Safe and reliable methods of contraception are important. They increase socioeconomic opportunities for women. Unintended pregnancies and births can also have significant negative consequences for mental and physical health, potentially leading to depressive episodes and unsafe abortions. Contraception can help prevent unintended pregnancies and thus mitigate these issues. It is therefore important to understand contraceptive use among women and we aim to do this by analysing patterns of contraceptive prescriptions within UK primary care.
In the UK, many different types of contraceptives are offered on prescription from GP surgeries. This data is contained within the CPRD GOLD and Aurum databases, alongside other relevant information such as ethnicity, socioeconomic status, and geographic region. By using this information, we aim to discover the types of contraceptives being prescribed to women in the UK and determine if there are any differences between difference groups of women. This will inform future studies investigating barriers to contraception and pregnancy both within CPRD data and in the wider academic field.
The CPRD GOLD and Aurum databases provide information on contraceptives prescribed in primary care. But many contraceptives are prescribed through specialist health clinics or purchased in retail and so not captured in CPRD GOLD or Aurum. A further aim of this study is to gain a better understanding of the limitations of CPRD GOLD and Aurum data in this regard.
Hormonal, and other medical, contraceptives provide reversible fertility management and therefore give women control of this important aspect of their lives. Access, and lack of access, to contraception have been recognised as important determinants of the opportunities available to women in developing countries and the patterns of inequality across and within those countries. Less work has been done on these problems in developed nations, though the existence of inequality and social exclusion are again obvious.
The CPRD Aurum and GOLD datasets capture primary care prescriptions along with many other details of people's lives. They cover a substantial proportion of the UK population over the last 20 years, and, in England, are linked to further information on measures of socioeconomic deprivation and whether individuals live in rural or urban environments. In this study, we will use linkages to Hospital Episode Statistics Admitted Patient Care, patient level Index of Multiple Deprivation and Rural Urban Classification data.
There are limits to these data, including that prescriptions written in specialist clinics and services are not currently captured. Despite this, the datasets contain a large amount of information that will allow both investigation of patterns in the available data and comparisons with other sources of information to assess biases.
The aim of this project is to identify differences in region, age, socioeconomic status, parity and ethnicity in the use of prescription contraceptives (e.g., the combined pill, intra-uterine devices/systems, implants and patches), and to look at how all these have changed over the period from first prescription to present. The main analyses will be generalised linear models, looking at the numbers and proportions of individuals prescribed to. Its main purpose is descriptive: to provide baseline information for future studies, and to assess completeness of data in CPRD GOLD and Aurum through comparison with external data sources.
Contraceptive product prescribed, broken down by category (injectables, pills, intra-uterine devices and systems, implants, patches, and non-hormonal contraceptives); number of contraceptive products prescribed in 12-month periods; incidence, duration, and prevalence, and variability of use. All stratified by: age; socioeconomic status; ethnicity; geographic location; gender, number of previous pregnancies, year of prescription.
Mike Lonergan - Chief Investigator - CPRD
Mike Lonergan - Corresponding Applicant - CPRD
Eleanor Axson - Collaborator - CPRD
Helen Booth - Collaborator - CPRD
Karen Cuenco - Collaborator - The Gates Foundation
Martin Holding - Collaborator - CPRD
Preeti Datta-Nemdharry - Collaborator - MHRA
Sergey Feldman - Collaborator - The Gates Foundation
2011 Rural-Urban Classification at LSOA level;2011 Rural-Urban Classification at LSOA level;CPRD Mother-Baby Link;HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;Pregnancy Register