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Table 1 Barriers to LARC use among young women

From: Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study

Shared barriers reported by young women and healthcare professionals Illustrative quotations from young women Illustrative quotations from healthcare professionals
Norms Receiving a script for oral contraceptives from general practitioners the norm “I think alotta younger kids also don’t know too much about the rest of the contraceptives, so they just go to the doctor and say, ‘I want the pill’. That’s what they get.” (Regional focus group 2) “If someone goes along to their GP (general practitioner) for a script for the pill, the GP probably just gives them a script for the pill. I don’t know whether they always necessarily assess whether that’s the best contraception for them and how they are going with it and whether they’re aware or interested in other methods.” (Participant 4, medical director, major city)
Not the norm for young people to use IUDs “[The IUD is] not common [in our age group] … I’m sure my mom had this, yes, and my neighbours, yes. This is a common method for their age, I think 30 to 40.” (Metropolitan focus group 2) “Most young people just rule an IUD out.” (Participant 5, medical director, major city)
Bodily consequences LARC changes bleeding patterns “I know some people might wanna be able to determine when they want their period and when they don’t. With the Implanon, it affects people differently. Some people might get their period lots and some don’t get it all.” (Regional focus group 2) “We are unable to predict how somebody’s going to react to [Implanon] in terms of bleeding … unfortunately with the Implanon they are taking a calculated risk.” (Participant 9, nurse, regional)
LARC implanted in the body semi-permanently “The thing about the pill is that there’s not as much of a commitment as some of the other [types of contraception] like the IUD and Implanon. If they don’t work, it could be you have to get it removed.” (Metropolitan focus group 2) “Well we heard reports … people who feel that if someone feels [the contraceptive implant] in their arm, and they’re in a social setting, that they will be considered to be sluts … I’ve heard women reporting back of that happening in pubs where men will come and it’s pretty bad. Rub your arms, you know, so they don’t want the device sitting there.” (Participant 8, nurse, major city)
Misconceptions Misconceptions about IUDs “I’ve talked with my doctor. I’ve heard they try not to give [IUDs] to younger women.” (Metropolitan focus group 2) “I think really mostly the education GPs have is not to give Mirena to young people. Unless they’ve had children.” (Participant 15, general practitioner, regional)
Misconception that condoms and pills are the only option “I think with the long term contraception stuff, it’s about people being more aware that there’s not just the pill. I think, you’re right, people always said, until your early 20s, you just sort of think, ‘Oh, it’s just the pill. That’s my only option’. Because it’s not talked about in schools. No one ever talked about Implanon or anything in school.” (Metropolitan focus group 1) “A lot of people just don’t have the knowledge or awareness of the LARC methods. I’ve had women that say, ‘Oh, look, I tried the pill and I tried lots of different sorts and they didn’t work for me, so there’s nothing else I can do.’ I mean they’re not even aware of other methods.” (Participant 4, medical director, major city)
LARC access issues Cost, time and distance Participant: “Cost [is an obstacle], because your parents might not know [you are using contraception].” “Recently we had a young girl who … wanted the copper IUD. It took us … probably three or four months for her to actually in the end have that inserted … the pharmacy locally actually didn’t have [the IUD] on stock so they had to order them in from [a nearby town] … By the time she’d had her specialist appointment, picked up her copper IUD and then had it inserted … It ended up costing her about $500.” (Participant 9, nurse, regional)
Participant: “Yeah [your parents] might not know so you might not be able to have the money to afford to buy a script.” …
Participant: “If your parents don’t know you’ve gotta catch buses and stuff like that, and sometimes that can be a bit hard with appointment times.” (Regional focus group 2)
Barrier reported by young women only
 Perceived lack of control over hormones entering the body “I don’t like the idea that you’re not in control with [the contraceptive implant]. With the pill, you take it. If that thing stops up, how do you know? You can’t.” (Metropolitan focus group 2)
“The rod in the arm … Just sounds really unappealing. Yeah, the whole idea of control and there’s just this thing that’s pumping out hormones, but you can’t stop it if it goes outta hand.” (Metropolitan focus group 2)
Barrier reported by healthcare professionals only
 Limited confidence and support in LARC insertions “You need to be quite confident to do [IUD insertions]. Particularly in general practice, where you maybe feel somewhat alone with it and not very supported … You need to get enough volume through to keep your skill up”. (Participant 6, general practitioner, major city)
“If you don’t do [Implanon insertions] often enough then it becomes nerve wracking just suddenly if you haven’t put one in for six months or something to suddenly have to put one in. It’s like everyone, everyone has the same feelings, you know. You’d get nervous about it.” (Participant 12, nurse/midwife, major city)