Patterns of contraceptive use through later reproductive years: a prospective cohort study of Australian women with chronic disease

Background Pregnancies among women with chronic disease are associated with poor maternal and fetal outcomes. There is a need to understand how women use or don’t use contraception across their reproductive years to better inform the development of preconception care strategies to reduce high risk unintended pregnancies, including among women of older reproductive age. However, there is a lack of high-quality longitudinal evidence to inform such strategies. We examined patterns of contraceptive use among a population-based cohort of reproductive aged women and investigated how chronic disease influenced contraceptive use over time. Methods and Findings Contraceptive patterns from 8,030 women of reproductive age from the Australian Longitudinal Study on Women’s Health (1973-78 cohort), who were at potential risk of an unintended pregnancy were identified using latent transition analysis. Multinomial mixed-effect logistic regression models were used to evaluate the relationship between contraceptive combinations and chronic disease. Contraception non-use increased between 2006 and 2018 but was similar between women with and without chronic disease (13.6% vs. 12.7% among women aged 40-45 years in 2018). When specific contraceptive use patterns were examined over time, differences were found for women with autoinflammatory diseases only. These women had increased odds of using condom and natural methods (OR=1.20, 95% CI=1.00, 1.44), and sterilisation and other methods (OR=1.61, 95% CI=1.08, 2.39) or no contraception (OR=1.32, 95% CI=1.04, 1.66), compared to women without chronic disease using short-acting methods and condoms. Conclusion Potential gaps in the provision of appropriate contraceptive access and care exist for women with chronic disease, particularly for women diagnosed with autoinflammatory conditions. Development of national guidelines as well as a clear coordinated contraceptive strategy that begins in adolescence and is regularly reviewed during care management through their main reproductive years and into perimenopause is required to increase support for, and agency among, women with chronic disease. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health (ALSWH) by the University of Newcastle and The University of Queensland and funded by the Australian Government Department of Health (G1700929). Dr Melissa L. Harris is funded through an Australian Research Council Discovery Early Career Researcher Award (DE190101134). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All data for this project were obtained from the ALSWH (see [www.alswh.org.au/][1] for further details), approved under Expression of Interest process (EOI A696) and provided in de-identified form. This project has ongoing ethical clearance from the University of Newcastle and University of Queensland’s Human Research Ethics Committees. Ethical approval for linkage of ALSWH survey data to the Admitted Patients Data Collections (APDC) was received from the NSW Population and Health Services Research Ethics Committee and other equivalent state and territory-based committees. Linkage to the National Death Index (NDI) was approved by the Australian Institute of Health and Welfare Ethics Committee. Women provided explicit written consent to participate in the ALSWH as well as for linkage to de-identified administrative health records prior to 2005. From 2005, an ‘opt-out’ consent process was approved by the data custodians and relevant ethics committees for data linkage, with participants regularly reminded of this process. ALSWH participants who decline health record linkage are excluded from data linkage requests. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable The data used as part of this analysis are bound by ethical restrictions due to containing person level data. These restrictions have been imposed by the respective data custodians for the administrative datasets including the Department of Health, Medicare Australia and the Australian Institute of Health and Welfare. For further information regarding access to Australian Longitudinal Study on Women’s Health data, including linked datasets, requests are to be sent to info{at}alswh.org.au. [1]: http://www.alswh.org.au/