Provision of contraception: a survey among primary care physicians in Finland

Objective. To investigate self-reported practices of contraceptive provision among primary care physicians. Design. A cross-sectional questionnaire study. Setting. All community health centers (n = 63) in an university hospital area in Western Finland. Sample and methods. A total of 122 health center physicians involved in contraceptive counseling (CC) were invited to participate in self-administered survey. Data were obtained on initiation of contraceptive methods and the limits and contraindications applied when prescribing combined hormonal contraception (CHC), and they were assessed against Finnish and WHO guidelines. Main outcome measures. Distribution of initiated contraceptive methods and of examinations and tests included, application of limits and contraindications in relation to age, smoking, body mass index or weight, blood pressure (BP) and migraine with aura when prescribing CHC (combined oral contraceptives (COCs), vaginal ring and contraceptive patch). Results. Responded physicians (n = 83.68%) said they most frequently prescribed the COC pill. Progestin-only pills, levonorgestrel-releasing intrauterine system and copper-releasing intrauterine device were also provided regularly. Most of the respondents routinely took numerous examinations and tests when initiating contraception, including also unnecessary ones. There were gaps in their knowledge about the limits and contraindications for CHC. For example, 41% of the respondents did not recognize migraine with aura as a contraindication and only 19% reported applying the recommended BP limit of 140/90 mmHg. Conclusions. The range of contraceptives available and examinations and tests offered were comprehensive. However, the inadequate procedures regarding assessment of contraindications for CHC suggests that updating CC practices is challenging in primary care.