Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study

Background Given chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor maternal and fetal outcomes, these women would benefit from effective preconception care. However, there is a lack of understanding of how these women use or don’t use contraception to inform such interventions. This study examined patterns of contraceptive use among an Australian cohort of young women, with and without chronic disease, and investigated factors which influenced contraceptive use over time. Methods Using data from 15,244 young women from the Australian Longitudinal Study on Women’s Health (born 1989-95), latent transition analysis was performed to identify distinct contraceptive patterns among women who were at risk of an unintended pregnancy. Multinomial mixed-effect models were used to evaluate the relationship between contraceptive combinations and chronic disease. Results Differences in contraceptive use over time were found for women with cardiac disease, those with autoinflammatory diseases. Compared to women without chronic disease using the pill alone, women with cardiac disease had double the odds of using ‘other’ low efficacy contraception and condoms (OR=2.2, 95% CI: 1.34-3.59) and a modest increase in the odds of using the combined oral contraceptive pill and condoms (OR=1.39, 95% CI: 1.03-1.89). Women with autoinflammatory disease had increased odds of using LARC and condoms (OR=1.58, 95% CI: 1.04-2.41), using ‘other’ low efficacy contraception and condoms (OR=1.69, 95% CI: 1.11-2.57), and using combined oral contraceptive pill and condom use (OR=1.38, 95% CI: 1.09-1.75), compared to women without chronic disease using the pill. There was little evidence to suggest that contraceptive patterns differed for women with asthma or diabetes from women without chronic disease. Conclusion The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between healthcare providers and women with chronic disease to improve young women’s contraceptive knowledge and agency in contraceptive choice, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.