Complexity and contraception

Image: Grab a Condom Embroidery Hoop/ Hey Paul Studios on flickr

People educated in Australia of  ‘a certain vintage’ have the pleasure of recalling the days when school sex education entailed a perky film about the family life of ducks and geese, followed by an obtuse talk from teachers about love and suddenly, babies. How things have changed: now children come home from school teaching their parents the proper (and not so proper) words for all things sexual and reproductive.

But we can’t take for granted that everyone in the Australian community has what they need to live informed and enjoyable sexual and reproductive lives. First, knowing where everything is and how to use it is only a small piece of the puzzle: this knowledge must be complemented by a solid grounding in respect and equality within relationships, and taught in the context of a broad, non-judgemental sexuality education. And what of migrants and refugees, the majority of whom arrive in Australia after secondary education is completed?

Recently we explored this question by conducting some research, together with researchers from Monash University, into immigrant and refugee women’s experiences of contraception in Australia. The findings, based on interviews with 84 women, were a little surprising in terms of what women know and what they choose to do with that knowledge.

Awareness of the range of contraceptives available to women was relatively high, with some variation depending on the availability of sexual and reproductive education and information in women’s country of origin. In some cases, state-funded education was available in country of origin, but only to the ‘about to be married’, which meant that many sexually active people missed out. In other cases, education was hard to come by through formal channels, and women relied on more informal means such as talking to family and friends, or Dr Google.

In many cases, awareness accorded with the likelihood that women would use that method: we noted a high awareness of non-hormonal methods (91%), such as male condoms, withdrawal, and natural family planning methods, which combined made up 76% of the women’s choices. Surprisingly, however, only 5% of women chose the pill even though 95% reported being aware of it.

A complex range of factors influenced women’s choices, including the cost and availability of, and access to, certain types and brands of contraception in Australia. Of the women who were using hormonal methods, such as Depo Provera, implants or the pill (total 15%), some obtained their supplies from practitioners overseas, in order to negotiate factors such as continuity of care, the difficulties of translating medical records, and the lack of interpreting services in Australia. A group of women reported waiting until their regular visits overseas to book in their gynecological appointments at which they would also arrange their contraception for the period until the next visit.

These findings indicate that for many immigrant and migrant women, contraception remains difficult to negotiate. Information is lacking, and structural barriers such as cost, language and lack of access prevent many women from making free and informed choices about what suits them best. What is needed is a broad and comprehensive program of sexual and reproductive education suitable for women from diverse communities. We also need to consider how access can be improved. If sex education at schools has progressed from the days of the duck family, we now need to extend that wisdom to ensure that informed choice is the order of the day for immigrant and refugee women.