Editorial: World Contraception Day

26 September 2019

Opinion piece co-authored by Dr Celia Devenish, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Te Kāhui Oranga ō Nuku (NZ Committee) Chair, Jackie Edmond, Chief Executive, Family Planning and Dr Samantha Murton President, Royal New Zealand College of General Practitioners

Today is World Contraception Day
 
While contraceptive options and access have expanded for women globally during the past few decades, not all New Zealand women are reaping the benefits of what medicine has to offer. Women in New Zealand face multiple barriers to accessing the most effective methods of contraception. Access to contraception is linked to abortion – a topic under the spotlight since the introduction of the Abortion Legislation Bill.

The Growing Up New Zealand study found that about 40% of pregnancies are unplanned, and a more recent analysis suggests the figure is closer to 50%. While declining, New Zealand has high rates of teenage pregnancy compared to other OECD countries. Barriers to effective contraception are amplified for Māori and Pasifika women, young women and women on a low income, who already experience barriers to primary care services. 

There are two specific actions which could make a difference – universal funding and access for all contraceptive options, and a long term national strategy for reproductive and sexual health.

Today, the most reliable methods of contraception are called long-acting reversible contraceptives or LARCs. They are more cost-effective than the oral contraceptive pill and people using LARCs are 20 times less likely to have an unintended pregnancy. There are three different types of LARCs available – the implant, copper intra uterine device (IUD) and hormonal IUD. 

LARCs are inserted by a health practitioner, then remain in place for three to ten years, relieving women of further steps like taking a pill every day or getting a shot every three months.  They have higher continuation rates than shorter acting methods meaning that women are satisfied with them. Despite their effectiveness, LARCs are not a common method of contraception used in New Zealand. 


Dr Celia Devenish, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Te Kāhui Oranga ō Nuku (NZ Committee) Chair, Jackie Edmond, Chief Executive, Family Planning and Dr Samantha Murton President, Royal New Zealand College of General Practitioners


Assuming PHARMAC finalises its recent proposal to fund the hormonal IUD so it is available to all women, it is our view that it will have a significant and positive impact on rates of unintended pregnancy and women’s reproductive health. We applaud PHARMAC for this step forward. To date the hormonal IUD has not been funded, however, PHARMAC has proposed to fund two hormonal IUDs, Mirena and Jaydess, after years of requests from our organisations and other health professionals. With a cost of about $340 - $500, the hormonal IUD has been unaffordable for many. This has contributed significantly to inequitable reproductive health outcomes. 

There is a lack of national leadership to promote contraceptive choice and access. There has not been a national strategy for reproductive and sexual health since 2001. There is variable health professional knowledge of contraceptive options, and insufficient opportunities for professional training and development in this area. Increased provision of funded quality contraceptive services which offer LARCs as an option is needed. 

Without universal funding and promotion of the choices available, New Zealand women are unable to access the right contraception for themselves. And without better opportunities for professional training and development, the availability of health practitioners trained to offer the full range of contraceptive options presents an additional barrier.  

There was a time in our history when sex and contraception were taboo. Women discussed these issues in hushed conversations with those doctors known among social circles for managing them. It is now 2019 and it shouldn’t be acceptable that this area of primary health care continues to be significantly neglected. We must do more to realise the vision of annual World Contraception Day and strive to make every pregnancy one that is wanted.