Contraceptive counselling in areas of high teenage pregnancy: a study of General Practitioners’ insights

Problem

There are negative social, economic and health outcomes associated with unintended teenage pregnancy. While the rates of teenage pregnancy in Australia have declined overall, there still exists geographical areas of relative high-risk. Effective contraception can prevent unintended pregnancies and general practitioners (GPs) are the first-line providers of prescription contraceptives in Australia. The delivery of contraceptive counselling and the contraceptive options offered, however, may be impacted by GPs’ perceptions, biases and beliefs and in areas of high-risk for teenage pregnancy this may be compounded by broader social disadvantage.

To date, there have been no studies investigating the approach taken by GPs to contraceptive counselling in areas of high risk for teenage pregnancy. The aim of this study was therefore to obtain GP insights into the challenges they faced when providing contraceptive counselling to teenagers in areas of high risk for teenage pregnancy and how they sought to overcome these challenges.

Approach

Using a qualitative study design, data was collected from semi-structured, in-depth, telephone interviews with 18 GPs who were purposively sampled from high-risk areas for teenage pregnancy across Victoria, Australia. This methodology allowed GPs to give rich descriptions of their contraceptive counselling, within the context of working in a high-risk area for teenage pregnancy. An interview guide was utilised and interviews were audio recorded and transcribed verbatim. Data were analysed using an inductive, grounded theory approach to develop themes.

Findings

Most GPs recognised that the teenagers in their area were a vulnerable group and found them difficult to engage in contraceptive counselling. They acknowledged multiple structural and patient barriers to the teenagers accessing care and described targeting their counselling to try and also address wider social and economic issues. However despite GPs believing that they provided best-practice contraceptive counselling many did not offer all contraceptive options. Contrary to existing guidelines there was no consistent approach to offering long-acting reversible contraception (LARC) to teenage women. GPs held many erroneous views about contraception and LARCs in particular, and LARCs were often reserved as a second-line contraceptive.

Consequences

Our study suggests that despite GPs being aware of the need to tailor the way they provide contraceptive counselling to teenagers in areas of high risk for teenage pregnancy, GP biases and misperceptions are still resulting in teenagers being offered less effective forms of contraception. Targeted interventions that improve GP knowledge and skills regarding LARCs and their usefulness in teenagers is required together with public health approaches that address structural and patient barriers to accessing care. Further research eliciting the views of teenagers would also provide further insight into these issues.