowe et al. 2016). Both teenage pregnancy and parenthood are associated with higher risks of maternal mortality and morbidity, experience of violence, and violations of rights to education, employment, and reproductive health (Loaiza and Liang 2013; Mann et al. 2020). Teenage mothers are more likely to experience obstetric complications and their children are at higher risk of low birth weight and pre-term delivery compared to older mothers (Ganchimeg et al. 2014; Kawakita et al. 2016; Diabelková et al 2023).
Unintended pregnancies can be primarily attributed to inconsistent or non-use of contraception or contraceptive failure (Rowe et al. 2016). Younger women are more likely to use less-effective methods of contraception such as the oral contraceptive pill, condoms, and withdrawal (Coombe et al. 2016; Harris et al. 2020). Limited availability of healthcare practitioners trained in insertion and removal procedures for long-acting reversible contraceptives, including the contraceptive implant and intrauterine devices (IUDs), also impedes uptake of these more effective methods, particularly in rural areas of Australia (Mazza et al. 2017).
Increased uptake of the most effective forms of contraception, including long-acting reversible contraceptives, would contribute to preventing unintended pregnancies, particularly in regions with higher rates of teenage pregnancy that could be considered ‘higher-risk’. Recommended approaches to teenage contraceptive counselling include provision of youth-friendly services, enabling informed choice for contraceptive methods, and decreasing barriers that limit access to all methods of contraception (Bitzer et al. 2016). In Australia, general practitioners (GPs) are the first-line providers of contraceptive counselling and prescription contraceptives (Garrett et al. 2015; Goldhammer et al. 2017). However, long-acting reversible contraceptives, particularly IUDs, may not always be discussed or offered in GP contraceptive consultations (Mazza et al. 2012; Bitzer et al. 2016), as GPs may limit the range of contraceptives offered depending on their comfort and confidence discussing particular forms of contraceptives. Structural factors such as availability of long-acting reversible contraceptive inserters may also impact contraceptives discussed (Dehlendorf et al. 2014; Rubin et al. 2016).
Little is known about how GPs approach contraceptive counselling with teenagers in higher-risk regions for teenage pregnancy in Australia. We therefore sought to obtain GP insights into the provision of contraceptive counselling to teenagers within the context of higher-risk regions in Victoria, Australia, with a particular focus on how GPs working in these areas of high teenage pregnancy approach contraceptive counselling.
Materials and methods
Study design, sample, and recruitment
We conducted a qualitative descriptive interview study with GPs (Neergaard et al. 2009). We purposively sampled GPs from nine Local Government Areas (LGAs) in Victoria, Australia, where the teenage pregnancy rate was higher than the state average (i.e. regions with a live teenage pregnancy rate of 18.3 or more live pregnancies per 1000 teenage women, compared to the state average of 9.5) (Women’s Health Victoria 2018). All regions identified were located in rural and regional areas of Victoria. For the purposes of this paper, teenagers are defined as young people aged 19 years or under.
To be eligible to participate, GPs had to work in one of the nine LGAs. Over a 3-week period, mail and email invitations were sent to prospective GPs (n = 436) and their associated practice managers listed on the Victorian Human Services Directory for the nine LGAs (Victoria State Government 2021), inviting GPs to contact the research team if they were interested in participating in an interview.
Data collection
Consenting GPs participated in a semi-structured telephone interview. They received an AUD$150 gift card to compensate them for their time. GP demographic data including age, long-acting reversible contraceptive inserter status, and years of practice, were recorded, and rurality was determined using the Australian Statistical Geography Standard Remoteness Areas (ABS 2016).
After the interview schedule was piloted with three GPs from rural and regional areas sourced from contacts of the research team, telephone interviews were conducted by GR over a period of 6 weeks. The three pilot interviews were not included in the final sample. Participants were asked to describe their approach to contraceptive counselling with teenagers, their recommended contraception methods for this age group, and any local area-specific challenges or considerations. The research team met fortnightly to review and discuss interviews as they were conducted. A reflexive research journal was kept by GR to record observations, notes, and reflections on the interviews. Interviews were, on average, 42 min in length.
Analysis
Audio recordings were transcribed verbatim by a professional transcription service and deidentified and checked for accuracy by GR. Following a reflexive thematic analysis approach (Braun et al. 2019), and recognising researcher subjectivity in the process, deductive codes initially derived from the interview schedule were then built upon with inductive codes identified through careful reviewing of transcripts by GR in NVivo 11. JB also reviewed all transcripts to contribute to the construction of themes. GR and EB constructed preliminary themes to discuss with the research team; these were then further refined in collaboration with JB. The coding approach, and development of themes, was collaborative to ensure engagement with the data and analytic process (Braun et al. 2019).
Results
All GP participants who responded to the study invitation consented to participate in a semi-structured telephone interview (n = 18). Participants were from seven of the nine identified LGAs. The majority of participants inserted the contraceptive implant as part of their practice (n = 17), but only four participants routinely inserted IUDs (Table 1). All participants felt there was an unmet need amongst teenagers in their region with regard to contraception information and care. Most suggested that the higher rates of teenage pregnancy in their region were related to limited knowledge of and access to contraception among teenagers due to the lower socioeconomic status of the community, the costs associated with some contraceptive methods, and the limited providers available to insert long-acting reversible contraceptives. Two overarching themes were constructed from the interview data, relating to GPs’ approaches to contraceptive counselling with teenagers and considerations for contraceptive methods commonly discussed.
| Demographics | n | |
|---|---|---|
| Age | ||
| 20–29 | 1 | |
| 30–39 | 4 | |
| 40–49 | 4 | |
| 50–59 | 6 | |
| >60 | 3 | |
| Sex | ||
| Female | 13 | |
| Male | 5 | |
| Rurality | ||
| Inner regional | 11 | |
| Outer regional | 7 | |
| Intra-uterine device inserter status | ||
| No | 10 | |
| Yes | 4 | |
| Former | 4 | |
| Contraceptive implant inserter status | ||
| Yes | 17 | |
| No | 1 | |
| Years in general practice | ||
| 0–19 | 9 | |
| 20–40 | 9 | |
| 40+ | 1 |
Theme 1: approaches to contraceptive counselling with teenagers
The majority of GP participants described the importance of building rapport with teenagers, with a focus on normalising contraceptive discussions and empowering teenagers to make informed contraceptive choices. Ensuring teenagers felt the practice was a safe place to discuss sexual and reproductive health issues was seen as important, to put them at ease and improve engagement in contraception discussions.
But I hope we do give it [contraceptive counselling] in a fairly friendly manner so that teenagers are happy to come and talk to us. (GP 5)
When you are dealing with the very young patients that come in they might be a bit nervous and a bit hesitant about talking about things, and if you are too judgemental they will probably close up and not talk about it any further and go off. (GP 11)
… I make an effort wherever possible when I’m talking about anything uncomfortable with a teenager to try to normalise it a little bit and just say, look, this is – I do this sort of consult all the time, I think it’s excellent you’ve come in … I’m just trying to put them at ease and have them understand that I am not judging them. (GP 14)
You try and empower the patient to make decisions for them … you’re giving the patient all the relevant information then letting them make a decision (GP 6)
Participants’ approaches to contraceptive counselling varied depending on the GP and the patient and their situation. Several GPs reported that they tried to discuss contraception as part of their standard practice for most teenage consultations, where appropriate, however, most described contraceptive discussions occurring when initiated by the teenager or opportunistically during existing appointments.
… even if they come for other consult like something like mental health, I always touch base about the gynae and obs part … because I’m working in an area where teenage pregnancies are very high … I make the opportunity to talk to them about their sort of contraception as a part of my consult and I make it as a priority when I see a teenager. (GP 8)
I do get a lot of mental health consults, a lot of kids that are struggling at school, I wouldn’t assume that a 13-year old’s not sexually active at all and I would ask and if they are then I’d be talking to them about contraception. (GP 14)
… normally it would be initiated by the patient more commonly, unless I was with a patient and became aware during that consult that sexual activity was something that was on the, was something they were engaging in, then I would talk about it. (GP 13)
I try and provide [contraceptive counselling] opportunistically at any occasion, so any time there’s somebody that presents with any sort of sexual health related matter, you know, general check-up, whether it’s teenagers or older, I’ll often ask about contraception or STD checks or things like that. (GP 11)
Most participants reported that a parent, often a mother, commonly attend consultations with their teenage child. They reflected that this often facilitated contraception discussions, with the parent often leading the discussion and/or having a strong influence on the chosen contraceptive method, based on their own preferences or personal experiences. However, participants also acknowledged that parental attendance could also be a barrier to contraceptive discussions, if the teenager did not want their parent to know they might be sexually active. Most discussed issues of ensuring informed consent and sufficient maturity and understanding when discussing and prescribing contraception to teenagers.
… mums will often come in with their daughter to arrange the pill. (GP 4)
… they often might want to talk it over with their parents so that they can decide which option is appropriate for them. (GP 7)
I don’t have these conversations in front of their parents so the parents usually will leave the room but sometimes you’ll have young people that want their parent there, they’ve come in for the pill and the parent knows about that and is good with it so that’s okay but usually I ask the parents to leave the room and then we talk about safe sex … (GP 14)
Theme 2: considerations for contraceptive options discussed during counselling
When discussing the general content of their contraceptive counselling, participants suggested they aimed to provide non-directive counselling and discuss all contraceptive options. Most highlighted the importance of supporting teenagers to make their own informed contraceptive choices.
That’s my philosophy that adolescents are pretty capable and if 99% of the time if you give them the right environment the right information and the enough time they’ll make the best decisions for themselves. (GP6)
The majority of participants stated they most commonly discussed (and prescribed) the oral contraceptive pill and contraceptive implant for teenagers. Although most participants reported including IUDs when discussing the suite of contraceptive options, many stated they often put less emphasis on this option. The most common reasons cited were that IUDs were perceived as (i) difficult to insert and/or less suitable for teenage or nulliparous people, and (ii) harder to access in terms of cost and finding a trained inserter. Some also suggested that adolescents would not want to go through an ‘invasive procedure’ or that they would find the insertion process too complex. Most participants in our study did not insert IUDs themselves and described wait times of 3–6 months for an IUD insertion in their region.
We might touch on Mirenas but I am a bit hesitant in younger people just in terms of inserting them because it can be difficult. Doesn’t mean you shouldn’t discuss it but most will tend to go pill or Implanon. (GP 4)
I will sometimes talk about Mirena if there are special circumstances, but I don’t really like using Mirena in women who haven’t had children. (GP 5)
… I was brought up in the age where you didn’t recommend the IUD for young women because of the increased risk of STDs […] I still stumble a little bit at recommending an IUD for a teenager but you know I would do so if that was really the only other solution or perhaps we have tried other things. (GP 18)
I would only consider a hormonal IUD with a woman that has already had at least one child … Because of the technical difficulty of placing it through a closed, tight, nulliparous cervix. (GP 14)
Probably old-fashioned concerns, just about damage to the cervix and the insertion of [an IUD]. I feel more comfortable with women who have gone through a pregnancy and having that inserted. So, I would, still not using that in or as a first line. (GP 12)
The Mirena, the access is a problem. So, they have to go and see a private gynaecologist and pay privately to have that put in, so, cost and access… it’s very hard to encourage people to have long-acting contraceptives put in if there’s no access or they can’t afford to … (GP 3)
Discussion
The GP participants in our study recognised there was an unmet need for contraception information and care amongst teenagers in their region and tried to normalise contraceptive counselling during consultations. Most suggested teenagers had limited knowledge of and access to contraception for reasons such as the lower socioeconomic status of their region, the costs associated with some contraceptive methods, and the limited providers available to insert long-acting reversible contraceptives in their region. Participants’ approaches to providing contraceptive counselling to adolescents varied, however, most provided this opportunistically. Although participants reported discussing all contraceptive options with teenagers, most were less inclined to recommend an IUD.
Most GP participants in our study highlighted the importance of normalising contraception discussions and creating a safe space for teenagers to discuss contraception and related issues. Most described contraceptive discussions occurring when initiated by their patient or opportunistically during existing appointments, rather than as part of more routine care for teenage consultations. Using a tool such as the HEEADSSS assessment tool, a widely accepted screening tool for assessing young people’s psychosocial wellbeing (Parker et al. 2010; Saw et al. 2020), can provide a framework to guide consultations with teenagers (RACGP 2018). Discussing contraception as part of routine care for teenagers, for example as part of a HEEADSSS assessment, will further normalise contraception and provide opportunities for education and provision.
There appeared to be considerable concerns and misunderstanding among GP participants in our study regarding the suitability of long-acting reversible contraceptive methods for teenagers, particularly IUDs. Misperceptions regarding the use of long-acting reversible contraceptives have been described previously, particularly in relation to the ‘hangover’ from out-dated teaching regarding the eligibility of nulliparous women for IUDs (Lodge et al. 2017). Misinformation regarding long-acting reversible contraception held by healthcare professionals are important to consider as they impact contraceptive counselling practices, and in turn teenagers’ contraceptive choices (Kumar and Brown 2016; Berlan et al. 2017; Coles and Shubkin 2018). Modern IUDs are safe for use by nulliparous and teenage women (Black et al. 2012; World Health Organization 2015; RACP 2015; Lodge et al. 2017), and international guidelines support the use of long-acting reversible contraception as a first-line contraceptive for young, nulliparous women due to their higher efficacy and no user compliance being required (World Health Organization 2015; FSRH 2023). Supporting informed contraceptive decision-making for teenagers will require addressing misunderstandings among GPs regarding IUD suitability for teenage and nulliparous people.
If GPs are to include long-acting reversible contraception as a viable contraceptive option for teenagers to consider, it will also be essential to ensure these methods are available and accessible. Despite the long-term cost-effectiveness of long-acting reversible contraception, the upfront costs and limited availability of IUD-inserters act as considerable barriers (Garrett et al. 2015; Mazza et al. 2017), an issue highlighted by GPs in our study. Incentivising GPs to undertake long-acting reversible contraceptive insertion and removal training, particularly in areas of high need, and ensuring appropriate remuneration for GPs providing long-acting reversible contraceptive services, may increase the number of IUD-inserters in primary care and subsequently reduce costs for patients. This could be facilitated through increased rebates through the government-funded Medicare Benefits Scheme (MBS) and subsidised costs for required training, supervision, and specialised equipment (Mazza et al. 2017; SPHERE Coalition 2022). The federal government’s 2024–2025 budget is seeking to address some of these issues, through a scholarship fund to support primary healthcare professionals to undertake IUD insertion training and the promise of an MBS item number review for long-acting reversible contraceptive procedures (Mazza 2024). Implementing these changes will better promote provision of these services in general practice.
We wish to note several limitations of our study and related areas for future research. Our interviewees were primarily female and in an older age bracket, which has the potential to bias our results. It may be valuable to use the qualitative results from our study to design a survey to further investigate the extent to which the views and beliefs reported in our study exist in the broader GP community and further explore their counselling and prescribing practices for Australian adolescents. It will also be important to explore teenagers perspectives and preferences regarding contraception counselling in regions at higher risk for teenage pregnancy, as well as parents, who are often gatekeepers for children’s health care until a certain age, and to compare and contrast these with the GP perspectives reported here. Lastly, in their interviews, GP participants consistently referred to contraceptive counselling with ‘young women’. In hindsight, it would have been beneficial to include questions in our interview schedule about contraceptive counselling for young men and gender-diverse teenagers.
In conclusion, supporting informed decision-making and facilitating access to all methods of contraception for teenagers in regions with higher incidence of teenage pregnancy will require addressing misunderstandings among GPs regarding IUD suitability for teenage and nulliparous people and increasing the number of IUD-inserting GPs. Building on GPs’ current efforts to provide contraceptive counselling to young people, discussing contraception as part of routine care for teenagers, will further support these endeavours.
Data availability
The data that support this study cannot be publicly shared due to ethical or privacy reasons and may be shared upon reasonable request to the corresponding author if appropriate.
Conflicts of interest
DM has received research funding, sponsorship to attend conferences, and been involved in training and education activities and advisory boards outside this submitted work related to Bayer Australia and MSD/Organon. JB is an Associate Editor of the Australian Journal of Primary Health. To mitigate this potential conflict of interest they had no editor-level access to this manuscript during peer review. The authors have no further conflicts of interest to declare.
Acknowledgements
We thank the general practitioners who took part in this study. We also thank Dr Christopher Barton for his support in developing the qualitative study design.
References
ABS (2016) 1270.0.55.005 - Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, July 2016. Australian Bureau of Statistics, Canberra, Australia. Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/1270.0.55.005Main%20Features15July%202016
Berlan ED, Pritt NM, Norris AH (2017) Pediatricians’ attitudes and beliefs about long-acting reversible contraceptives influence counseling. The Journal of Pediatric and Adolescent Gynecology 30(1), 47-52.
| Crossref | Google Scholar | PubMed |
Bitzer J, Abalos V, Apter D, Martin R, Black A, Global CARE (Contraception: Access, Resources, Education) Group (2016) Targeting factors for change: contraceptive counselling and care of female adolescents. European Journal of Contraception and Reproductive Health Care 21(6), 417-430.
| Crossref | Google Scholar | PubMed |
Black K, Lotke P, Buhling KJ, Zite NB, Intrauterine contraception for Nulliparous women: Translating Research into Action (INTRA) group (2012) A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women. European Journal of Contraception and Reproductive Health Care 17(5), 340-348.
| Crossref | Google Scholar | PubMed |
Coles CB, Shubkin CD (2018) Effective, recommended, underutilized: a review of the literature on barriers to adolescent usage of long-acting reversible contraceptive methods. Current Opinion in Pediatrics 30, 683-688.
| Crossref | Google Scholar | PubMed |
Coombe J, Harris ML, Wigginton B, Loxton D, Lucke J (2016) Contraceptive use at the time of unintended pregnancy: findings from the contraceptive use, pregnancy intention and decisions study. Australian Journal for General Practitioners 45, 842-848.
| Google Scholar |
Dehlendorf C, Kimport K, Levy K, Steinauer J (2014) A qualitative analysis of approaches to contraceptive counseling. Perspectives of Sexual & Reproductive Health 46(4), 233-240.
| Crossref | Google Scholar |
Diabelková J, Rimárová K, Dorko E, Urdzík P, Houžvičková A, Argalášová Ľ (2023) Adolescent pregnancy outcomes and risk factors. International Journal of Environmental Research and Public Health 20(5), 4113.
| Crossref | Google Scholar | PubMed |
FSRH (2023) FSRH Guideline (March 2023) Intrauterine Contraception. BMJ Sexual & Reproductive Health 49(Suppl 1), 1-142.
| Crossref | Google Scholar |
Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, Yamdamsuren B, Temmerman M, Say L, Tuncalp O, Vogel JP, Souza JP, Mori R, WHO Multicountry Survey on Maternal Newborn Health Research Network (2014) Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 121, 40-48.
| Crossref | Google Scholar | PubMed |
Garrett CC, Keogh LA, Kavanagh A, Tomnay J, Hocking JS (2015) Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study. BMC Womens Health 15, 72.
| Crossref | Google Scholar | PubMed |
Goldhammer DL, Fraser C, Wigginton B, et al. (2017) What do young Australian women want (when talking to doctors about contraception)? BMC Family Practice 18, 35.
| Crossref | Google Scholar |
Harris ML, Coombe J, Forder PM, Lucke JC, Bateson D, Loxton D (2020) Young women’s complex patterns of contraceptive use: findings from an australian cohort study. Perspectives on Sexual and Reproductive Health 52, 181-190.
| Crossref | Google Scholar |
Kawakita T, Wilson K, Grantz KL, Landy HJ, Huang C-C, Gomez-Lobo V (2016) Adverse maternal and neonatal outcomes in adolescent pregnancy. Journal of Pediatric Adolescent Gynecology 29(2), 130-136.
| Crossref | Google Scholar | PubMed |
Kumar N, Brown JD (2016) Access barriers to long-acting reversible contraceptives for adolescents. Journal of Adolescent Health 59, 248-253.
| Crossref | Google Scholar |
Lodge G, Sanci L, Temple-Smith M (2017) GPs’ perspectives on prescribing intrauterine contraceptive devices. Australian Family Physician 46(5), 328-333.
| Google Scholar | PubMed |
Mann L, Bateson D, Black KI (2020) Teenage pregnancy. Australian Journal of General Practice 49(6), 310-316.
| Crossref | Google Scholar | PubMed |
Mazza D (2024) Monash Expert: SPHERE NHMRC Centre of Research Excellence federal budget response. Monash Media. Available at https://www.monash.edu/news/articles/monash-expert-sphere-nhmrc-centre-of-research-excellence-federal-budget-response
Mazza D, Harrison C, Taft A, Brijnath B, Britt H, Hobbs M, Stewart K, Hussainy S (2012) Current contraceptive management in Australian general practice: an analysis of BEACH data. Medical Journal of Australia 197, 110-114.
| Crossref | Google Scholar | PubMed |
Mazza D, Bateson D, Frearson M, Goldstone P, Kovacs G, Baber R (2017) Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: an expert roundtable discussion. Australian and New Zealand Journal of Obstetrics and Gynaecology 57, 206-212.
| Crossref | Google Scholar | PubMed |
Neergaard MA, Olesen F, Andersen RS, Sondergaard J (2009) Qualitative description – the poor cousin of health research? BMC Medical Research Methodology 9, 52.
| Crossref | Google Scholar |
Parker A, Hetrick S, Purcell R (2010) Psychosocial assessment of young people – refining and evaluating a youth friendly assessment interview. Australian Family Physician 39(8), 585-588.
| Google Scholar |
RACP (2015) Position statement: sexual and reproductive health care for young people: contraception, termination and teenage pregnancy care. pp. 19–21. (The Royal Australasian College of Physicians: Sydney, Australia) Available at https://www.racp.edu.au/docs/default-source/default-document-library/racp-sexual-and-reproductive-health-care-for-young-people-position-statement.pdf?sfvrsn=0
Rassi A, Wattimena J, Black K (2013) Pregnancy intention in an urban Australian antenatal population. Australian and New Zealand Journal of Public Health 37(6), 568-573.
| Crossref | Google Scholar | PubMed |
Rowe H, Holton S, Kirkman M, Bayly C, Jordan L, McNamee K, et al. (2016) Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey. Australian and New Zealand Journal of Public Health 40(2), 104-109.
| Crossref | Google Scholar | PubMed |
Rubin SE, Coy LN, Yu Q, Muncie HL, Jr. (2016) Louisiana and Mississippi family physicians’ contraception counseling for adolescents with a focus on intrauterine contraception. Journal of Pediatric Adolescent Gynecology 29(5), 458-463.
| Crossref | Google Scholar | PubMed |
Saw C, Smit A, Silva D, Bulsara MK, Nguyen ETTT (2020) Service evaluation and retrospective audit of electronic HEEADSSS (e-HEEADSSS) screening device in paediatric inpatient service in Western Australia. International Journal of Adolescent Medicine and Health 34(6), 401-409.
| Crossref | Google Scholar |
SPHERE Coalition (2022) Increasing access to effective contraception in Australia: a consensus statement. Available at www.spherecre.org/images/Increasing_access_to_effective_contraception_in_Australia_A_consensus_statement_.pdf [Accessed 16 April 2024]
Taft AJ, Shankar M, Black KI, Mazza D, Hussainy S, Lucke JC (2018) Unintended and unwanted pregnancy in Australia: a cross-sectional, national random telephone survey of prevalence and outcomes. Medical Journal of Australia 209(9), 407-408.
| Crossref | Google Scholar | PubMed |
Victoria State Government (2021) Better Health Channel. General Practitioner Services. Available at https://www.betterhealth.vic.gov.au/health/serviceprofiles/General-practitioner-services
Women’s Health Victoria (2018) Sexual and reproductive health: Teenage fertility: Rate per 1000. Women’s Health Victoria Atlas, Melbourne, Victoria, Australia. Available at https://whv.org.au/resources/victorian-womens-health-atlas
World Health Organization (2015) ‘Medical eligibility criteria for contraceptive use,’ 5th edn (WHO: Geneva, Switzerland) p. 107. Available at https://apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf?sequence=9
