“For most women,” wrote American Democratic politician Louise Slaughter, “contraception is not an option: it is basic healthcare necessity.” Certainly, for many, taking the pill every day is as elementary—and as effective—as remedying a headache with aspirin. Yet just half a century ago, such measures were not available.
The contraceptive pill was first approved in the United States in early May of 1960, and reached the United Kingdom and New Zealand the following year. It was the reliable and safe method that women had been waiting for, and was readily adopted by those who could access it. Now, it’s widely available and heavily subsidised—but by no means has it resolved all of New Zealand’s issues with contraceptive health. In fact, many within the public health sector consider that these are still not being adequately addressed.
Prior to its introduction in New Zealand, women had been doing whatever possible to plan and space the births of their children. The methods used, which included the use of a diaphragm, which was often poorly-fitted; the ‘rhythm’ method; condoms; and withdrawal, were often ineffective, and as a result, the rate of self-abortions was high. The McMillan Inquiry of 1937 found that at least one pregnancy in five ended in abortion, and that the majority of women dying were married with four or more children.
“People have always used whatever’s been available,” says Dame Margaret Sparrow. Sparrow, now President of the Abortion Law Reform Association of New Zealand, has had an active role in promoting safe sexual practices, as well as the use of contraception. She was one of the first women in New Zealand to use the pill, and said in Helen Smyth’s book, Rocking The Cradle: Contraception, Sex and Politics in New Zealand, that it changed her life: “That was the first time that I ever really experienced good fertility control.”
Certainly, it’s hard to exaggerate the impact that the pill had on women’s lives. “They truly saw it as liberating,” says feminist and women’s health campaigner Sandra Coney. “And they enjoyed the chance to be sexual and to choose sexual partners, not guarding their virginity while lining men up for marriage… and the fear of pregnancy, which had been such a great constraint, was removed.”
In Rocking The Cradle, Smyth wrote that within just five years of its introduction to New Zealand, 40 per cent of married, fertile women were on the pill, equating to some 100,000 packets a month. Today, the pill is taken by more than 100 million women worldwide, and a wide range of contraception is easily attainable in most developed countries. It’s inconceivable—if you’ll excuse the pun—that women once had to struggle to obtain access to the pill, even after it had been made legal.
All the single ladies, put a ring on it
New Zealand—the first country to grant women the vote–was among the first to introduce the pill, but it did so unwillingly. For the decade following its introduction, the pill was largely prescribed only to married women, and while this had an immediate impact on the rate of self-abortion among that group, there was no mind giving to the huge number of unmarried women who were struggling to avoid falling pregnant.
“[The introduction of the pill] had a huge impact, except it took a while to catch on, because doctors were very reluctant to prescribe it,” remembers Sparrow. “There was even a statement from the New Zealand Medical Association, saying that doctors shouldn’t prescribe the pill to unmarried women because of moral objection.”
This didn’t deter Sparrow, who worked at Victoria University’s Student Health Services between 1969 and 1981—over which period, attitudes towards sexual health changed a great deal. She modestly allows that she was “instrumental” in ensuring access to contraception for students.
“I saw that as one of my roles, and that was why I became involved at Family Planning, so that I could give students a better service,” she remembers. “I think when you’re sitting in a consultation room and students come to you, it does push you to think—well, why shouldn’t I prescribe it?”
Sparrow also wrote articles for Salient on services such as pregnancy testing and emergency contraception, “just to let students know that they could come to Student Health for contraceptive advice”.
Sympathetic doctors such as Sparrow were godsends for unmarried women seeking access to the pill and, as Smyth writes, many women were prepared to go to great lengths to do so. Many women bought themselves engagement and wedding rings in order to coax their doctors into writing them a prescription. Family Planning found what Chief Executive Jackie Edmond describes as “a more pragmatic way” of resolving the issue.
“We used to give them things to put on their finger when they came to see us,” Edmond says with a wry smile.
The momentum of the women’s movement
Thanks to the efforts of individual doctors who understood that contraception was indeed “a basic healthcare necessity”, the pill became more accepted and accessible in the 1970s. Lynda Williams, coordinator of the Auckland Women’s Health Council, says that that decade’s women’s liberation movement was an important milestone.
“During the 1970s, there was more pressure to make the pill more widely available to young women, because this was when the feminist movement finally reached New Zealand,” she says. “We had consciousness-raising groups getting involved with menstrual extraction techniques; looking at their cervices; reclaiming knowledge of their own bodies…
“The expectation that the pill would be made more readily available started to impact on the medical profession, and I think they were slowly forced to become a lot more liberal, instead of trying to impose their own beliefs—religious or otherwise—on women.”
Certainly, Coney says, “It didn’t take much to change women’s ideas.” She asserts that the women’s liberation movement began as a “reaction against the homebound role of our mothers, and the expectation that we would simply leave school and marry.
“Contraception was embraced as a tool to allow this freedom to make life choices that were not dictated by biology and social expectations.”
Feminist groups began to promote the formerly taboo topic of sexual education. As part of Knowhow, Coney gave out leaflets on safe sex practices at the gates of schools, and ran a telephone advice group.
“It wasn’t just women’s lib, though these ideas were promoted and explored through writing, discussions, abortion law reform, workshops and so on,” she remembers. “There was a workshop on how to masturbate at the 1979 United Women’s Convention.”
The difference 50 years makes
Sparrow agrees that today, contraception must constitute a significant percentage of the work of Victoria’s Student Health Services. “Times have changed!” she says.
Edmond suggests that modern women—and even those of her generation (“I’m 47, and all my sexual reproductive years, I’ve had access to services and contraception. I’ve never even had to consider that I wouldn’t… and same for you, though I’m slightly older than you.”)—tend to take these services for granted. Contraception is available from most chemists, general practitioners and public health services, and in most cases, it is subsidised for people under 22 years old. While most acquiesce that it is preferable that teenagers use contraception than have unplanned pregnancies, there are small but vocal (“Very vocal!” interjects Edmond) groups that think otherwise.
“We’re constantly being accused by groups such as Family First and Right to Life, and [New Zealand Herald columnist] Garth George,” sighs Edmond. “All we’re doing is offering the same services as any GP offers—we just talk about it a bit more.
“They’re trying to take things back to how they were, but in fact it wasn’t that good. All this stuff was happening in the background: people were getting pregnant when they didn’t want to be, then. I think it’s all a bit idealistic really.”
Despite the efforts of groups such as Family Planning, New Zealand has the third highest rate of teenage pregnancy of the 31 developed countries recognised by the Organisation for Economic Cooperation and Development (OECD). The result is reminiscent of a report recently prepared for the Ministry of Health by the Public Health Advisory Committee, which showed that among the most deprived neighbourhoods, New Zealand’s rate of infant mortality is worse than that of all developed countries bar Mexico and Turkey. Evidently, the discrepancy between New Zealand’s richest and its poorest is immense.
Williams points out that the OECD figure of teenage pregnancies is misleading because “there are specific ethnicities that are overrepresented in these figures”—as, she says, both the Maori and Public Health Advisory Committee have attested to.
“At a board meeting I was at two weeks ago, we were told that a certain age group—up to, I think, 25-years-old—something like one in five Maori women were getting pregnant,” she says. “The figure was so staggering that the board asked that it be checked.
“There are a lot of factors involved,” continues Williams. “There’s alcohol, there are heavy religious and cultural norms about not talking about contraception and sexuality. And Pacific women, even those that are married, tend not to have much control over their own fertility.”
Edmond says that Faming Planning has “still got a lot of work to do” before the issue of unplanned teenage pregnancies is addressed.
“I think young women continue to struggle to negotiate condom use—and that’s a challenge even when you’re my age, let alone when you’re 16 or 17,” she says. “Alcohol, too, has had a huge impact on decision making and doing things at haste, then repenting at leisure. We haven’t been really very good at getting the message out that young women should be using contraception as well as condoms.”
In a bid to tackle the problem, the Auckland District Health Board enabled women aged under 25 years old to access the emergency contraceptive pill (ECP) for free, as part of a five-month trial that started at the end of 2009. A preliminary evaluation of the scheme last year found a 13% reduction in the number of abortions at the Epsom Day Unit, the region’s principal abortion clinic, while last month The Manawatu Standard reported an increased demand in the ECP. However, the Auckland DHB decided that these figures were not able to be considered “statistically significant”.
“I have argued vociferously that [the ECP be made free permanently], as it would save money, but the Board is financially strapped,” says Williams. “They’ve put it on their list of priorities, but there is no talk of it coming in for the next wee while.
“We still have very conservative people around. There are one or two [men] on the Board who would vote against it.”
Women’s Health Action Trust’s policy advisor Christy Parker considers it a “shame” that the DHB has decided not to continue with the scheme.
“We strongly support increasing the accessibility of emergency contraception, and see accessing it as a fundamental sexual and reproductive right,” she says. “Our argument would be that a five month trial was too short a time period to demonstrate the success of such an intention.”
Areas for improvement
Although it seems that it will be some time before the ECP is made free of charge, there has been some development in the range of contraception available. 3 News reported in early June that the government’s drug-buying agency Pharmac intends to fund the long-acting reversible contraceptive Jadelle. Once implanted, Jadelle offers contraceptive coverage for five years, although it can be easily removed from a woman if she decides to change contraceptive, or try to conceive. Usually $300, it will be available free, bar the cost of a doctor’s visit and a dispensing fee, and Pharmac expects that some 35,000 women will take it.
“It’s one of our claims to fame,” says Edmond, visibly excited. “We’ve been advocating [for it] for two years, so we’re thrilled—we don’t get many wins.
“The pill relies on a human factor, and we’re all human, we forget… which is why we’re so keen on Jadelle. It’s really going to offer another option for young women.”
Although it is a long-term contraceptive, it remains to be seen just how effective the Jadelle will be in reducing the rate of teenage pregnancies, although Williams says she’s unsure of the number of Maori and Pacific teenagers that use services such as Family Planning. In order to ensure that sexual education and services are more wide-reaching, Williams would like to see Family Planning have direct access to schools.
“If I could wave a magic wand, I would insist upon government funding for Family Planning to offer comprehensive education on sex and contraceptive options in high schools,” she says. “The government needs to put a whole programme in place that looks at dealing with all of these issues, rather than [taking] a piecemeal approach.”
Parker cites a “damning” report from the Education Review Office into sexual education in schools, released June 2007. She describes it as a “really horrifying read”.
“Although we have quite a good sexuality education curriculum, it really wasn’t being implemented in practice in schools, and I’m not convinced we’ve seen any effective response to that yet,” she says. “I guess we feel that we’re really failing our young people in terms of sexual education.”
Parker says that sexual health education is not being approached in a “nationally coordinated and consistent fashion”, and that it’s a huge problem.
“It’s not about the birds and the bees, or pointing to an anatomy diagram. We see the need for quite a holistic framework around sexual education that integrates sexuality as part of the whole person.”
Sparrow also believes that sexual education is an area that needs immediate improvement. She hotly agrees that the government was shirking its responsibilities when it comes to issues of sexual education and contraception.
“My impression is that it’s quite patchy, and although some schools do take responsibility, it’s probably a little bit too little and too late—and often not relevant to the big questions that young people really want to know.”
What does Family Planning want to see implemented over the next five to ten years?
“We want comprehensive sexual education in schools, and we’d love to see more programmes for parents to learn more about talking about sexuality and sex,” says Edmond immediately, ticking them off one by one. “We would like to see a range of services for young people to access their sexual health, while keeping up-to-date with any new contraception out there.
“Public health programmes that push the use of condoms and contraception. More discussion around drinking and its impact on decision making. And programmes on gender-based violence and coercion.
“So we don’t want much!” she jokes.
“The other thing we’re saying is not universally liked, but you should be enjoying having sex; it should be a pleasurable activity,” says Edmond. “If you don’t want to have it, don’t have it. Don’t do it because you think you should do it: do it because you want to…
“People don’t like it, but I think it’s a good message. It’s pragmatic.”
Controversy aside, contraception is about choice. Being well-informed and aware of the options available enables a woman to make a decision that suits her and her individual needs. With the assortment available, it’s strange to consider that not so long ago, there wasn’t much of a selection to choose from. Who knows what changes to contraception and sexual health services the next half-century will bring about, but what can be counted upon is this: groups such as Family Planning will work to bring about the best and most convenient service possible.