Asian Bioethics Review

, Volume 11, Issue 1, pp 95–109 | Cite as

Closing the Gap between Need and Uptake: a Case for Proactive Contraception Provision to Adolescents

  • Rebecca DuncanEmail author
  • Lynley Anderson
  • Neil Pickering
Original Paper


In New Zealand, there are adolescents who are at risk of pregnancy and who do not want to become pregnant, but are not using contraception. Cost and other barriers limit access to contraception. To address the gap between contraceptive need and contraceptive access, this paper puts forward the concept of proactive contraception provision, where adolescents are offered contraceptives directly. To strengthen the case for proactive contraception provision, this paper addresses a series of potential objections. One is that such a programme would cause harm; another that such a programme would not have sufficient benefit. In rebutting these objections, the conclusion is reached that proactive contraception provision is a model worth pursuing as a means of meeting the needs of the New Zealand adolescent population and may be of interest more widely.


Adolescent Access to contraceptives Contraception New Zealand 



  1. Abajobir, Amanuel Alemu, Joemer Calderon Maravilla, Rosa Alati, and Jackob Moses Najman. 2016. A systematic review and meta-analysis of the association between unintended pregnancy and perinatal depression. Journal of Affective Disorders 192: 56–63. Scholar
  2. ACOG. 2012. ACOG Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstetrics and Gynecology 120 (4): 983–988. Scholar
  3. Adams, Robert John. 2010. Improving health outcomes with better patient understanding and education. Risk Management and Healthcare Policy 3: 61–72. Scholar
  4. Advisory Committee on Assisted Reproductive Technology. 2018. Posthumous reproduction – a review of the current guidelines for the storage, use, and disposal of sperm from a deceased man to take into account gametes and embryos. Advisory Committee on Assisted Reproductive Technology. Accessed 13 November 2018.
  5. American Medical Association. n.d. AMA code of medical ethics. American Medical Association, revised June 2001. Accessed 20 March 2019.
  6. Babcock, Rebecca. 2016. Medical decision-making for minors: using care ethics to empower adolescents and amend the current power imbalances. Asian Bioethics Review 8 (1): 4–19. Scholar
  7. Bahamondes, Luis, M. Valeria Bahamondes, and Lee P. Shulman. 2015. Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Human Reproduction Update 21 (5): 640–651. Scholar
  8. Barrett, Mark, and Kim Connolly-Stone. 1998. The treaty of Waitangi and social policy. Social Policy Journal of New Zealand 11: 29–48.Google Scholar
  9. Bateson, Deborah, Sukho Kang, Helen Paterson, and Kuldip Singh. 2017. A review of intrauterine contraception in the Asia-Pacific region. Contraception 95 (1): 40–49. Scholar
  10. Birgisson, Natalie E., Qiuhong Zhao, Gina M. Secura, Tessa Madden, and Jeffrey F. Peipert. 2015. Preventing unintended pregnancy: the contraceptive CHOICE project in review. Journal of Women’s Health 24 (5): 349–353. Scholar
  11. Blanc, Ann K., Amy O. Tsui, Trevor N. Croft, and Jamie L. Trevitt. 2009. Patterns and trends in adolescents’ contraceptive use and discontinuation in developing countries and comparisons with adult women. International Perspectives on Sexual and Reproductive Health 35 (2): 63–71. Scholar
  12. Brown, George F., and Ellen H. Moskowitz. 1997. Moral and policy issues in long-acting contraception. Annual Review of Public Health 18 (1): 379–400.CrossRefGoogle Scholar
  13. Care of Children Act 2004 (New Zealand). Accessed 20 March 2019.
  14. Clark, Terryann C., Theresa M. Fleming, Patricia Bullen, Simon J. Denny, Sue Crengle, Ben Dyson, Sarah Fortune, Mathijs F.G. Lucassen, Roshini Peiris-John, and Elizabeth M. Robinson. 2013. Youth’12 overview: the health and wellbeing of New Zealand secondary school students in 2012. Auckland: University of Auckland. Accessed 20 March 2019.
  15. Clark, Terryann C., Mathijs F.G. Lucassen, Theresa M. Fleming, Roshini Peiris-John, Amio Ikihele, Tasileta Teevale, Elizabeth M. Robinson, and Sue Crengle. 2016. Changes in the sexual health behaviours of New Zealand secondary school students, 2001–2012: findings from a national survey series. Australian and New Zealand Journal of Public Health 40 (4): 329–336.
  16. Crimes Amendment Act 2015 (New Zealand). Accessed 20 March 2019.
  17. Duncan, Rebecca, Helen Paterson, Lynley Anderson, and Neil Pickering. 2019. A qualitative analysis of adolescents’ opinions of proactive long-acting reversible contraceptive (LARC) provision. New Zealand Medical Journal 132 (1488).Google Scholar
  18. Edelman, Alison. 2015. Teens and young adults should be started on long-acting reversible contraceptives before sexual activity commences: against: pre-emptive use without need or benefit may cause more harm than good. BJOG 122 (8): 1052–1052. Scholar
  19. Education Review Office. 2018. Promoting wellbeing through sexuality education. Education Review Office. Accessed 20 March 2019.
  20. Family Planning. 2015. Contraception - your choice. Family Planning. Accessed 15 March 2019.
  21. Family Planning. n.d. Emergency contraception - ECP: Te ārai hapū ohotata. Family Planning. Accessed 20 March 2019.
  22. Family Planning NSW. 2013. Reproductive and sexual health in Australia. Ashfield: Family Planning NSW. Accessed 15 March 2019.
  23. Finer, Lawrence B., and Jesse M. Philbin. 2013. Sexual initiation, contraceptive use, and pregnancy among young adolescents. Pediatrics 131 (5): 886–891. Scholar
  24. Gallagher, Katherine E., D. Scott LaMontagne, and Deborah Watson-Jones. 2018. Status of HPV vaccine introduction and barriers to country uptake. Vaccine 36 (32): 4761–4767. Scholar
  25. General Medical Council. 2008. Consent: patients and doctors making decisions together. General Medical Council. Accessed 15 March 2019.
  26. Gillick v. West Norfolk and Wisbech Area Health Authority. [1986]. AC 112.Google Scholar
  27. Glasier, Anna. 2006. Non-contraceptive benefits of contraceptive methods. Medicine 34 (1): 23–24. Scholar
  28. Gomez, Anu Manchikanti, Liza Fuentes, and Amy Allina. 2014. Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods. Perspectives on Sexual and Reproductive Health 46 (3): 171–175. Scholar
  29. Grubb, Amy, and Emily Turner. 2012. Attribution of blame in rape cases: a review of the impact of rape myth acceptance, gender role conformity and substance use on victim blaming. Aggression and Violent Behavior 17 (5): 443–452 Scholar
  30. Health and Disability Commissioner. 1996. Code of health and disability services consumers’ rights.. Accessed 15 March 2019.
  31. Hoggart, Lesley, and Victoria Louise Newton. 2013. Young women’s experiences of side-effects from contraceptive implants: a challenge to bodily control. Reproductive Health Matters 21 (41): 196–204. Scholar
  32. Jackson, Stevi. 2006. Gender, sexuality and heterosexuality: The complexity (and limits) of heteronormativity. Feminist Theory 7 (1): 105–121. Scholar
  33. Kavanaugh, Megan L., Kathryn Kost, Lori Frohwirth, Isaac Maddow-Zimet, and Vivian Gor. 2017. Parents’ experience of unintended childbearing: a qualitative study of factors that mitigate or exacerbate effects. Social Science & Medicine 174: 133–141. Scholar
  34. Lawton, Beverley, Charrissa Makowharemahihi, Fiona Cram, Bridget Robson, and Tina Ngata. 2016. Pounamu: E Hine: access to contraception for indigenous Mãori teenage mothers. Journal of Primary Health Care 8 (1): 52–59. Scholar
  35. Lebow, Morton A. 1999. The pill and the press: reporting risk. Obstetrics & Gynecology 93 (3): 453–456.CrossRefGoogle Scholar
  36. MacPherson, Liz. 2017. Births and deaths: year ended December 2016 and March 2017. Stats NZ. Accessed 15 March 2019.
  37. Medical Council of New Zealand. 2011. Information, choice of treatment and informed consent. Medical Council of New Zealand. Accessed 30 Septermber 2016.
  38. Mermelstein, Sarah, and Katie Plax. 2016. Contraception for adolescents. Current Treatment Options in Pediatrics 2 (3): 171–183.
  39. Miller, Dawn. 2016. Guest editorial: equity in sexual and reproductive health–an ongoing challenge. Journal of Primary Health Care 8 (1): 3–4. Scholar
  40. Ministry of Health. 2019. HPV immunisation programme. Ministry of Health. Accessed 20 March 2019.
  41. Mollborn, Stefanie. 2016. Teenage mothers today: what we know and how it matters. Child Development Perspectives 11 (1): 63–69. Scholar
  42. Moreno, Megan A. 2016. Long-acting reversible contraception for adolescents. JAMA Pediatrics 170 (5): 516–516. Scholar
  43. Patseadou, Magdalini, and Lina Michala. 2017. Usage of the levonorgestrel-releasing intrauterine system (LNG-IUS) in adolescence: what is the evidence so far? Archives of Gynecology and Obstetrics 295 (3): 529–541. Scholar
  44. Paul, Charlotte. 2015. Re: teens and young adults should be started on long-acting reversible contraceptives before sexual activity commences an opt-out programme to avoid teen pregnancy. BJOG 122 (13): 1848–1848. Scholar
  45. Petta, Carlos Alberto, Melissa McPheeters, and I-Cheng Chi. 1996. Intrauterine devices: learning from the past and looking to the future. Journal of Biosocial Science 28 (2): 241–252. Scholar
  46. PHARMAC. 2016. Decision to list an additional copper intra-uterine contraceptive device. PHARMAC (Pharmaceutical Management Agency). Accessed 7 July 2016.
  47. PHARMAC. n.d. New Zealand pharmaceutical schedule - genito urinary system. PHARMAC (Pharmaceutical Management Agency). Accessed 20 March 2019.
  48. Pickering, Neil, Lynley Anderson, and Helen Paterson. 2015. Teens and young adults should be started on long-acting reversible contraceptives before sexual activity commences: FOR: An opt-out programme would avoid teen pregnancy and associated costs. BJOG 122 (8): 1052–1052. Scholar
  49. Privacy Act 1993 (New Zealand). Accessed 20 March 2019.
  50. Privacy Commisioner. 2017. Releasing personal information to police and law enforcement agencies: guidance on health and safety and maintenance of the law exceptions. Office of the Privacy Commissioner - Te Mana Motapono Matatapu. Accessed 15 March 2019.
  51. Privacy Commissioner. n.d. Privacy act and codes: introduction. Office of the Privacy Commissioner - Te Mana Motapono Matatapu., accessed 20 March 2019.
  52. Roke, Christine, Helen Roberts, and Anna Whitehead. 2016. New Zealand women’s experience during their first year of Jadelle® contraceptive implant. Journal of Primary Health Care 8 (1): 13–19. Scholar
  53. Russo, Jennefer A., Elizabeth Miller, and Melanie A. Gold. 2013. Myths and misconceptions about long-acting reversible contraception (LARC). Journal of Adolescent Health 52 (4): S14–S21. Scholar
  54. Shoupe, Donna. 2016. LARC methods: entering a new age of contraception and reproductive health. Contraception and Reproductive Medicine 2 (1): 1–9. Scholar
  55. Skovlund, C., L. Mørch, L. Kessing, and Ø. Lidegaard. 2016. Association of hormonal contraception with depression. JAMA Psychiatry.
  56. Smith, Sarah A. 2015. The use of intrauterine devices (IUDs) in adolescents and nulliparous women: a systematic review. Journal of Women's Health Care 4: 277. Scholar
  57. Steinbock, Bonnie. 1995. Coercion and long-term contraceptives. The Hastings Center Report 25 (1): S19–S22. Scholar
  58. Steiner, R.J., N. Liddon, A.L. Swartzendruber, C.N. Rasberry, and J.M. Sales. 2016. Long-acting reversible contraception and condom use among female us high school students: Implications for sexually transmitted infection prevention. JAMA Pediatrics.
  59. Stoljar, Natalie. 2011. Informed consent and relational conceptions of autonomy. Journal of Medicine and Philosophy 36 (4): 375–384. Scholar
  60. Sundaram, Aparna, Barbara Vaughan, Kathryn Kost, Akinrinola Bankole, Lawrence Finer, Susheela Singh, and James Trussell. 2017. Contraceptive failure in the United States: Estimates from the 2006–2010 National Survey of Family growth. Perspectives on Sexual and Reproductive Health 49 (1): 7–16. Scholar
  61. Thompson, Gillian, Canadian Paediatric Society, and Adolescent Health Committee. 2016. Meeting the needs of adolescent parents and their children. Paediatrics & Child Health 21 (5): 273–273. Scholar
  62. UNICEF. 1989. The convention on the rights of the child. Participation rights: having an active voice. UNICEF. Accessed 15 March 2019.
  63. United Nations. 2015. World contraceptive use 2015, survey-based observations contraceptive prevalence by method. United Nations, Department of Economic and Social Affairs, Population Division.Google Scholar
  64. University of Waikato. 2013. Current trends for teenage births in New Zealand. National Institute of Economic and Demographic Analysis, University of Waikato. Accessed 15 March 2019.
  65. Watson, Angel. 2018. Florida actual versus expected teen births and repeat teen births by county 2015 through 2017. Florida Department of Health, Division of Community Health Promotion, Bureau of Family Health Services., Accessed 15 March 2019.
  66. WHO. 2015. 19 th WHO model list of essential medicines. World Health Organization. Accessed 15 March 2019.
  67. WHO. 2019. Human papillomavirus (HPV) and cervical cancer. WHO. Accessed 15 March 2019.
  68. Wigginton, Britta, Claire Moran, Melissa L. Harris, Deborah Loxton, and Jayne Lucke. 2016. Young Australian women explain their contraceptive choices. Culture, Health & Sexuality 18 (7): 727–741. Scholar
  69. Williamson, Nancy E. 2012. Motherhood in childhood: facing the challenge of adolescent pregnancy. UNFPA State of World Population 2013. United Nations Population Fund. Accessed 15 March 2019.
  70. Winner, Brooke, Jeffrey F. Peipert, Qiuhong Zhao, Christina Buckel, Tessa Madden, Jenifer E. Allsworth, and Gina M. Secura. 2012. Effectiveness of long-acting reversible contraception. New England Journal of Medicine 366 (21): 1998–2007.CrossRefGoogle Scholar

Copyright information

© National University of Singapore and Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Bioethics Centre, Division of Health SciencesUniversity of OtagoDunedinNew Zealand

Personalised recommendations