Women urged to ditch the pill

SCOTTISH women will be advised to ditch the contraceptive pill in favour of longer-lasting and more reliable implants and injections, under a revolutionary change to family planning aimed at reducing the rate of unwanted pregnancies.

Around a quarter-of-a-million Scottish women aged 18-40 who currently use the pill will be told they should consider switching to "long-acting reversible" methods that last from three months to five years.

Only a tiny minority of Scottish women of child-bearing age currently use implants and injections. Health minister Shona Robison will launch the strategy next spring in a bid to cut the growing number of unwanted pregnancies which result in more than 1,000 abortions a month.

Ministers will spend about £270,000 a year publicising the new strategy which was welcomed last night by many doctors and sexual health specialists. But the campaign has also sparked controversy with experts warning it could exacerbate fertility problems among older women wanting to start families because normal fertility can take five or more months to return after some long-term contraceptives stop working.

The strategy is being launched as Scotland's abortion rate stands at a record high. There were 13,703 terminations carried out last year – an average of 38 per day. Forgetting to take a pill or using a condom incorrectly are common causes of unplanned pregnancies.

Just 4% of Scottish women aged 15-49 currently take long-acting contraceptives compared with around 23% who take the pill. A further 18% use condoms and this group will also be targeted in the campaign alongside those who use the patch, caps or diaphragms and women requesting emergency contraception.

The remainder are not using contraception, either because they or their partner have been sterilised, are not in relationships or are trying to conceive.

Last night a Scottish Government spokeswoman said: "The campaign will feature all types of long-lasting, reversible contraception – injections, coil and implants. The aim will be to reduce unintended pregnancies, because of the low failure rate and high reliability rates of these methods."

Robison added: "Knowledge is power and by increasing knowledge and providing better information people will be able to make more informed choices."

As well as advertising the options to women, it is expected that GPs and nurses will be urged to inform patients about long-acting contraceptives during family planning consultations.

The contraceptives concerned include Depo Provera, a hormone injection which offers three months of protection; Implanon, a small rod implanted into the arm which gives three years of protection; the coil; and Mirena, an intra-uterine device which lasts five years.

All cost less than £27 a year per patient compared with £29-£36 a year for some common contraceptive pills.

The pill generated huge social change during the 1960s by giving women control over their fertility for the first time.

However, it must be taken at the same time every day to ensure its effectiveness, making it prone to 'user-failure'. The failure rate of the pill at around 8% is much higher than the 1%-3% for long-acting alternatives.

Lorraine Mann, a sexual health promotion specialist at NHS Highland, said: "The advantage of long-acting methods is that once you have it you don't have to remember to take it every day or every time you have sex, and you will get called back to the surgery when you need to have it again. I very much welcome this development."

One Glasgow-based doctor said: "These long-acting methods are also seen as being reliable and cost effective. Most of these methods are suitable for women with medical conditions such as obesity, high blood pressure, migraines and previous deep-vein thrombosis who can't use the pill. We are seeing more and more fat people, it's becoming a significant problem."

But Dr Stuart Scott, deputy chairman of the British Medical Association's Scottish GP Committee, urged caution. He said: "There are political imperatives to prevent unwanted pregnancies so there are drivers from the Government to change that. But we need to be sure we are not forcing people to have a form of contraceptive they are not happy with, and that's certainly a risk."

One patient, a 35-year-old mother of two from Elgin, Moray, who asked not to be named, said she was deeply unhappy with her experience of taking Depo Provera and blames the drug for the fact she has failed to conceive a third child despite two years of trying.

She said: "I developed quite bad depression, and I put on over two stone even though I hadn't changed my eating or exercise habits. I have also been left with fertility difficulties. I was not warned of any of this when I was given the injection."

A spokesman for Pfizer, which makes Depo Provera, said there was no evidence it caused permanent infertility. He added: "Depo Provera is an option for patients, but has side effects that should be discussed with the patient by the doctor."

Bayer Schering Pharma, which manufactures Mirena, would not comment directly, but referred to its product information leaflet. Schering-Plough, which makes Implanon, did not return calls.