Free Long Lasting Contraceptives for Teens
In an article that appeared in late June in the British Journal of Obstetrics and Gynaecology, senior academics at the University of Otago made the case for an opt-out programme that would see teens started on long-acting reversible contraceptives (LARCs) before they become sexually active.1
The three long-acting contraceptives the academics had in mind are the copper IUD which lasts for ten years, the Mirena IUD which lasts for five years, and the Jadelle implant which lasts for five years. The latter device became funded by PHARMAC five years ago.
The resulting publicity in the New Zealand media focused solely on one side of this highly-charged debate and totally ignored the contrary view put forward on the same page and in the same issue by Alison Edelman who argued that pre-emptive use of such contraceptives without need or benefit may cause more harm than good. Referring to the three Otago University lecturers as “researchers” further confused the situation as it implied that the proposal was based on new research results when this was not the case at all.2
As women’s health groups around the country expressed their disbelief and outrage at the prospect of young girls being targeted as candidates for an opt-out programme involving the use of long-term hormonal contraceptives, Dr Neil Pickering was quoted as saying “We would see it happening as a normal part of a person’s health care through school, just in the same way children are vaccinated.” This would save adolescents from having to go and seek care, he said.2 Of course, the adolescents he was referring to were all female. Perhaps he was thinking of 12-year-old school girls having the HPV vaccine Gardasil in one arm while a contraceptive implant is inserted in the other arm.
For some of us the suggestion brought back memories of the bad old days when young Māori and Pacific young women were often injected with Depo Provera without their knowledge or consent.
Fortunately, this time round Family Planning was against the idea of young women being part of an opt-out contraceptive programme. Family Planning’s chief executive Jackie Edmond said most young women aren’t having sex before they turn 16. “We’re overkilling it putting implants in people who aren’t intending to or aren’t having sex,” she said.3
Teen pregnancy rates declining
It is worth noting at this point that a recent report published in January 2015 by the Social Policy Evaluation and Research Unit stated that while New Zealand has the second-highest teen pregnancy rate in the developed world, rates were declining in all regions except Northland. In 2013, the proportion of all births that were teen births was 5.9% - the lowest ever recorded – and 71% of the births were to 18 and 19 year old mothers.4
The Abortion Supervisory Committee reports over recent years have also recorded a declining teenage abortion rate. The rate has halved between 2007 and 2013.
So let’s not get too carried away here about the teen pregnancy “problem.”
Who takes responsibility?
Jackie Edmond also commented on the issue of young women being made to take full responsibility for contraception even before they become sexually active, thus giving young men a free pass, as it were.
Following on from this, radio show host Kerre McIvor wrote in her column in the Herald on Sunday that Family Planning “believe young women should be able to have a choice when it comes to contraception and that young men should be using condoms, no matter what form of contraception young women are on. Well, good luck with that message getting through.”5
She was one of the few commentators to question the health implications of hormones being released into the bodies of young women who are still growing, developing physically as well as emotionally.
The link between oral hormonal contraceptives and breast cancer has been known for a decade or more. Extreme caution must be used before health authorities begin planning a mass programme of inserting hormonal implants in young teenage girls. Then there is the issue of it being much easier to implant these devices than it is to remove them.
Kerre McIvor went on to say:
“Sex is about so much more than not getting pregnant and I think the researchers are missing the point on that. It’s about a desire to be wanted, a desire to belong, and, far too often, it’s about power and control.
One of the correspondents to my radio show had an excellent take on the issue: vasectomies are a low cost, relatively simple operation these days. What’s more, they’re reversible. So why not offer free, universal vasectomies to all 13-year-old boys who can then reverse the vasectomy if they want children in the future? Surely that’s a suggestion as worthy of debate as inserting IUDs in the uteruses of the nation’s adolescent girls, or pumping them full of hormones.”5
It certainly is. So let’s begin the debate about a school-based programme for Gardasil and vasectomies for 13-year-old boys.
BJOG Debate. British Journal of Obstetrics and Gynaecology. June 2015