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Contraceptive use is often compromised for women living with violence. 

Contraceptive options that are safe and appropriate for one woman may not work for another. If you're working with women experiencing violence, it's important to explore each woman’s unique circumstances and draw on her own knowledge to assess the degree of comfort and safety with her contraceptive options.

Important factors to consider include whether the perpetrator is likely to:

  • Monitor the woman’s Medicare or prescription records through her MyGov account;
  • Restrict or monitor access to health care professionals;
  • Monitor menstruation and fertility patterns;
  • Engage in severe physical assaults;
  • Be actively searching for the use of contraceptive drugs or devices; and/or
  • Engage in rape and other forms of sexual assault.

The guide below is not intended to replace a full medical consultation with a professional, but does provide a starting point for thinking further about which contraceptive options might be safest and most appropriate given an individual patient's or client's circumstances.

You can download a full copy of this resource here. More information about each of these contraceptive options is available on our contraception information page

 


Method
Efficacy
Will someone else know I’m using it?
Could someone else tamper with it?
Hormonal IUD

(also called by its brand name, Mirena)

99.9%

 

The strings may be detectable but can be trimmed short by the doctor doing the insertion (although this may cause difficulties in removal). If the device is correctly fitted, the stem should not be detectable. Menstruation may be disrupted.

 

Could be forcibly removed, especially if the strings are not cut off at the opening of the cervical canal. 
Copper IUD

99%

 

The strings may be detectable but can be trimmed short by the doctor doing the insertion (although this may cause difficulties in removal). If the device is correctly fitted, the stem should not be detectable. Menstruation may be disrupted.

 

Could be forcibly removed, especially if the strings are not cut off at the opening of the cervical canal. 
Injection

(also called Depo or DMPA)

99% perfect use

94% typical use

 

The only signs of use are the injection site on the day of each injection, and the ceasing of regular menstruation. Medicare records of regular three-monthly doctor visits may be an issue for women experiencing high levels of surveillance or monitoring. 

 

Once injected it cannot be tampered with for that 12 week period.

Implant

(also called the rod, the bar, or by its brand name, Implanon)

99.9%

 

The bandaging post-insertion can make it obvious that it has been done, and it is possible to feel the rod at the insertion site. It is usually inserted in the upper arm but may be less detectable by others if it is inserted in another place, eg leg. 

 

It could be forcibly removed so may not be suitable in situations of more extreme violence. If it is cracked whilst in place it may shorten the life of the rod, so risk of damage due to physical violence or assault could be a consideration for some women. 
Sterilisation

(also called tubal ligation or occlusion)

99.5%

 

Depending on the method, there may be a need for incisions and anaesthesia, and/or a follow up at three months, which can make it hard to have it done discreetly. Menstruation is maintained. No ongoing signs of use once any incision scars are healed. 

 

It cannot be tampered with. 
Vaginal ring

(also called by its brand name, NuvaRing)

99% perfect use

91% typical use

 

Easily detected, although it can be removed for short periods of time (maximum three hours) without becoming less effective, so could be discreetly removed just before sex and reinserted immediately afterwards. 

 

Easily removed so may not be suitable for women who have little control over if, when or how sex happens. Emergency contraception may need to be accessed in these circumstances. 
Diaphragm

(also called the cap)

95%  perfect use

85% typical use

 

It may be detectable during sex, particularly by fingers but less so by penile penetration. It is fairly distinguishable in shape due to the lipped rim so may be obvious to others when not in use. 

 

 

Needs forward planning so may not be suitable for women who have little control over if, when or how sex happens.

Can be easily removed by another person before or during sex.

 

Condoms

98% perfect use

85% typical use

Female condoms vary from 80-95%

Condoms are one of the most obvious forms of contraception and need to be negotiated each time penetrative sex takes place.

The man can easily take control of putting on a male condom or removing a female condom so this method is very open to sabotage. Condoms can be damaged or removed, or the man may not put one on after promising to. 

Fertility awareness methods

Varies from 75 - 99% effective

 

Fertility awareness methods, when used properly, require record keeping about cyclical changes. These could be concealed in code in a diary or on a fertility app, but may still be risky for women experiencing high levels of monitoring and surveillance. 

 

Not suitable for women who have little or no control over if, when or how sex happens. Emergency contraception may need to be accessed in these circumstances. 
Combined oral contraceptive pill
99% perfect use

92% typical use

 

Pills in their packaging can be easily recognisable. They could be removed from their packaging and hidden elsewhere to reduce this risk, but this could alter their effectiveness if they’re hidden in places exposed to heat, light or moisture. 

 

Pills can be easily disposed of by anyone with access to them. Instructions about what to do if a pill is missed are easily available online if it’s unsafe to keep that information in printed form. 
Progesterone only pill

(often called the mini pill)

98% perfect use

92% typical use

 

Pills in their packaging can be easily recognisable. They could be removed from their packaging and hidden elsewhere to reduce this risk, but this could alter their effectiveness if they’re hidden in places exposed to heat, light or moisture. 

 

Pills can be easily disposed of by anyone with access to them. Instructions about what to do if a pill is missed are easily available online if it’s unsafe to keep that information in printed form. 
Withdrawal

96% perfect use

78% typical use

Because this method relies almost entirely on the man’s skill and motivation, they will have full knowledge of this form of contraception. 

 

Not suitable for women who have little or no control over if, when or how sex happens. Emergency contraception may need to be accessed in these circumstances. 

 

Last modified on: 22 May 2017
Contraception use for women living with violence
22 May 2017

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