Most Australian women don’t know that intrauterine devices (IUDs) are the most effective form of contraception.
Experts say this nationwide “failure in public education” has contributed to low uptake and caused Australia to lag behind other western countries.
The latest Jean Hailes National Women’s Health Survey of 3,537 reproductive age women found more than 80% of 18-to-24-year-olds and 60% of 25-to-44-year-olds want to avoid getting pregnant.
The survey found only 7% of women aged 18 to 24 and 11% of women aged 25 to 44 reported using an IUD.
The CEO of Jean Hailes, Dr Sarah White, said the results show Australia is “far behind” equivalent countries such as the UK, South Korea, France and the US. In Sweden and England rates of use are over 30%.
IUDs are small devices implanted in the uterus. As a form of long-acting reversible contraceptives (LARCs), they are the most effective way to prevent pregnancy (over 99%).
Contraceptive pills also have a rate of efficacy above 99% if taken correctly. But its effectiveness can be reduced if taken irregularly or absorption can be affected by diarrhoea and vomiting.
When the survey tested women’s knowledge on which methods were best at preventing pregnancy, the most common answer (32%) incorrectly identified condoms, while 27% said all are equally effective. Just one in four women (27%) correctly identified IUDs.
Conducted online in mid-2024, the survey found three in 10 women aged 25 to 44 and 8% of women aged 18 to 24 said they’d had an unplanned pregnancy.
White said “most women are not aware that these long-acting, reversible contraceptives are actually the most effective form of contraception at a time when so many of them are saying it’s really important for them not to become pregnant”.
“They’re walking past one of the best options they’ve got because they just don’t know about it.”
The lack of knowledge of the effectiveness of IUDs “goes a long way to driving that low uptake”, White said. IUDs had other benefits, she said, including their convenience in not interrupting sex, easing period pain and being more cost effective over the long term than other forms of contraception.
The leader of the Sphere Centre of Research Excellence in women’s sexual and reproductive health in primary care, Prof Danielle Mazza, said not enough healthcare providers in Australia are trained in the insertion of IUDs, and may be less likely to emphasise the benefits. Sphere conducted the survey in collaboration with Jean Hailes.
In its most recent budget, as part of the half a billion dollar package for women’s health, the federal government increased payments to doctors and nurse practitioners to insert and remove IUDs. Eight centres will be set up to train healthcare professionals.
White said access issues in rural and regional Australia might be alleviated if more women were considered using IUDs.
IUD insertions by a private provider has higher upfront costs, White said, but that cost is “well and truly recouped” compared with buying the pill or condoms over the long term.
As several states have moved towards pharmacy prescribing the contraceptive pill, Mazza said it is important women are still being advised about all their contraceptive options, including LARCs, even though pharmacists can’t provide them.
White said some women are also concerned about the pain of insertion, in part fuelled by social media amplifying negative experiences. “But in fact, there’s a lot of people who really swear by having IUDs and love how convenient they are.”
The chair of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ sexual reproductive health committee, Prof Kirsten Black, said in her experience patients will often say “that’s not nearly as bad as they thought” after the procedure.
Black said it was surprising knowledge was so low in the survey, but added “we have a real failure of public education in this area”, unlike in northern Europe.
Black said she hopes the government incentives will improve the skills of primary care practitioners to provide IUDs.
