# data[].attributes.body
1967 The development of contraceptive hormone-filled silastic capsules which could be implanted under the skin started in America.

1993 Norplant, consisting of six progestogen (levonorgestrel)- releasing rods, was introduced in the UK.

1999 Norplant discontinued. Introduction of single rod implant (Implanon) containing etonorgestrel.

2010 Nexplanon phased in to replace Implanon. This is the same as Implanon, except that Nexplanon is radio-opaque and the insertion procedure is different.

# data[].attributes.headline
Despite the implant being one of the most effective forms of contraception, currently only 2% of the UK population have the implant as their chosen form of contraception. The most popular contraceptive choices are the pill and the male condom.

# data[].attributes.subject
Despite the implant being one of the most effective forms of contraception, currently only 2% of the UK population have the implant as their chosen form of contraception. The most popular contraceptive choices are the pill and the male condom.

# data[].attributes.attachment_link.readable_text
As there are no comprehensive published health service statistics on patterns of contraceptive use in the UK, the main sources used in this factsheet are the Office for National Statistics (ONS) Omnibus Survey(1) covering Great Britain, and the Continuous Household Survey(2) covering Northern Ireland.
Contraception: patterns of use factsheet (PDF)
Contents

Great Britain

In 2006/07, three quarters (76 per cent) of women aged 16-49 in Great Britain used at least one form of contraception (see table 1). The most used methods were oral contraceptives, sterilisation and male condoms, but this varies by age group(1) (see table 2).

Oral contraceptives

The pill first became available in Great Britain in 1961 and its use increased rapidly. Between 1962 and 1969, the number of women using the pill rose from an estimated 50,000 to around one million(3) and in 2000 was about three and three quarter million.

Pill usage declines steeply with age, from two-thirds of women aged 20-24, to 11 per cent of women in their late 40s. Women over 35 who smoke should not take the combined pill, but there is no upper age limit for healthy non-smoking women with no medical contraindications. Misinformation among women and contraceptive providers can lead to age alone being given as a reason for not taking the combined pill.

An enormous number of studies have been published over the last 30 years into the benefits and possible adverse health risks of the pill. Studies on adverse health risks usually receive widespread publicity which can result in troughs in pill usage as women, worried by the reports, stop using the method(4,5,6).

In general, most women don't use the pill consistently through their lifetime, tending to stop and start according to their life circumstances, relationships and child bearing.

Condoms (male and female)

Before the pill became widely available in Great Britain, the most used contraceptive methods were condoms, withdrawal and diaphragms/caps. A survey of married women in 1967-68 showed that 47 per cent of women using any method were using condoms(7).

However, by 1983, more than twice as many women used the pill as used condoms (28 per cent compared with 13 per cent). Since then, increased awareness about sexually transmitted infections (STIs), including HIV/AIDS and the promotion of safer sex messages have led to increased condom use and by 2006/07, nearly a third of women (30 per cent) who were using contraception were using this method, sometimes in addition to another form of contraception. Condoms are not used only as a primary method of contraception and in the Omnibus Survey two fifths (43 per cent) of men aged 16-69 said they had used them in the previous year. While nine out of ten said they had used them to prevent pregnancy, nearly half said it was to prevent infection. 60 per cent of men and women said that they always used condoms. In the National Survey of Sexual Attitudes and Lifestyles (Natsal)(8) a quarter of men and one in five women reported consistent condom use in the past four weeks.

The female condom was introduced in the UK in 1992. 1 per cent of women use this method.

Sterilisation (male and female)

Male and female sterilisation have been available under the NHS for many years, although originally these would have been performed on medical grounds rather than by choice. The choice of sterilisation for contraceptive purposes alone became available in the early 1970s.

There is no centralised statistical collection of the number of sterilisation operations performed in the UK, as a large number are carried out privately. In 2005, over 18,000 female sterilisations and over 28,000 vasectomies were performed in NHS hospitals or clinics(9).

The proportion of couples where one or other has been sterilised has more than doubled since the early 1970s, and has remained around 10 per cent since 1986. In 2006/07, 12 per cent of women who used contraception had been sterilised, while 15 per cent relied on their partner's sterilisation.

Over half of couples aged 40 and over rely on sterilisation. This proportion has been steadily increasing over the last 20 years, particularly among women in their late 40s. Among couples in their 30s, there has been a drop in the number using sterilisation since the mid-1980s, reflecting the fact that more couples are delaying having children until their 30s.

Few younger people are sterilised. Clinical guidelines suggest additional care when counselling people under the age of 30 without children who request sterilisation, due to the possible increased incidence of regret(10).

When men aged 16-69 were surveyed separately(1) 17 per cent reported having had a vasectomy. This was more common in men aged 45-49 (33 per cent) than either younger or older men. The fact that only 22 per cent of men in their late 60s had had a vasectomy suggests that this is becoming more popular.

Long-acting reversible contraceptive methods

Long-acting reversible methods (LARC) include injections, implants, intrauterine devices (IUDs) and the hormonal intrauterine system (IUS). Use of these methods has remained relatively low over the last few years. In 2006/07, 14 per cent of women using contraception were using a LARC method. Guidance from the National Institute of Health and Clinical Excellence in 2005 stressed that these methods, which are more cost effective than oral contraceptives, should be offered to all women (11).

Research has shown that many health professionals are unwilling to prescribe LARC because they lack good information about, and experience of using these methods(11,12).

Other methods

Use of other methods remains relatively low. In the 2006/07 Omnibus Survey, 1 per cent of women using contraception used the patch,1 per cent caps or diaphragms, and 3 per cent natural family planning.

Emergency contraception

In 2006/07, 6 per cent of women in Great Britain had used emergency contraception at least once during the last year. The majority of these had used hormonal methods. Use of emergency contraception was highest in women in their twenties, 10 per cent of whom had used it at least once in the previous year.

Emergency hormonal contraception was licensed as a pharmacy product in January 2001, making it available without prescription to women aged 16 and over. The proportion of women who obtained the method from a pharmacy or chemist increased from 20 per cent in 2001/02 to 55 per cent in 2006/07, while fewer women obtained the method from general practice (35 per cent) or community contraceptive clinics (6 per cent).

(Due to the small sample size, the recent figures should be used with caution.)

Northern Ireland

Contraception was last included in the Continuous Household Survey in 2003/04(2) , when women aged 16-49 were asked about contraceptive use in the previous two years. 6 per cent had been sterilised, and 6 per cent had a partner who had been sterilised. The methods used by the remaining women who were not pregnant nor trying to get pregnant were: 40 per cent oral contraceptives, 26 per cent condoms, 6 per cent IUDs, 6 per cent injectables, 5 per cent natural family planning, and 2 per cent diaphragms.

11 per cent had used emergency contraception at least once in the previous two years. Two thirds of these (66 per cent) had obtained it from general practice, and a quarter (28 per cent) from community contraceptive clinics. Pharmacists are not mentioned as a source.

References

1 Lader D, Contraception and Sexual Health 2006-07 (London: Office for National Statistics, 2007).

2 Northern Ireland. Statistics and Research Agency. Central Survey Unit, Continuous Household Survey 2003/04 (Belfast: NISRA, 2004) Bulletin 3.

3 Wellings K, Trends in contraceptive usage since 1970, British Journal of Family Planning, vol 12, no 2 (1986), 15-22.

4 Thorogood M and Vessey M P, 'Trends in the use of oral contraceptives in Britain', British Journal of Family Planning, vol 16, no 2 (1990), 41-53.

5 Wellings K, 'Help or hype: an analysis of media coverage of the 1983 'pill scare''. British Journal of Family Planning, vol 11, no 3 (1985), 92-98.

6 Furedi F and Furedi A, The International Impact of a Pill Panic in the UK (London: Birth Control Trust, 1996).

7 Langford C, Birth Control Practice and Marital Fertility in Great Britain (London: Population Investigation Committee, 1976).

8 Johnson A et al, 'Sexual behaviour in Britain: partnerships, practices and HIV risk behaviours', Lancet vol 358, 1 December (2001), 1835-1842.

9 Information Centre, NHS Contraceptive Services, England 2006-07, (Leeds: IC, 2007).

10 Royal College of Obstetricians and Gynaecologists. Male and Female Sterilisation. Evidence Based Clinical Guidelines 4, (London: RCOG 2004).

11 National Collaborating Centre for Women's and Children's Health, Long-acting Reversible Contraception: the Effective and Appropriate Use of Long-acting Reversible Contraception (London: RCOG Press, 2005).

12 Wellings K et al, 'Attitudes towards long-acting reversible methods of contraception in general practice in the UK', Contraception, vol 76, no 3 (2007), 208-214.

Tables

# data[].attributes.attachment_link.title
Contraception: patterns of use factsheet

# data[].attributes.attachment_link.description
As there are no comprehensive published health service statistics on patterns of contraceptive use in the UK, the main sources used in this factsheet are the Office for National Statistics (ONS) Omnibus Survey(1) covering Great Britain, and the Continuous Household Survey(2) covering Northern Ireland.

# data[].attributes.body
All LARC methods are suitable for:

nulliparous women

women who are breastfeeding

women who have had an abortion – at time of abortion or later

women with BMI > 30

women with HIV – encourage safer sex Note 2013: for sub‑dermal implants, see section 1.5

women with diabetes

women with migraine with or without aura – all progestogen‑only methods may be used

women with contraindication to oestrogen

The Implant is not recommended for women taking enzyme‑inducing drugs

NICE (2014)

# data[].attributes.body
Long-acting reversible contraceptives, including
intrauterine devices and implants are the most
effective methods of reversible contraception. These
methods have multiple advantages over other
reversible methods. Most importantly, once in place,
they do not require daily or monthly dosing and their
duration of contraceptive action ranges from 3 to 5
years.

# data[].attributes.body
you may experience temporary side effects during the first few months, like headaches, nausea, breast tenderness and mood swings

your periods may be irregular or stop altogether

you may get acne or your acne might get worse

you'll need a small procedure to have it fitted and removed

it doesn't protect you against sexually transmitted infections (STIs), so you may need to use additional contraception (such as condoms) as well

# data[].attributes.body
It works for 3 years

it doesn't interrupt sex

it's an option if you can't use oestrogen-based contraception, such as the combined contraceptive pill, contraceptive patch or vaginal ring

it's safe to use while you're breastfeeding

your fertility will return to normal as soon as the implant is taken out

it may reduce heavy or painful periods

# data[].attributes.headline
How soon after the birth of my baby can I have the implant inserted?

# data[].attributes.subject
How soon after the birth of my baby can I have the implant inserted?

# data[].attributes.body
You can have the implant fitted any time after you've given birth.

If it's fitted on or before day 21 after the birth, you'll be immediately protected against becoming pregnant.

If it's fitted after day 21, you'll need to use additional contraception (such as condoms) for the next 7 days.

It's safe to use the implant while you're breastfeeding.

# data[].attributes.body
The implant is more than 99% effective.

Once the implant is in place, you don't have to think about it again for 3 years.

It can be useful for women who can't use contraception that contains oestrogen.

It's very useful for women who find it difficult to remember to take a pill at the same time every day.

The implant can be taken out if you have side effects.

You can have it removed at any time, and your natural fertility will return very quickly.

When it's first put in, you may feel some bruising, tenderness or swelling around the implant.

Your periods may become irregular, lighter, heavier or longer.

A common side effect is that your periods stop (amenorrhoea). It's not harmful, but you may want to consider this before deciding to have an implant.

Some medicines can make the implant less effective.

It doesn't protect against sexually transmitted infections (STIs), so you may need to use condoms as well.

# data[].attributes.attachment_link.authors[].name
Worcestershire Health and Care NHS Trust