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[5 min read] Family planning in primary care
Family planning is a common reason for attendance at primary care and affects most women at some stage in their life. Good family planning provision is essential for both maternal and child health and involves not only the prevention of pregnancy but ensuring good reproductive health overall, including pre-conception advice.
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Family planning is often used synonymously with birth control, and as a general practitioner, it is important to have a good understanding of the types of contraceptives available, their mechanisms of action, side effects, benefits, risks and contraindications. It is also useful to know which types of contraceptives are available via government subsidies.
Prior to prescribing contraception, it is important to take a good medical history, including asking about underlying health conditions, risk of sexually transmitted infections, family history, allergies and regular medications. This allows the general practitioner to ascertain which methods are suitable and safe for the patient.
The Faculty of Sexual and Reproductive Health (FSRH) UK Medical Eligibility Criteria (UKMEC) provides useful information on the suitability of all types of contraception. It is also important to discuss the person’s overall sexual and reproductive needs, for example, which types of contraception have they used before, if they plan on becoming pregnant in the near future, if they wish a method that they do not need to remember, or if they have particular preferences concerning exogenous hormones.
Long-acting reversible contraception (LARC), sometimes known as “set and forget” methods, are highly effective and often offer additional benefits such as reducing menstrual bleeding. The long-acting reversible contraceptives are the copper intrauterine device (IUD), the hormonal intrauterine system (IUS), the contraceptive implant, and the contraceptive injection. These methods are the most effective at preventing pregnancy, however do require input from a practitioner to insert or administer.
Hormonal methods of contraception aside from LARC include combined hormonal contraception (available as a pill, patch and vaginal ring), and the progestogen-only pill (POP). These are less effective in the real world than LARC, as they require more user input, however they remain one of the most popular methods in Australia.
Emergency contraception (EC) in the form of the “morning after pill” is a hormonal method used immediately after unprotected sex. EC is not one hundred per cent effective, and should not be used as routine contraception.
Non-hormonal methods of contraception include the IUD, and also barrier methods (male condoms, female condoms, and the diaphragm). Condoms are the only method of contraception that also protects against sexually transmitted infections.
Fertility awareness methods (FAM) involve the tracking of the menstrual cycles over time in order to delineate fertile and infertile times. These methods involve a great deal of user input and are not effective immediately. However, these may suit the patient who is planning pregnancy.
Finally, methods of contraception considered permanent are vasectomy and tubal ligation, which are suited to patients who have no future fertility desires.
Family planning should be patient-centred, and the role of the general practitioner is to provide patients with the relevant information to allow them to make the decision that is right for them. It is important to explain that a method may not be suitable, and it may take a trial period of several different methods of contraception before finding the right one. In addition, different methods may be suitable for different life stages, and a person may use several different methods over their life course.
The Family Planning Alliance Australia has some excellent resources for both clinician and patient to facilitate making the right choice.
Dr Samantha Miller, MBChB
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- Marie Stopes Australia (2022). Contraception. https://www.contraception.org.au/
- Department of Health, State Government of Victoria, Australia (2021). Better Health Channel: Contraception – Choices. https://www.betterhealth.vic.gov.au/health/healthyliving/contraception-choices
- Gallagher J, Beattie V, Vrahmides, J (2014). Tips for GP trainees working in family planning. British Journal of General Practice. 64 (618) 52–54. https://bjgp.org/content/64/618/52/tab-article-info
- Family Planning Alliance Australia (2022). https://www.familyplanningallianceaustralia.org.au/fpaa/
- Sexual Health and Family Planning Australia (2022). http://shfpa.org.au/
- Faculty of Sexual and Reproductive Health (2016). UK Medical Eligibility Criteria (UKMEC). https://www.fsrh.org/ukmec/
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