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Our article How has contraceptive provision at Family Planning clinics in Aotearoa New Zealand changed between 2009, 2014 and 2019: a cross-sectional analysis, published in the 30 July issue of the New Zealand Medical Journal, noted that the full impact of the PHARMAC funding change to the intra-uterine system (IUS) could not be detected because of the timing of our research. This letter provides more recent data on IUS starts among Family Planning clients following the funding change.

Here we report de-identified administrative data (refer to our article for more information about research methodology and terminology) about the type of long-acting reversible contraceptive (LARC) start provided to Family Planning clients for three months (November–January) across four time-periods from November 2017 to January 2021. Three months of data, rather than a full year’s, are reported because of the impact of COVID-19 on the number of LARC starts in 2020 and 2021. While Family Planning continued seeing clients during COVID-19 lockdowns, the number of in-person consultations for LARC starts were fewer than under normal circumstances. We present the actual number of LARC starts by ethnicity and LARC starts as a proportion of all types of LARCs, but we have not conducted any further statistical analysis. The data are for observation; they are not formal research findings.

The data show that, since PHARMAC started funding IUS for contraception at the end of November 2019, there has been a large increase in IUS starts (Table 1) and IUS starts as a proportion of all LARC starts. The percentage increase of IUS starts from 2018/19 to 2020/21 is nearly 400% among Pasifika clients, 200% among Māori clients and about 140% among NZ European/Other. In contrast, the number of IUS starts remains relatively consistent when comparing the two periods prior to funding (2017/18 and 2018/19). It is interesting to note that our original research found a statistically significant reduction in intrauterine contraceptives (IUC) starts for Pasifika clients (25% to 19%) between 2009 and 2019, presumably because of the subsiding of the implant from 2010. Although these data show the greatest increase in IUS starts for Pasifika clients between 2018/19 and 2020/21, in 2020/21 Pasifika are still the ethnic group least likely to start an IUS compared to a copper intrauterine device (IUD) and implant. This information provides another example of the need for more information about factors influencing contraceptive decision-making by ethnicity.

Table 1: Number and proportion of LARC starts by type and ethnicity in four periods. View Table 1.

These data support the findings and conclusions in our originalresearch article, indicating that the cost of IUS was a barrier to access priorto the funding decision. However, it does not provide any other information aboutthe observed differences in contraceptive starts by ethnicity. As noted in the originalarticle, contraceptive starts are influenced by a range of factors, of which costis only one. For example, cost does not explain why Māori and Pasifika clients startimplants at much higher proportions than NZ European/Other clients in 2020/2021,since all LARCs are funded during this time.

Contraceptive starts are influenced by other factors, such asclient preference and clinician influence. For example: How does the lived experienceof contraception among family and friends impact contraceptive decision-making?How does clinician preference and/or unconscious bias impact the way that informationis delivered to clients? When considering equity in access to contraception forMāori and Pasifika people, thepotential impact of racism within the health sector cannot be ignored.[[1,2]]Further research is needed to fully understand the observed differences in contraceptivestarts by ethnicity.

As stated in the original research article, Family Planning datacannot be compared with data from other primary care providers because this informationis not collected consistently or comprehensively. This means policies on contraceptiveaccess in primary care are not currently based on evidence. Policies must enablepeople to choose the contraceptive type that works best for them by removing barriersto accessing contraception and also by protecting people against bias and coercion.[[3]]

Reproductive rights—the right to decide if and when to have achild and to have control of reproductive decision-making and fertility—is centralto wellbeing and self-determination, and any barriers to people exercising theserights fully should be identified and addressed.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Beth Messenger, MBBS FNZCSRH Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Amy Beliveau: MPH, Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Mike Clark: Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Caroline Fyfe: MPH, He Kainga Oranga, University of Otago Wellington, 23a Mein Street, Wellington, New Zealand. Alison Green: Ngāti Awa, Ngāti Ranginui, Te Whāriki Takapou, Raglan, New Zealand.

Acknowledgements

Correspondence

Amy Beliveau, Senior Policy and Research Advisor, Family Planning New Zealand

Correspondence Email

amy.beliveau@familyplanning.org.nz

Competing Interests

Beth Messenger, Amy Beliveau and Mike Clark report they are employees of Family Planning. Beth Messenger also reports she is Chair of the New Zealand College of Sexual and Reproductive Health, and that she was a member of the Ministry of Health National Contraception Guidelines Steering Group.

1) Waitangi Tribunal Te Rōpū Whakamana i te Tiriti o Waitangi. Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry - Wai 2575. Waitangi Tribunal Report 2019. Available from: https://forms.justice.govt.nz/search/Documents/WT/wt_DOC_152801817/Hauora%20W.pdf. Accessed 1 July 2021.

2) British Pregnancy Advisory Service (BPAS), Lancaster University, Decolonising Contraception, Shine Aloud UK. Long-acting reversible contraception in the UK. Available from: https://www.bpas.org/media/3477/larc-report-final-laid-up.pdf. Accessed 1 July 2021.

3) Cappello O. Powerful Contraception, Complicated Programs: Preventing Coercive Promotion of Long-Acting Reversible Contraceptives. Guttmacher Policy Review. 2021;24.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Our article How has contraceptive provision at Family Planning clinics in Aotearoa New Zealand changed between 2009, 2014 and 2019: a cross-sectional analysis, published in the 30 July issue of the New Zealand Medical Journal, noted that the full impact of the PHARMAC funding change to the intra-uterine system (IUS) could not be detected because of the timing of our research. This letter provides more recent data on IUS starts among Family Planning clients following the funding change.

Here we report de-identified administrative data (refer to our article for more information about research methodology and terminology) about the type of long-acting reversible contraceptive (LARC) start provided to Family Planning clients for three months (November–January) across four time-periods from November 2017 to January 2021. Three months of data, rather than a full year’s, are reported because of the impact of COVID-19 on the number of LARC starts in 2020 and 2021. While Family Planning continued seeing clients during COVID-19 lockdowns, the number of in-person consultations for LARC starts were fewer than under normal circumstances. We present the actual number of LARC starts by ethnicity and LARC starts as a proportion of all types of LARCs, but we have not conducted any further statistical analysis. The data are for observation; they are not formal research findings.

The data show that, since PHARMAC started funding IUS for contraception at the end of November 2019, there has been a large increase in IUS starts (Table 1) and IUS starts as a proportion of all LARC starts. The percentage increase of IUS starts from 2018/19 to 2020/21 is nearly 400% among Pasifika clients, 200% among Māori clients and about 140% among NZ European/Other. In contrast, the number of IUS starts remains relatively consistent when comparing the two periods prior to funding (2017/18 and 2018/19). It is interesting to note that our original research found a statistically significant reduction in intrauterine contraceptives (IUC) starts for Pasifika clients (25% to 19%) between 2009 and 2019, presumably because of the subsiding of the implant from 2010. Although these data show the greatest increase in IUS starts for Pasifika clients between 2018/19 and 2020/21, in 2020/21 Pasifika are still the ethnic group least likely to start an IUS compared to a copper intrauterine device (IUD) and implant. This information provides another example of the need for more information about factors influencing contraceptive decision-making by ethnicity.

Table 1: Number and proportion of LARC starts by type and ethnicity in four periods. View Table 1.

These data support the findings and conclusions in our originalresearch article, indicating that the cost of IUS was a barrier to access priorto the funding decision. However, it does not provide any other information aboutthe observed differences in contraceptive starts by ethnicity. As noted in the originalarticle, contraceptive starts are influenced by a range of factors, of which costis only one. For example, cost does not explain why Māori and Pasifika clients startimplants at much higher proportions than NZ European/Other clients in 2020/2021,since all LARCs are funded during this time.

Contraceptive starts are influenced by other factors, such asclient preference and clinician influence. For example: How does the lived experienceof contraception among family and friends impact contraceptive decision-making?How does clinician preference and/or unconscious bias impact the way that informationis delivered to clients? When considering equity in access to contraception forMāori and Pasifika people, thepotential impact of racism within the health sector cannot be ignored.[[1,2]]Further research is needed to fully understand the observed differences in contraceptivestarts by ethnicity.

As stated in the original research article, Family Planning datacannot be compared with data from other primary care providers because this informationis not collected consistently or comprehensively. This means policies on contraceptiveaccess in primary care are not currently based on evidence. Policies must enablepeople to choose the contraceptive type that works best for them by removing barriersto accessing contraception and also by protecting people against bias and coercion.[[3]]

Reproductive rights—the right to decide if and when to have achild and to have control of reproductive decision-making and fertility—is centralto wellbeing and self-determination, and any barriers to people exercising theserights fully should be identified and addressed.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Beth Messenger, MBBS FNZCSRH Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Amy Beliveau: MPH, Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Mike Clark: Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Caroline Fyfe: MPH, He Kainga Oranga, University of Otago Wellington, 23a Mein Street, Wellington, New Zealand. Alison Green: Ngāti Awa, Ngāti Ranginui, Te Whāriki Takapou, Raglan, New Zealand.

Acknowledgements

Correspondence

Amy Beliveau, Senior Policy and Research Advisor, Family Planning New Zealand

Correspondence Email

amy.beliveau@familyplanning.org.nz

Competing Interests

Beth Messenger, Amy Beliveau and Mike Clark report they are employees of Family Planning. Beth Messenger also reports she is Chair of the New Zealand College of Sexual and Reproductive Health, and that she was a member of the Ministry of Health National Contraception Guidelines Steering Group.

1) Waitangi Tribunal Te Rōpū Whakamana i te Tiriti o Waitangi. Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry - Wai 2575. Waitangi Tribunal Report 2019. Available from: https://forms.justice.govt.nz/search/Documents/WT/wt_DOC_152801817/Hauora%20W.pdf. Accessed 1 July 2021.

2) British Pregnancy Advisory Service (BPAS), Lancaster University, Decolonising Contraception, Shine Aloud UK. Long-acting reversible contraception in the UK. Available from: https://www.bpas.org/media/3477/larc-report-final-laid-up.pdf. Accessed 1 July 2021.

3) Cappello O. Powerful Contraception, Complicated Programs: Preventing Coercive Promotion of Long-Acting Reversible Contraceptives. Guttmacher Policy Review. 2021;24.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Our article How has contraceptive provision at Family Planning clinics in Aotearoa New Zealand changed between 2009, 2014 and 2019: a cross-sectional analysis, published in the 30 July issue of the New Zealand Medical Journal, noted that the full impact of the PHARMAC funding change to the intra-uterine system (IUS) could not be detected because of the timing of our research. This letter provides more recent data on IUS starts among Family Planning clients following the funding change.

Here we report de-identified administrative data (refer to our article for more information about research methodology and terminology) about the type of long-acting reversible contraceptive (LARC) start provided to Family Planning clients for three months (November–January) across four time-periods from November 2017 to January 2021. Three months of data, rather than a full year’s, are reported because of the impact of COVID-19 on the number of LARC starts in 2020 and 2021. While Family Planning continued seeing clients during COVID-19 lockdowns, the number of in-person consultations for LARC starts were fewer than under normal circumstances. We present the actual number of LARC starts by ethnicity and LARC starts as a proportion of all types of LARCs, but we have not conducted any further statistical analysis. The data are for observation; they are not formal research findings.

The data show that, since PHARMAC started funding IUS for contraception at the end of November 2019, there has been a large increase in IUS starts (Table 1) and IUS starts as a proportion of all LARC starts. The percentage increase of IUS starts from 2018/19 to 2020/21 is nearly 400% among Pasifika clients, 200% among Māori clients and about 140% among NZ European/Other. In contrast, the number of IUS starts remains relatively consistent when comparing the two periods prior to funding (2017/18 and 2018/19). It is interesting to note that our original research found a statistically significant reduction in intrauterine contraceptives (IUC) starts for Pasifika clients (25% to 19%) between 2009 and 2019, presumably because of the subsiding of the implant from 2010. Although these data show the greatest increase in IUS starts for Pasifika clients between 2018/19 and 2020/21, in 2020/21 Pasifika are still the ethnic group least likely to start an IUS compared to a copper intrauterine device (IUD) and implant. This information provides another example of the need for more information about factors influencing contraceptive decision-making by ethnicity.

Table 1: Number and proportion of LARC starts by type and ethnicity in four periods. View Table 1.

These data support the findings and conclusions in our originalresearch article, indicating that the cost of IUS was a barrier to access priorto the funding decision. However, it does not provide any other information aboutthe observed differences in contraceptive starts by ethnicity. As noted in the originalarticle, contraceptive starts are influenced by a range of factors, of which costis only one. For example, cost does not explain why Māori and Pasifika clients startimplants at much higher proportions than NZ European/Other clients in 2020/2021,since all LARCs are funded during this time.

Contraceptive starts are influenced by other factors, such asclient preference and clinician influence. For example: How does the lived experienceof contraception among family and friends impact contraceptive decision-making?How does clinician preference and/or unconscious bias impact the way that informationis delivered to clients? When considering equity in access to contraception forMāori and Pasifika people, thepotential impact of racism within the health sector cannot be ignored.[[1,2]]Further research is needed to fully understand the observed differences in contraceptivestarts by ethnicity.

As stated in the original research article, Family Planning datacannot be compared with data from other primary care providers because this informationis not collected consistently or comprehensively. This means policies on contraceptiveaccess in primary care are not currently based on evidence. Policies must enablepeople to choose the contraceptive type that works best for them by removing barriersto accessing contraception and also by protecting people against bias and coercion.[[3]]

Reproductive rights—the right to decide if and when to have achild and to have control of reproductive decision-making and fertility—is centralto wellbeing and self-determination, and any barriers to people exercising theserights fully should be identified and addressed.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Beth Messenger, MBBS FNZCSRH Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Amy Beliveau: MPH, Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Mike Clark: Family Planning New Zealand, Level 2, 205 Victoria Street, Wellington, New Zealand. Caroline Fyfe: MPH, He Kainga Oranga, University of Otago Wellington, 23a Mein Street, Wellington, New Zealand. Alison Green: Ngāti Awa, Ngāti Ranginui, Te Whāriki Takapou, Raglan, New Zealand.

Acknowledgements

Correspondence

Amy Beliveau, Senior Policy and Research Advisor, Family Planning New Zealand

Correspondence Email

amy.beliveau@familyplanning.org.nz

Competing Interests

Beth Messenger, Amy Beliveau and Mike Clark report they are employees of Family Planning. Beth Messenger also reports she is Chair of the New Zealand College of Sexual and Reproductive Health, and that she was a member of the Ministry of Health National Contraception Guidelines Steering Group.

1) Waitangi Tribunal Te Rōpū Whakamana i te Tiriti o Waitangi. Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry - Wai 2575. Waitangi Tribunal Report 2019. Available from: https://forms.justice.govt.nz/search/Documents/WT/wt_DOC_152801817/Hauora%20W.pdf. Accessed 1 July 2021.

2) British Pregnancy Advisory Service (BPAS), Lancaster University, Decolonising Contraception, Shine Aloud UK. Long-acting reversible contraception in the UK. Available from: https://www.bpas.org/media/3477/larc-report-final-laid-up.pdf. Accessed 1 July 2021.

3) Cappello O. Powerful Contraception, Complicated Programs: Preventing Coercive Promotion of Long-Acting Reversible Contraceptives. Guttmacher Policy Review. 2021;24.

Contact diana@nzma.org.nz
for the PDF of this article

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