From awareness to usage of long-acting reversible contraceptives: Results of a large European survey

Objective: The PULSE survey investigated contraceptive decision making, focusing on the use of long-acting reversible contraceptives (LARCs) to determine reasons for their low adoption rates. Methods: An online questionnaire was sent to women aged 18-49 years in 14 European countries who were considering starting or changing contraceptive method and asked questions based on four stages of contraceptive decision making: awareness, consideration, consultation, and adoption. Results: Overall, 7221 women responded. LARC awareness was high (similar to 73%) but current usage was low (11.3%). Only 24% of LARC-aware women would consider switching to them. Factors associated with decision making differed depending on the stage: e.g. at the awareness phase, women were concerned with suitability, reversibility, and whether the method is hormonal; and at the consideration phase, the efficacy, convenience, and adverse-effect profile were important. Healthcare professionals (HCPs) were the most trusted information source for women's contraceptive decision making. LARCs were discussed less frequently during consultations than other contraceptives and HCPs may be perceived to hold negative opinions on LARCs. Conclusion: A lack of knowledge about the features and benefits of LARCs can contribute to misconceptions and low adoption rates. HCPs play an important role in addressing this, as information conveyed during consultations influences women's contraceptive choices.