A scheme that gave GP surgeries cash incentives to tell women about long-acting reversible methods of contraception has been linked to a sharp fall in abortion rates.
Long-acting reversible contraceptives, known as Larcs, include the implant, intrauterine device and contraceptive injection and are highly effective.
Researchers have found that when GPs in Britain were given financial incentives to tell women about such contraceptive methods in 2009, uptake increased and abortion rates fell markedly, particularly among younger women and those from more disadvantaged backgrounds.
The study prompted calls for the incentives scheme, which was scrapped this year, to be reinstated.
Financial incentives are commonly used in healthcare settings to encourage the uptake of certain interventions, including flu vaccinations.
In 2009/10 a system was introduced by the UK government whereby GP surgeries received a payment for reaching targets on offering information about Larcs to female patients aged 13 to 54 who had previously used prescription contraception, including the morning-after pill. The incentives were not linked to actual uptake of the methods.
Overall, the team say that for a practice of about 6,000 patients, this would equate to a financial boost for the practice of about £700 a year if 90% or more of eligible women were given Larc advice.
The incentive scheme was scrapped in part in 2014/15 and completely by 2019/20.
Writing in the journal PLOS Medicine, the researchers reported how they analysed health records of more than 3 million women in England, Wales and Scotland covering the period 2004/05 to 2013/14.
The team looked at the trend for prescriptions of different contraceptives, as well as abortions, before the incentive scheme was introduced – and from this predicted the number of prescriptions that would be expected for different contraceptives in 2013/14, as well as the number of abortions.
When they looked at the figures for 2013/14 itself, they found the number of Larc prescriptions was 13% higher than expected from trends before the incentive scheme was introduced. By contrast, total prescriptions for other hormonal contraceptives were 17% lower than expected.
Dr Richard Ma of Imperial College London, a co-author of the study, said the findings implied the uptick in Larc use is unlikely to be largely down to a general increase in awareness of contraception, but potentially a result of women switching to a better method for them.
While abortion rates were already falling before the scheme was introduced, the number of abortions was 38% lower in 2013/14 than would have been predicted.
“The trend of abortion has been coming down quite slowly, but it came down a lot more after the incentive was introduced,” said Ma.
Ma said it is not known whether GPs are continuing to ensure women are given information about Larcs, or whether scrapping the incentive scheme has had an impact on measures such as abortion rates.
“Incentive or not, it is definitely good practice to give women more options about contraception,” he said.
Dr Asha Kasliwal, the president of the Faculty of Sexual and Reproductive Healthcare, said the financial incentives should be reinstated, noting fewer and fewer women are accessing contraception in primary care as result of factors including budget cuts.
“[The study shows] when GPs have more time and are rightly supported to provide information about intrauterine contraception, contraceptive implants and injections, their patients are more likely to try these methods,” she said. “It is a win-win situation for both doctors and patients.”
