How have changes in public funding and accessibility influenced contraceptive use among Norwegian adolescents? A cohort study

Abstract

Introduction - Since the law on the right to self-determined abortion passed in 1978, the Norwegian Government have intensified their work on preventing unintended pregnancies and abortions among adolescents. Some of the measures that have been introduced are the reimbursement scheme for hormonal contraceptives and the authorization of public health nurses and midwives to prescribe hormonal contraceptives. This study aims to examine the impact of public funding and increased accessibility on contraceptive use among Norwegian adolescents. <p> <p>Material and methods - Data sources for this cohort study were the Norwegian Prescription database (NorPD) and Statistics Norway. The study population comprised 174 653 Norwegian women born in 1989-1990, 1994-1995 and 1999-2000. We examined their use of hormonal contraception through dispensed prescriptions from age 12 through age 19. The statistical analysis was done in SPSS using chi-square test and survival analysis with p-values < 0.05. <p> <p>Results - By age 19 based on 2-year birth cohorts (1989-1990, 1994-1995, 1999-2000), between 74.1 % and 75.5 % of women had used any hormonal method. The main providers of first prescription for all birth cohorts were general practitioners (between 33.0% and 36.4%) and public health nurses (between 34.7% and 37.2%). There has been a significant increase across the birth cohorts in the number of women who continuously use hormonal contraception with same method (from 25.3% to 33.5% (p<0.001)) and after switching methods (from 3.8% to 18.7% (p<0.001)). There was an increase across birth cohorts in switching methods from COC to implant (from 5.4% to 51.7% (p<0.001)). Using first method or using hormonal contraception continuously for ≥ 2 years, was more common in the youngest birth cohort (from 16.5% to 24.2% (p<0.001) and from 25.1% to 31.8% (p<0.001)). <p> <p>Conclusion - The overall use of hormonal contraception has been stable since the implementation of the reimbursement scheme (2002). Public health nurses have become important prescribers of first prescription since they were authorized to prescribe contraceptives (2002). The use of LARC has increased since its inclusion in the reimbursement scheme (2015), and at time when public health nurses and midwives were given the right to prescribe LARC (2016). Our findings indicate that increased LARC use leads to an increase in continuous use. There has been a steep decline in induced abortions and births among Norwegian adolescents in recent years, suggesting that the changes in the reimbursement scheme and extended rights to prescribe contraception for public health nurses and midwives have had a measurable impact on the rates of induced abortions and births for women under 20 years of age.