Background Reducing unplanned pregnancy in Scotland is a key government objective. Long-acting reversible contraception (LARC) is a cost-effective way to reduce unintended pregnancy. Abortion and teenage pregnancy rates are highest in the most deprived areas. One possible explanation could be contraceptive prescribing inequality. This study examined the relationship between area deprivation measured by the Scottish Index of Multiple Deprivation and LARC prescription.
Methods Using Scottish electronic prescribing data from primary care and sexual and reproductive health clinics, this study analysed female Lothian residents with a valid postcode aged 16–49 years who received a contraceptive prescription from 1 April 2012 to 31 March 2014. Prescription of LARC (intrauterine, implant or injectable contraceptive) compared with non-LARC (oral pill, patch, ring or diaphragm) was examined. Logistic regression was performed adjusting for age group and prescription location.
Results A total of 90 150 women were included; 21.1% of prescriptions were LARC and 15.3% vLARC (intrauterine method or implant). Women residing in the most deprived quintile (Q1) and prescribed contraception received a significantly higher proportion of LARC than quintiles 2–5 (Q2–5). Odds ratios compared with Q1 were: Q2 0.86, Q3 0.77, Q4 0.59 and Q5 0.51. Women in quintile 1 were also significantly more likely to receive vLARC than quintiles 2–5.
Conclusion Women in the most deprived quintile in Lothian who are prescribed contraception are significantly more likely to receive LARC and vLARC compared with women in less deprived quintiles.
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Acknowledgements The authors would like to thank NHS Lothian Data Analysts Ms Eilidh Fletcher, Ms Ana Rodriguez and Mr Andrew Massie for their help in extracting and matching data. They would like to thank Ms Dona Milne, Deputy Director of Public Health and Health Policy at NHS Lothian, for agreeing to the project and the Caldicott Guardian Professor Alison McCallum, Director of Public Health and Health Policy at NHS Lothian for approval of the Caldicott application. The authors accept full responsibility for the analysis and interpretation of the data presented. This work formed part of CM’s thesis towards the Masters in Public Health, University of Manchester.
Competing interests None declared.
Patient consent The author did not have access to any patient identifiable data. All the patient level data was analysed in a safe NHS Lothian Server. Aggregated data only left NHS Lothian once it had been aggregated and it complied with NHS Lothian Statistical Disclosure Guidance.
Ethics approval Caldicott guardian NHS Lothian.
Provenance and peer review Not commissioned; externally peer reviewed.
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