Training primary care physicians to deliver structured contraceptive counseling and streamlined referrals was associated with greater use and persistence of long-acting reversible contraception (LARC) among Australian women, according to 3-year findings from the Australian Contraceptive ChOice pRoject (ACCORd).1
In Australia, approximately 40% of pregnancies are unintended, and one-third result in abortion.2 The burden is particularly high among younger women and those outside metropolitan regions. LARC methods—including hormonal and copper intrauterine devices (IUDs) and contraceptive implants—offer effective, long-term prevention.1
Key takeaways:
- Training family physicians in structured contraceptive counseling and rapid LARC referral increases long-acting contraception use.
- Women who chose LARC had higher continuation rates at 3 years compared with oral contraceptive users.
- Satisfaction was significantly higher among LARC users than oral contraceptive users.
- The intervention was associated with lower rates of unintended pregnancy and abortion over 3 years.
- Scaling the ACCORd model in primary care could improve reproductive health outcomes and reduce health care costs.
"Despite evidence indicating the high effectiveness and reversibility of LARC... it is estimated that only 10.8% of women aged 15 to 44 years are currently using LARC in Australia," wrote investigators.
Key findings
- Higher use: 41% of women in the intervention group used LARC at 3 years, compared with 28% in the control group.
- Greater continuation: Two-thirds of women using LARC at 6 months were still using it at 3 years, compared with 55% of oral contraceptive users.
- Higher satisfaction: 82% of LARC users reported being very satisfied vs 63% of pill users.
- Fewer unintended pregnancies: 3.1% of the intervention group reported an unintended pregnancy vs 6.3% of controls.
- Lower abortion rates: 0.9% of the intervention group underwent abortion vs 3.6% of controls.
Study design and intervention
The ACCORd trial was developed to increase LARC adoption in primary care by addressing barriers related to counseling, referral, and access. Physicians randomized to the intervention group received training on structured contraceptive discussions that provided balanced, standardized information on all methods, emphasizing efficacy and safety.
They were also given access to an online referral platform for quick scheduling of LARC insertions. Physicians in the control group received no additional training or tools.
Previous 12-month results from the ACCORd trial showed that women counseled by trained physicians were more likely to choose and continue LARC, with higher satisfaction compared with those using short-acting methods. The new 3-year analysis examined whether these differences persisted over time.
Participants and follow-up
The follow-up study, approved by the Monash University Human Research Ethics Committee, invited participants from the original trial who had not withdrawn at 12 months to complete an online survey. The questionnaire assessed contraceptive use, satisfaction, and pregnancy outcomes 3 years after enrollment.
Among 705 eligible women, 531 completed the survey—229 from the intervention group and 302 from the control group. Baseline demographics, including age and parity, were similar across groups, with most participants under 35 years and nulliparous.
Contraceptive continuation and satisfaction
At 3 years, LARC use remained greater in the intervention group (41%) than in the control group (28%; OR, 1.75; 95% CI, 1.10–2.80; P = .019). Of participants who initiated LARC within 6 months of the trial, 66% continued use at 3 years, compared with 55% of oral contraceptive users (OR, 1.63; 95% CI, 1.06–2.51; P = .027). Continuation rates were highest for hormonal IUDs (80%), followed by copper IUDs (69%) and implants (46%).
Satisfaction remained higher among LARC users, with 82% describing themselves as very satisfied, compared with 63% of oral contraceptive users (OR, 4.29; 95% CI, 1.79–10.27; P = .001). Among LARC methods, hormonal IUDs had the highest satisfaction (86%), followed by copper IUDs (78%) and implants (72%).
Between 12 months and 3 years, unintended pregnancies occurred in 3.1% of women in the intervention group and 6.3% of women in the control group (OR, 0.38; 95% CI, 0.16–0.86; P = .021). Abortions were reported in 0.9% and 3.6% of participants, respectively (OR, 0.10; 95% CI, 0.02–0.50; P = .0051).
Implications and economic impact
These findings suggest that brief, structured physician training paired with efficient referral pathways can have lasting effects on contraceptive behaviors. By improving patient counseling and facilitating timely access to LARC insertion, primary care clinicians can support more consistent contraceptive use and reduce unplanned pregnancies.
Economic analyses indicate potential cost savings. Prior modeling suggests that switching from oral contraceptives to LARC could save individual users $114 to $157 AUD annually, with system-wide savings projected at $68 million AUD over 5 years. Avoided costs related to abortion and miscarriage were estimated at $24.8 million AUD over the same period.
"However, the capacity of the ACCORd intervention to support the uptake and sustained continuation of LARC methods needs to be further explored in contexts without universal health coverage or where specific sexual and reproductive health services are not accessible or available," wrote investigators.
References
- 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
- 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(2):104-9. doi:10.1111/1753-6405.12461
