DHBs use ethnicity for low-cost contraception criteria


The Ministry of Health gave $4.5 million to District Health Boards in 2019 for contraception services.

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The Ministry of Health gave $4.5 million to District Health Boards in 2019 for contraception services.

Māori and Pacific women are among those targeted in a contraceptive initiative that has a researcher concerned women will be prevented from having babies “for their own good”.

The $4.5 million Ministry of Health fund for free or low-cost contraception is for women at risk of an adverse outcome as a result of an unintended pregnancy.

But several district health boards are targeting Māori and Pacific women, those at risk of family violence, or with mental health or substance issues, University of Auckland researchers and GPs say in a paper published in the New Zealand Medical Journal on Friday.

“You are creating a mindset where some women perhaps need to be prevented from having children for their own good, and that has no place in a modern healthcare system,” GP and lead author Dr Orna McGinn​ said.

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Auckland GP Orna McGinn says contraception should be free for all and prioritising certain groups can lead to stigma.

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Auckland GP Orna McGinn says contraception should be free for all and prioritising certain groups can lead to stigma.

Researchers asked DHBs and primary health organisations how contraception services had been configured when the scheme started in August 2019 and again in August 2020. The researchers found complex eligibility criteria which McGinn said could lead to stigma, even if done “in the spirit of equity”.

“The UN has stipulated this clearly: contraception should be freely available without bias on religion on ethnicity,” she said.

“The fact we are doing this in New Zealand is very sad and I think it’s just a way of rationing.”

Instead, McGinn and her two fellow authors called for contraception to be free at the point of access. She had patients who would benefit from free contraception, such as those whose existing medication would harm a growing pregnancy.

Types of oral contraceptives are subsidised, while an Intra Uterine Device (IUD) is free.

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Types of oral contraceptives are subsidised, while an Intra Uterine Device (IUD) is free.

“I’ve got young women with other medical issues, with very poorly controlled diabetes, which gives very poor outcomes in pregnancy but again – not funded,” she said.

“In primary care we look after an enormous number of people with mental health and addiction problems: 40 per cent of our workload is mental health. How bad do your problems have to be before the DHB will fund your contraception?”

Prioritising certain groups encouraged a “similar approach” to the free long-term contraception for beneficiaries scheme set up by the previous government, she said. The scheme, labelled insulting and intrusive when it was announced in 2012, was scrapped in 2018.

A range of contraception options are free or subsidised, including condoms, diaphragms, IUDs, the Pill and injection, but users may still pay a prescription fee and for an appointment.