New Zealand's Contraceptive Revolutions
by Ian Pool, Janet Dickson, A Dharmalingam, Sarah Hillcoat-Nalletamby, Kim Johnstone and Helen Roberts
Population Studies Centre, University of Waikato 1999
Dr Margaret Sparrow
New Zealand Family Planning Association
What are New Zealand's Contraceptive Revolutions? According to the authors of this monograph they are four in number.
(1) The shift from traditional to barrier methods of contraception. Traditional methods included abstinence, breastfeeding, withdrawal and avoiding intercourse at the presumed fertile time of the cycle, often called the rhythm method. Barrier methods included the diaphragm, cap. vaginal sponge, spermicides and condoms. Barrier methods were promoted by the New Zealand Family Planning Association formed in 1936, at a time when septic abortions were so common that a government enquiry was held to examine the problem.
The Family Planning Association faced much opposition from conservative sections of the community, from the Roman Catholic Church and from the medical profession. The first clinic was not opened until 1953. Traditional methods have never disappeared entirely and the rhythm method has been replaced by more scientific methods of natural family planning.
(2) The shift from barrier methods to hormonal methods. The most significant single event was the introduction of oral contraceptive pills in New Zealand in 1961. New Zealand women (only if married and their doctor approved) were among the first in the world to take advantage of this new method of birth control and together with the women of the Netherlands, they led the world in the proportion of women using the pill.
Strict abortion laws at that time meant that many women faced the difficult choice of having another unplanned birth, or an illegal or self-induced abortion, if their method of contraception failed. No wonder that a method that promised truly safe contraception had appeal - similarly with the controversial Depo-Provera injection method. This was introduced into New Zealand in 1969 and still has a place in the range of methods available to New Zealand women. For many years it was not available in Australia, the United Kingdom and the United States of America. It was finally approved by the Food and Drug Administration (FDA) in the USA for use as a contraceptive in October 1992.
(3) The widespread use of sterilisation, both male and female, once families were complete. This is a trend that has been noted in other developed countries. Significant factors affecting family limitation are the economic cost of bringing up children, the needs of children for care and attention and the needs of mothers in a society where many mothers are now working to contribute to the family income. The feminist movement of the 1970s also contributed to a change of attitude to the role of women in society. Women experiencing side effects on the pill and fears about the safety of the pill contributed to the shift from hormones to sterilisation. Sterilisation became more accessible following the Contraception, Sterilisation and Abortion Act of December 1977. New Zealand men became world leaders in the proportion having a vasectomy.
The shift away from hormonal contraception also included an upsurge in the use of the intrauterine device (IUD) but unlike sterilisation, this increase was not sustained. Sterilisation of male or female is now the most common method of contraception for women over the age of 30 years.
(4) The reprise of the condom. For various reasons condoms were never as popular in New Zealand as in European and some other countries. New Zealand did not have a rubber industry and imported condoms often arrived in a perished condition after being transported through the tropics on ships.
The stimulus for the shift to condoms was the appearance of HIV/AIDS. The first case was reported in New Zealand in 1983. Credit must go to the AIDS Foundation for promoting condom use for men who have sex with men, and these safer sex programmes also brought significant changes to the contraceptive practices of heterosexual couples. There have also been major improvements in the quality of condoms and in their promotion by marketing and public education. The condom is the only method of contraception that also provides significant protection from sexually transmissible diseases including HIV/AIDS.
These then are the four contraceptive revolutions and they make a fascinating story. But do they warrant the term revolutions? The authors justify the use of the term by explaining that this is a term that has been used in population literature to describe major shifts in the practice of contraception and voluntary sterilisation. Moreover they are associated in turn with the most fundamental of social transformations - changes in the size and structure of families. But if you are looking for the cut and thrust of revolutionary movements you will not find it here.
This monograph has been written for those who are seriously interested in population dynamics and women's health. Policy makers, health service providers, academics and students of demography, sociology, health sciences and medicine are the target audience, but the information deserves a wider readership. This is the first detailed scientific study that we have had of the New Zealand population, its fertility and family formation. The monograph is well presented with 24 tables and 21 figures, mainly graphs supporting the text.
In many other countries, the demographic changes of this century have been recorded and analysed but apart from some regional studies, regrettably, New Zealand has never carried out a study representative of the total population. Such studies require funding and leadership and Professor Ian Pool has provided that leadership. The funding has come from many sources. The list of people and organisations involved in the study demonstrates the diversity of interest in the topics covered. The forward is written by
Barbara Glenie, the current National President of the National Council of Women, and she pays tribute to the coordinating role of Past President Jocelyn Fish.
This monograph provides us with information derived from fieldwork carried out in October-November 1995, when a national sample survey of New Zealand Women: Family, Employment and Education (NZW:FEE) was undertaken by the Population Studies Centre at the University of Waikato. Interviewers conducted detailed questionnaires on the main sample of 2,507 women aged 20-59 throughout New Zealand. An over-sampling of Māori women (181 additional interviews) enabled more statistical calculations to be made for this group. An oversampling of women within the Midland Regional Health Authority (329 additional interviews) was required by the contract with the RHA, to provide the RHA with regional data. This gave a total of 3,017 interviews.
Each interview lasted approximately one hour and provided data on household characteristics, parental home and migration history, partnerships and family/household structures, children, other pregnancies, fertility regulation, contraceptive history, views on having children, education, work, income support, partner characteristics. The New Zealand questionnaire was based on one used by the Population Activities Unit of the United Nations Economic Commission in Europe in 1988-91.
Only part of the questionnaire, that part which dealt with fertility regulation and family formation, is covered in this monograph. There is a wealth of other material in the data collected, which has already been reported upon or will be published in the future. The women in the study were born between 1936 and 1975. The period covering their reproductive years extends from the early 1950s to 1995, just over four decades. It spans each of the four revolutions but more especially the last three. This is the sort of quality information that has been missing from the public debate on population issues for too long.
The monograph is presented in three main parts. The first part covers contraceptive use and sterilisation and is divided into several chapters covering the biosocial context of fertility regulation in New Zealand. This includes age at first intercourse, number of unions, pregnancies, infertility and a brief section on the role of induced abortion - too brief, in my opinion, as abortion is inextricably linked with contraception. Lifetime contraceptive use gives details of the method, if any, which was used at first intercourse and all methods used thereafter. Geographical variations are noted. There are relatively few differences between urban and rural women but southern women are better protected from pregnancy than northern women are. The concluding chapter on why women discontinued various methods is essential reading for those providing reproductive health services. A high proportion of women who stopped using the pill cited contraceptive failure - a disturbing result, given the pill's efficacy if used properly.
The second part deals with cohort and period trends in contraceptive use and sterilisation, analysing by the life table approach groups of women born in five-year periods, with the oldest group born 1936-40. Each successive generation presents a different profile with an overall trend towards sexual intercourse at an earlier age, the use of contraception at an earlier age and the increasing use of more reliable methods. Māori cohort trends are similar to non-Māori although the pattern for Māori women is for younger childbearing and a younger age at female sterilisation. Māori women are less likely to have a partner who has had a vasectomy. Marriage is still a popular choice for New Zealand women. There is a periodicity to these changes, the authors identifying pivotal time periods, which define the successive revolutions.
The third part is the most challenging and is devoted to the interpretation of patterns and trends. It attempts to answer important questions but in the process, raises many new ones.
Are New Zealand women efficient users of contraception and sterilisation? Answer: yes.
How does New Zealand compare internationally? Answer: the New Zealand pattern of contraceptive use is broadly similar to that seen in North America and Europe. A key difference is that intrauterine devices are less used in New Zealand and vasectomy is used more often. Fertility rates are higher in New Zealand and the authors suggest that this requires more detailed investigation.
How can New Zealand patterns and trends be explained? Answer: this is a complex interaction between:
- international and national macro-level factors such as government health policies and generational shifts in values and norms;
- community level factors such as service provision, cohort effects and community and family attitudes;
- micro-level factors such as influences from partner, the medical profession, personal characteristics and life experience.
What is the future of fertility control in New Zealand? Answer: the maintenance of replacement-level fertility is seen as being desirable demographically and for social and economic development. We have achieved this level since 1988 but doubts are raised as to whether this will continue and the lack of public policy on what will happen if we enter a period of sub-replacement fertility is viewed as a major concern.
This last question is probably the most important. Demographers have provided us with important information and opened the public debate on vital issues for future generations. It is now up to other disciplines to contribute to the discussion. May we learn from the information provided and ensure that future studies are properly funded so that decisions are made on the basis of sound facts, facts that change with each succeeding generation.
