Abortion Services in New Zealand

Contraception

Prevention of unplanned pregnancies relies on consistent use of contraception. There are many different types and the following list is restricted to those that are available in New Zealand in 2004. Some others are available via the Internet. All methods have their advantages and disadvantages.

Natural methods

Abstinence

Abstinence or celibacy may be a lifestyle choice. Saying "no" and meaning it is the most appropriate response in many situations. However, strong, passionate feelings or undue pressure can make it hard to refrain from having sex. Alcohol and drugs can seriously interfere with decision making. Making a pledge may help motivation but is no protection in many situations.

Be realistic if using this method.

Withdrawal

The technical term for this method is coitus interruptus but it also has many popular names such as "being careful" or "pulling out". The man recognises when he is about to come (ejaculate) and withdraws the penis so that the sperm does not enter the woman's vagina. Sometimes he withdraws too late and then the woman will need to take the emergency contraceptive pill. If he withdraws before she has reached her climax (orgasm) clitoral stimulation can be continued in other ways.

The success of the method depends on the skill and experience of the man but alcohol and drugs can ruin the best of intentions. Another hazard is that the pre-ejaculate may contain sperm.

Natural Family Planning

There are a number of terms that are used for natural methods e.g. fertility awareness, sympto-thermal method, "safe times". If mucus changes only are used this is referred to as the Billings Method. Natural family planning relies on the fact that the physiological changes that occur in a normal menstrual cycle can be detected by the woman. Ovulation normally occurs about 14 days before the onset of the next menstrual period. The two most reliable signs are the changes in cervical mucus and the rise in temperature that occurs after ovulation. Specialist clinics that teach this method are provided by Natural Fertility New Zealand. For women wanting to take advantage of new technology, 'Persona' is a minicomputer that assists women with readings of their hormone levels obtained from morning urine tests.

The success of the method depends on the care with which it is used and the natural fertility of the woman. For careful users the failure rate is as low as 2 pregnancies per hundred couples using it over a year. An average failure rate is about 20 pregnancies per hundred couples per year.

Lactational Amenorrhoea Method (LAM)

This is a good method for those who are fully breastfeeding i.e. on demand without food supplements. The guidelines advise that it can only be relied upon in the first 6 months after delivery and only if there is no return of menstruation in that time. Suckling by other means such as a "dummy" is discouraged.

The risk of conception up to 6 months is about 2%.

Emergency methods

Emergency contraceptive pill

Previously called the "morning after pill", this is used when either no method has been used or there has been a problem when using another method of contraception e.g. a condom leaking. It should be used as soon as possible and within 72 hours of unprotected sex. Postinor-1 is a hormone pill prescribed by a doctor. Levonelle-1 is the same thing, just a different brand name, which can be bought over the counter at a pharmacy.

There is a failure rate of about 2% so a follow-up pregnancy test should be carried out if the next period is late or unusual.

Emergency contraceptive IUD

This is when an intrauterine device (IUD) is inserted in the womb after intercourse but before implantation. It is not used nearly as often as the emergency contraceptive pill, but it is useful if more than 72 hours have passed and it is still within 5 days of unprotected sex. It is also useful if the woman would like to use the IUD, not only for the emergency but as ongoing method of contraception. It is not advised if there has been a risk of infection with an STI (sexually transmitted infection).

Hormonal methods

Combined contraceptive pill

In New Zealand this is the most common method used by young women and is usually referred to as "the pill". The pill contains two hormones, an oestrogen and a progestogen, which if taken correctly stops the ovaries from releasing an egg. It is very effective. Most pill failures are due to women forgetting pills or not realising they are less safe if they have a stomach upset or are taking medicines that may interfere with the pill e.g. some antibiotics. Some women cannot take the pill because of a medical problem and that is why it is not available over the counter but must be prescribed by a doctor. Most women find the pill the most convenient method but some find it really hard to take a pill at the same time every day and some get side effects. Occasionally there may be more severe problems such as a blood clot in the veins. One of the benefits of the pill is that menstruation is controlled by the pill and therefore very regular (every 4th week) and usually lighter and less painful.

The failure rate with the pill depends on how reliably it is taken and annual figures as high as 7% have been obtained in actual use. In studies where women are usually taking it more reliably the range is from 2 in 1000 to 3 in 100 for women using it over a year.

Progestogen-only pill

Sometimes called the "minipill", this pill has only one hormone, a progestogen. It is taken every day, 365 days a year, without a break between hormone pills as in the combined pill. Women need to be even more careful in taking this pill and keep to a 3 hour safety margin. Because it is taken continuously it can upset the normal menstrual cycle but because it only has a low dose of progestogen it is uncommon to have other side effects. It is often suitable for women with medical problems who cannot take the combined pill. It is often taken by breast feeding mothers. It is not quite as effective as the combined pill.

For reliable users the failure rate is from 3 in 1000 to 4 in 100 for women using it over a year.

Depo-Provera

This is an injectable hormone method given every 3 months. The injection is not painful. Depo-Provera releases a progestogen, a hormone which acts to stop the release of an egg form the ovary. It is therefore a very effective method. It is particularly suitable for women who find it difficult to remember taking a contraceptive pill each day. It can be used by women who cannot take oestrogens e.g. those with a tendency to blood clots or high blood pressure or focal migraine. Some women lose their periods but this is not harmful. Some women experience side effects such as weight gain or irregular bleeding.

It is one of the most reliable methods and failures are extremely rare if it is given at the correct time.

Implants

In 2010 two implants are available in New Zealand. These are usually inserted above the elbow on the inner aspect of the upper arm. When they are no longer needed or they have expired they are removed through a small incision.

(1) Jadelle consists of two small rods and releases a progestogen, levonorgestrel. It can remain in place for five years.

(2) Implanon consists of one rod and releases a third generation progestogen, 3-keto-desogrestrel. It can remain in place for three years.

Hormone Releasing Intrauterine System

See below, Mirena, under Intrauterine devices

Barrier methods

Condom (latex)

Condoms are the only contraceptive method that also give good protection from STIs (sexually transmitted infections). Even if the woman is taking the pill for reliable contraception she may also need condoms for protection from STIs. The condom is a latex rubber sheath that is rolled on to the erect penis just before sex and removed before the penis has had time to relax. There is now a whole variety of condoms and they can be purchased from pharmacies, supermarkets, garages and other outlets. Some brands can be prescribed free by a doctor and this is the cheapest way of getting condoms. If there is an accident with a condom bursting, slipping or leaking then the woman will need emergency contraception.

Failure is usually due to not using the condom on every occasion or not taking emergency contraception after an accident. Even if used correctly there is still a small failure rate of about 2-4 pregnancies per 100 couples using the method over a year.

Non-latex condoms

Occasionally the man or the woman may have an allergic reaction either to the latex of a rubber condom or to the chemicals that are used in the manufacture of the condom or to the substances like colourings and flavourings that are sometimes added to condoms. Changing brands will sometimes help but if it is a true latex allergy then non-latex condoms will be needed. The only brand available in New Zealand is Durex 'Avanti'. They are a little more expensive than latex condoms.

Their reliability is about the same as latex condoms and is dependent on the care with which they are used.

Female condom

Female condoms are only available from Family Planning clinics. The female condom or vaginal liner is another non-latex device. It is made of polyurethane. It has an inner ring which is floating free. This just helps insertion. It has an outer ring which is attached to the rim of the condom and rests on the woman's genital area. The female condom can be disinfected after use with household bleach, washed in detergent and dried before re-using. With care they can be re-used for about five times. At about $12 for a packet of 3 this works out quite reasonably. Like the male condom they provide good protection from STIs.

The female condom has about the same failure rate as the male condom and like the male condom this depends on how carefully it is used.

Diaphragm

This is an old method which is still useful when women are unable or unwilling to use hormonal methods. The diaphragm is a rubber dome that is fitted within the vagina and covers the cervix acting as a barrier to sperm. The correct size must be fitted by a doctor or nurse experienced in the method. Spermicidal jelly is applied to the diaphragm before use. The diaphragm is inserted before sex and left in place for 6-8 hours after sex. If necessary it can safely be left in for longer. After removal the diaphragm is washed and dried. With care it will last for 2 years. A prescription for the right size can be taken to any pharmacy or diaphragms can be obtained from a Family Planning clinic.

The failure rate is higher in new users and in younger women who are more naturally fertile. Average figures range from 2-20 per 100 women using the method over a year.

Cervical cap

There are different types of cap but the most common is one that fits neatly over the cervix, like a thimble over the thumb. Caps are smaller than diaphragms and come in different sizes. The correct size must be fitted by an experienced doctor or nurse. Family Planning clinics import the devices and they are not available through pharmacies. Like diaphragms they are used with spermicidal jelly, inserted before sex, removed 6-8 hours after sex, then washed and dried and can be re-used for 2 years.

The cap has about the same reliability as the diaphragm.

Spermicide

Currently in New Zealand we only have one spermicidal preparation - Gynol II, a contraceptive jelly. It is not recommended for use alone but can be used in conjunction with a diaphragm or cervical cap. It contains nonoxynol-9 which has been found to damage the delicate genital tissues, especially when used frequently. For this reason it is no longer recommended for use as a lubricant with condoms.

The failure rate when used alone depends on the age and natural fertility of the woman. While it may be quite suitable for a woman around the time of the menopause it cannot be recommended for younger more fertile women.

Intrauterine devices

Copper-bearing IUDs

Intrauterine devices are small devices which are inserted by a doctor to fit inside the uterus (womb). They are plastic with copper wound around the stem. They have fine threads which can be felt protruding from the cervix. They can be fitted at any time but are usually done at the time of a period to exclude the possibility of a pregnancy. They can be left in place for 5 years. There is only a small risk of pregnancy, about 1-2 for every 100 women using the method over a year. They do not cause ectopic pregnancies (in the fallopian tube) but if a pregnancy does occur there is a small chance that it may be ectopic. They are best used in women who have had children and are in a stable relationship. Multiple partners expose the woman to the risk of infection and this can lead to scarring of the fallopian tube and infertility problems. Sometimes periods may be heavier than normal but this is not usually a big problem.

Mirena

This is hormone-releasing intrauterine system. Instead of having copper wound around the stem, there is a special membrane which releases a small amount of progestogen, a hormone which affects the lining of the womb making it rare for a fertilised egg to implant. If women are anaemic through heavy menstrual bleeding Mirena can be provided free, otherwise it costs about $360. It lasts for 5 years. It is a very effective contraceptive - in some large studies there have been no pregnancies. It is also used in older women as part of hormone replacement therapy for menopausal symptoms. Many women with Mirena lose their periods altogether and this is medically safe.

Sterilisation

Female sterilisation

Female sterilisation requires minor surgery by a gynaecologist. The fallopian tubes which carry the egg from the ovary to the womb are sealed off. Various techniques are used but the most common one in New Zealand at present is the application of a clip to block the fallopian tubes. This can be done through a small incision using an instrument called a laparoscope. A new method is "Essure" which involves a small metal spring being fitted at the junction of the fallopian tube and the uterus. Over the next 3 months scarring and blocking occurs. The device is inserted by a gynaecologist using an instrument called a hysteroscope. Sterilisation can also be carried out after birth at the time of a Caesarian section.

Failures following sterilisation are rare, about 0-5 per thousand.

Vasectomy

This is male sterilisation where the tube (vas deferens) which carries the sperm from the testis is cut and sealed off. The trapped sperm are absorbed naturally by the body. The operation is done in a clinic or surgery under a local anaesthetic. It is a simpler procedure for the man than for the woman. The man is not sterile immediately because there are still sperm in the storage areas and on average it will take 16 ejaculations or 3 months for these stored sperm to be cleared out of the system.

Failures are most likely to occur before the system is clear of sperm but even after this there is a rare chance that the tubes can rejoin, about 1 in a thousand.

The operation does not affect the man's hormones or his sex drive.

Links to other websites giving contraceptive information

Last Updated: 5 January 2010