Primary Care Training Improves Uptake and Long-Term Use of Long-Acting Reversible Contraception

Equipping primary care physicians with focused training and streamlined referral systems was associated with sustained improvements in long-acting reversible contraception (LARC) use and reproductive outcomes, according to 3-year outcomes from the Australian Contraceptive ChOice pRoject (ACCORd)1 trial, published in the American Journal of Obstetrics and Gynecology.

LARC methods, ie, hormonal and copper intrauterine devices (IUDs) and contraceptive implants, are the most effective reversible contraceptives, yet use among Australian women aged 15–44 years remains low, at about 11%,2 the authors wrote. Unintended pregnancies in the country are common, particularly among younger, nonurban women, with nearly 40% of pregnancies unintended and a third ending in abortion.2

The original cluster randomized ACCORd trial provided training for general practitioners (GPs) in structured, nonbiased contraceptive counseling and access to rapid referral for LARC insertion while control physicians provided usual care. Results were published in 20203 and demonstrated much higher rates of LARC uptake among women who were treated by the trained GPs.1

This 3-year longitudinal follow-up of ACCORd included women seen by the intervention group of clinicians ACCORd family physicians who had completed a survey 12 months after LARC insertion.

The primary outcome was continuation of LARC versus non-LARC methods; secondary outcomes included contraceptive method choice, satisfaction with the choice, and rates of unintended pregnancy and abortion.1

Outcomes

LARC uptake and continuation. At 3 years after intervention, 41% of women in the intervention group continued using LARC, compared to 28% in usual care.

OC continuation. Among those initiating LARC within 6 months, 66% sustained use at 3 years, above the 55% continuation rate for oral contraceptives.

IUD continuation. Continuation rates for hormonal IUDs were highest at 80%, with copper IUDs at 69% and implants at 46%. These results, consistent with international trends, validate the provider-centered approach.

Unintended pregnancy and procedure rates. The 3-year incidence of unintended pregnancy was reduced by half in the intervention group compared to the standard care group (3.1% vs 6.3%), and abortion rates dropped (0.9% vs 3.6%).

User satisfaction and method preferences. Eighty-two percent of LARC users were “very satisfied,” compared to 63% for oral contraceptive users. Hormonal IUDs led satisfaction ratings (86%), followed by copper IUDs (78%) and implants (72%).

IUDs predominated in the intervention group, while implant use was higher in controls, reflecting patient and provider differences that support flexible counseling tailored to preference.1

Navigating Barriers

Costs for LARC insertion and limited access to trained providers remain persistent obstacles, the authors pointed out. Most contraceptives other than copper IUDs receive subsidies in Australia, yet many GPs still refer women to specialist clinics for IUD placement. The authors acknowledge these structural challenges but note that the study's success in metropolitan Melbourne suggests similar interventions could work in other healthcare systems, even those without comprehensive contraceptive coverage.1

Among the study's limitations, thought noted as minor, the authors acknowledge the geographic scope and limited data completeness; sensitivity analyses showed results remained stable overall, they explained. 1

Investigators reiterate that ACCORd’s 3-year data provide strong evidence that structured counseling and efficient referral systems in primary care can improve contraceptive continuation and satisfaction while reducing unintended pregnancy. The concluded that broader implementation will require attention to structural barriers and local adaptation. For clinicians and health leaders, ACCORd signals a pragmatic, evidence-driven path to improving reproductive health in everyday practice.1

References

1. Mazza D, Assifi AR, McGeechan K, et al. Increasing the uptake of long-acting reversible contraception through family practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomized controlled trial 3-year follow-up. Am J Obstet Gynecol. 2025;233:299.e1-7. doi:10.1016/j.ajog.2025.03.020

2. Rowe H, Holton S, Kirkman M, et al. Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey. Aust N Z J Public Health. 2016;40:104–9. doi:10.1111/1753-6405.12461

3. Mazza D, Watson CJ, Taft A, et al. Increasing long-acting reversible contraceptives: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomized trial. Am J Obstet Gynecol. 2020;222:S921.e1-13. doi: 10.1016/j.ajog.2019.11.1267