E Hine: access to contraception for indigenous Māori teenage mothers
Beverley Lawton 1 5 , Charrissa Makowharemahihi 1 , Fiona Cram 2 , Bridget Robson 3 , Tina Ngata 41 Women’s Health Research Centre, Department of Primary Care, University of Otago, Wellington, New Zealand
2 Director, Katoa Ltd, Auckland, New Zealand
3 Director, Te Ropu Rangahau Hauora a Eru Pomare, Department of Public Health, University of Otago, Wellington
4 Resource Development, Te Wānanga o Aotearoa, University of Otago Wellington
5 Correspondence to: Beverley Lawton, Women’s Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, PO Box 7343, Wellington 6242, New Zealand. Email: bev.lawton@otago.ac.nz
Journal of Primary Health Care 8(1) 52-59 https://doi.org/10.1071/HC15021
Published: 31 March 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Timely and equitable access to contraception enables teenage mothers to make informed choices about their sexual and reproductive health. This study aimed to identify barriers and facilitators to contraception for Māori teenagers who become mothers.
METHODS: ‘E Hine’ is a longitudinal qualitative Kaupapa Māori (by Māori for Māori) study involving Māori women (aged 14–19 years), following them through pregnancy (n = 44) and the birth of their babies until their babies’ first birthdays (n = 41). This analysis focusses on contraception access pre-and post-pregnancy.
FINDINGS: Pre-pregnancy most participants accessed contraception or advice. Contraception use was compromised by a lack of information, negative side effects, and limited follow up. All reported their subsequent pregnancies as unplanned. Participants gave considerable thought to post-pregnancy contraception. Despite this many experienced clinical and service delays, financial barriers, and negative contraceptive side effects. There was little focus on contraception initiation and a lack of integrated care between midwives and other primary care services, leaving many participants without timely effective contraception. The system worked well when there was a contraception plan that included navigation, free access, and provision of contraception.
CONCLUSION: The majority of participants actively sought contraception pre- and post-conception. Despite a publicly funded system, a lack of health sector integration resulted in multiple missed opportunities to meet the needs of these teenagers for effective contraception. Health service funding formulas should define the goal as initiation of contraception rather than advice and provide funding to improve timely access to long acting reversible contraception.
KEYWORDS: Indigenous teenage pregnancy; contraception; barriers to contraception; Māori mothers
References
[1] The return on investments in services for the urban poor. 6th International Dialogue on Population and Sustainable Development Meeting the challenge - Sexual and reproductive health and rights in an urbanising world; 2008; Berlin. Bayer Schering Parma AG.[2] Larkins SL, Page RP, Panaretto KS, et al. The transformative potential of young motherhood for disadvantaged Aboriginal and Torres Strait Islander women in Townsville, Australia. MJA 2011; 194 551–5.
| 21644911PubMed |
[3] Ministry of Health. Sexual and Reproductive Health Strategy: Phase One. Wellington: Ministry of Health, 2001.
[4] Clark TC, Robinson E, Crengle S, Herd R, Grant S, Denny S. Te Ara Whakapiki Taitamariki, Youth07: The Health and Wellbeing Survey of Secondary School Students in New Zealand. Results for Māori Young People. Auckland: The University of Auckland, 2008.
[5] Larkins SL, Page RP, Panaretto KS, et al. Attitudes and behaviours of young indigenous people in Townsville concerning relationships, sex and contraception: the “U Mob Yarn Up” project. MJA 2007; 186 513–8.
| 17516898PubMed |
[6] Clark T, Crengle S, Sheridan J, et al. Factors associated with consistent contraception and condom use among Māori secondary school students in New Zealand. J Paediatr Child Health 2014; 50 258–65.
| Factors associated with consistent contraception and condom use among Māori secondary school students in New Zealand.Crossref | GoogleScholarGoogle Scholar | 24372724PubMed |
[7] Crengle SCT, Robinson E, Bullen P, Dyson B, Denny S. et al. The health and wellbeing of Māori New Zealand secondary school students in 2012. Te Ara Whakapiki Taitamariki: Youth’12. Auckland: The University of Auckland, 2013.
[8] Clark TCFT, Bullen P, Denny S, Crengle S, Dyson B. et al. Youth’12 Overview: The health and wellbeing of New Zealand secondary school students in 2012. Auckland: University of Auckland, 2013.
[9] Ministry of Health. Well Child / Tamariki Ora National Schedule 2013. Wellington, 2013.
[10] Johnson AM, Mercer CH, Cassell JA. Social determinants, sexual behaviour and health. Oxford: Oxford University Press, 2006.
[11] Archibald L. Teenage pregnancy in Inuit communities: Issues and perspectives. Ottawa Pauktuutit Inuit Women’s Association, 2004.
[12] Eni R, Phillips-Beck W. Teenage pregnancy and parenthood perspectives of First Nation women. IIPJ 2013; 4 http://ir.lib.uwo.ca/iipj/vol4/iss1/3
| Teenage pregnancy and parenthood perspectives of First Nation women.Crossref | GoogleScholarGoogle Scholar |
[13] Lawton B, Cram F, Makowharemahihi C, et al. Developing a Kaupapa Māori research project to help reduce disparities experienced by young Māori women and their babies. AlterNative 2013; 9 246–61.
[14] Mason M. Sample Size and Saturation in PhD Studies Using Qualitative Interviews. 2010;
| 21605534PubMed |
[15] Saldana J. The coding manual for qualitative researchers. London: Sage, 2013.
[16] Swartzendruber A, Zenilman JM. A national strategy to improve sexual health. JAMA 2010; 304 1005–6.
| A national strategy to improve sexual health.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXhtFWjtLrP&md5=ff3e40b55c9b3bcafc238f04f5c8cd4aCAS | 20810379PubMed |
[17] American College of Obstetricians and Gynecologists Adolescents and long-acting reversible contraception: implants and intrauterine devices. Committee Opinion No. 539. Obstet Gynecol 2012; 120 983–8.
| Adolescents and long-acting reversible contraception: implants and intrauterine devices. Committee Opinion No. 539.Crossref | GoogleScholarGoogle Scholar | 22996129PubMed |
[18] Bitzer J. Oral contraceptives in adolescent women. Best Pract Res Clin Endocrinol Metab 2013; 27 77–89.
| Oral contraceptives in adolescent women.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXitFKmurg%3D&md5=209d27bda0909da61a7d5a048a3da494CAS | 23384748PubMed |
[19] Dalby J, Hayon R, Carlson J. Adolescent Pregnancy and Contraception. Prim Care Clin Pract 2014; 41 607–29.
| Adolescent Pregnancy and Contraception.Crossref | GoogleScholarGoogle Scholar |
[20] Faculty of Sexual and Reproductive Healthcare. Postnatal Sexual and Reproductive Health. England Royal College of Obstetricians & Gynaecologists, 2009.
[21] Makowharemahihi C, Lawton B, Cram F, et al. Initiation of maternity care for Maori women <20 years. NZMJ 2014; 127 52–61.
[22] Ministry of Health. Kōrero Mārama: Health Literacy and Māori. Wellington: Ministry of Health, 2010.
[23] Kickbusch IWS, Magg D. Navigating Health: The role of health literacy. In: Alliance for Health and the Future, ed.: International Longevity Centre-UK, 2005.
[24] Ministry of Health. Tatau Kahukura: Māori Health Chart Book, 2nd Edition. Wellington: Ministry of Health, 2010.
[25] Yee L, Simon M. The Role of Health Literacy and Numeracy in Contraceptive Decision-Making for Urban Chicago Women. J Community Health 2014; 39 394–9.
| The Role of Health Literacy and Numeracy in Contraceptive Decision-Making for Urban Chicago Women.Crossref | GoogleScholarGoogle Scholar | 24105614PubMed |
[26] AHRQ Health Literacy Universal Precautions Toolkit 2nd Edition. http://wwwahrqgov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/. Rockville,MD.: Agency for Healthcare Research and Quality.
