Proactive approach to teenage contraception needed - researchers

The current system for providing teenagers with contraception is not working and should be replaced with a proactive approach, University of Otago researchers say.

In a paper, Proactively Providing Contraception to New Zealand Adolescents, led by Dr Rebecca Duncan, researchers say New Zealand’s high adolescent pregnancy rates are influenced by limited access to contraception.

In 2013, New Zealand had 23.8 births per 1,000 women aged 15 to 19, second only in the developed world to the United States.

“Our adolescent rates of effective contraception stack up poorly against our overseas counterparts, more than 93 per cent of adolescent pregnancies are unintended, and consistent contraceptive use amongst sexually active adolescents in New Zealand has actually decreased since 2001,” Dr Duncan says.

“The current system is not working, and the consequences for those it fails are life-changing.”

Current provision of contraception to New Zealand adolescents is reactive, rather than pro-active and does not focus on long-acting reversible contraceptives, such as implants and intrauterine devices, which are 22 times more effective than oral contraceptive pills, she says.

Some 40.5 per cent of New Zealand teenagers aged between 17 and 19 have had intercourse, but only 52 per cent of sexually active adolescents use contraception consistently.

Dr Duncan says a system where doctors and health professionals proactively offer long acting reversibly contraceptives would break down the stigma for teenagers seeking contraception and would overcome many of the barriers currently limiting access.

“Medical professionals can and often do bring up the topic of contraception, but they have no requirement to do so. For a medical professional to broach the topic would require the teenager to make an appointment in the first place, and there are barriers such as financial cost, transport, shame, and opportunity cost that prevent teenagers getting in the door.

“Once the teenager is in the door and in front of a medical professional, often the onus is on the teenager to start the conversation about what they want, and if they are not aware of all options they are only offered contraceptive methods familiar to the provider.”

Ideally this system – which would proactively offer confidential and free consultations to all adolescents, regardless of sexual activity - would also result in “increased contraceptive uptake and reduced incidence of unintended teenage pregnancy”.

“Proactively providing contraception would serve to increase contraceptive health literacy amongst adolescents and would give adolescents greater control of their reproductive and sexual health.

“For those who are at risk of pregnancy, access to good contraception allows adolescents to grow and learn with a reduced risk of unintended pregnancy, which can have a major impact on one’s life course. For those who are not at risk of pregnancy, the proactive contraception model would also provide education and an avenue for discussions about sexual health.”

Dr Duncan is aware the model may not be welcomed by all.

“There are always challenges in healthcare implementation, but we foresee two immediate challenges – public opinion and planning. We don’t believe public opinion should prevent efforts to improve access to essential healthcare, but healthcare - like all public services - is not immune to politics and public debate. We hope others will see that this is simply a concept with the goal of removing barriers to what the World Health Organization considers to be essential healthcare.”

The paper will be published in the Australian and New Zealand Journal of Obstetrics and Gynaecology on Tuesday.