Geographical variation in use of hormonal long-acting reversible contraceptives in Australia between 2018 and 2021: Analysis of national dispensing data

OBJECTIVE: To examine geographical variation in utilisation of hormonal long-acting reversible contraceptives (LARCs), namely the hormonal intrauterine device (IUD) and implant. STUDY DESIGN: Cross-sectional study of Australian women aged 15-54 years using Pharmaceutical Benefits Scheme (PBS) dispensing data from 2018 to 2021. We calculated age-standardised rates of LARC dispensing per 1000 women across each Statistical Area Level 3 (SA3) according to remoteness and socioeconomic status (SES) indices. Differences between minimum and maximum rates of LARC utilisation in SA3s were used to determine magnitude of variation. RESULTS: Between 2018 and 2021, hormonal IUD dispensing rates increased from 18.4 to 21.6 per 1000 women in major cities, 25.2 to 30.6 per 1000 in inner regional, 25.4 to 28.7 per 1000 in outer regional, and 17.7 to 20.0 per 1000 in remote areas. This corresponded to decreases in implant dispensing rates from 14.6 to 12.6 per 1000 women in major cities, 25.3 to 23.1 per 1000 in inner regional, 28.0 to 25.3 per 1000 in outer regional, and 20.7 to 19.6 per 1000 in remote areas. Rates of LARC utilisation varied considerably across SA3s, ranging from 10.9 to 37.8 per 1000 women. Increasing SES was associated with increasing hormonal IUD rates in major cities (incidence rate ratio (IRR) 1.06, 95% CI 1.04 to 1.08), inner regional (IRR 1.06, 95% CI 1.03 to 1.09) and remote (IRR 1.44, 95% CI 1.12 to 1.85) areas, but decreasing implant rates in major cities (IRR 0.89, 95% CI 0.86 to 0.91) and inner regional areas (IRR 0.91, 95% CI 0.88 to 0.94). CONCLUSION: Given observed variation in LARC utilisation, efforts to identify and address barriers towards more equitable access to LARC methods appear warranted.