JMIR Publications

ABSTRACT

Background:

Prescribed contraception is used worldwide by over 400 million women of reproductive age. Monitoring contraceptive use is a major public health issue that usually relies on population-based surveys. However, these surveys are conducted on average every 6 years and do not allow close follow-up of contraceptive use. Moreover, their sample size is often too limited for study of population subgroups. Health administrative data could be an innovative and less costly source to study contraceptive use.

Objective:

We aimed to explore the ability of health administrative data to study prescribed contraceptive use and compared these data with observations based on survey data.

Methods:

We selected all women aged 15-49 years, covered by French health insurance and living in France, in the health administrative database (n=14,770,256) and in the last French population-based survey (n= 4,285). In health administrative data, contraceptive use was recorded with detailed information on the product delivered, whereas in the survey it was self-declared by the women. In both sources, prevalence of contraceptive use was estimated globally for all prescribed contraceptives and by type of contraceptive: oral contraceptives, IUDs and implants. Prevalences were analyzed by age.

Results:

There were more economically disadvantaged women in health administrative data than in the population-based survey (11% vs. 7%, respectively, P<.001). In administrative data, 48% (95% CI: 48-48%) of women aged 15-49 years used a prescribed contraceptive vs. 51% (95% CI: 49-52%) in the population-based survey. Considering prevalences by type of contraceptive in administrative data vs. survey data, they were 27% (95% CI: 27-27%) vs. 28% (95% CI: 26-29%) for oral contraceptives, 18% (95% CI: 18-18%) vs. 20% (95% CI: 19-21%) for IUDs, and 3% (95% CI: 3-3%) vs. 3% (95% CI: 3-4%) for implants. In both sources, the same overall tendency in prevalence was observed for oral contraceptives, IUDs and implants. Implants remained little used at all ages with a peak around 5% at 20-24 years, oral contraceptives were highly used among young women with a peak around 40% at 20-24 years, whereas IUD use was low among young women and levelled at around 30% among women aged 35-44 years.

Conclusions:

Using health administrative data, the prevalence of contraceptive use was estimated by type of contraceptive. Compared with survey data, the same overall tendency was found for oral contraceptives, IUDs and implants. One of the main strengths of health administrative data is the high quality of information on contraceptive use and the large number of observations, allowing studies of subgroups of population. Health administrative data therefore appear as a promising new source to monitor contraception in a population-based approach. They could open new perspectives for research and be a valuable new asset to guide public policies on reproductive and sexual health.