World Contraception Day brought focus to family planning as a human right protected by international law. This year, with the Covid-19 pandemic causing disruption around the globe, UN human rights experts said they were concerned about the impact of disrupted supply chains and production cuts.
A UN statement read; “everyone must have access to scientifically based comprehensive sexuality education included in school curricula, as well as timely access to safe, effective, affordable and acceptable methods of family planning of their choice.”
Access, education and choice have been pillars in the work of Family Planning organisations for some time. It’s a constantly developing field as the medical advances, technology, politics and social attitudes change and evolve.
Dr Deborah Bateson is the Clinical Associate Professor of Gynaecology & Neonatology at the University of Sydney and is the Medical Director of Family Planning, New South Wales. During her 20 years in the field she says she’s seen a lot of changes.
“It’s certainly not dull and there’s always interesting challenges. I think in family planning organisations, there’s always been that focus on excellent communication and I think that is really important. Patient or client central care is what has remained central too.”
Making sure patients are aware of choice
The amount of choice available in contraceptive methods – and how we can communicate this to patients – has changed a lot over the last decade.
“In the medical world now we’re much more aware of communication and shared decision making – I think there’s a heightened awareness around that,” says Dr Deborah.
“Just ensuring that people have all the information for themselves and we’re supporting that informed choice. When it comes to contraception, people are not unwell, they’re there to choose the contraception that best suits their needs. One size doesn’t fit all!”
LARCs (Long Acting Reversible Contraceptives) are one such change and Dr Deborah says there’s new options on the horizon.
The scope of what Family Planning does has changed
Dr Deborah adds that the scope of what family planning organisations do has changed too. Abortion care, gynaecological problems, cervical screening and domestic violence have been added to the scope of what Family Planning does.
“We’ve got consumer groups – we’ve got young people’s and Indigenous women’s consumer groups, for example, who feed into how we design and how we run our practice. That’s also a real change.
“Those expanded services too – about 12 years ago we introduced domestic violence screening. Now we’re asking around reproductive coercion. There’s been a big change in how we address gender-based violence.
“It’s a really important opportunity to ask these questions – you can’t miss those opportunities so we’ve embedded it into our practice.
“There’s also education around LARC methods, IUDs different options around contraceptives and we’ve also got trained people who can put them in. I think that’s a really important thing – we do a lot of training for GPs and nurses too. We want to make sure that if there’s a woman in a rural town, there’s pathways for her to access her chosen contraceptive safely.”
The future of contraception and family planning
Telehealth has changed the way in which organisations and clinics can deliver care. While it won’t replace face-to-face consultations, Dr Deborah says it’s an important change that’s opening up access for people in rural areas.
But that’s not the only change in the future of family planning.
“I think there’s going to be huge changes and I have to say I’m delighted,” says Dr Deborah, There’s something of a renewed interest in contraception which is great. There’s a lot around autonomy and what we call self-care. That’s a really important thing and that comes back to that shared decision making.
“One of the big changes will be in technology. Now we’ve got these huge technological advances with e-health and mobile health which can provide women and men with contraceptive options. We’ve got telehealth… I was just reading about artificial intelligence ‘boxes’ in Kenya which can provide information and answers to young people’s questions. Again, we must remember, it won’t replace face-to-face consultations, but things will change.”
‘Green’ contraception and multi-purpose contraception
Another interesting ‘trend’ in the world of family planning is ‘green’ contraception. As the world becomes more conscious of protecting the planet, women (and men) want more environmentally friendly contraception options.
“We recognise that women want to manage contraception themselves, so there’s things like the Sayana Press which allows women to give themselves the contraceptive injections.
“The other key area is multi-purpose technologies, such as vaginal rings which can prevent HIV or other STIs at the same time as providing contraception. There’s lots of exciting innovations and it has been recognised that the users – whether that’s women or men – they need to be involved from the beginning in the design of these new products.
“The other key development is what we’re calling ‘green contraception’. That’s around recognising climate change – it’s important to consider when we’re thinking about contraceptive methods and we know that women are looking for contraceptives that have a lesser footprint on the environment. For example, methods with lower doses of hormones (like LARCs). […] There’s a real impetus now to look at effective non-hormonal methods of contraception. There’s a renewed interest in contraceptive methods for men too; they’re wanting to take more responsibility and women are accepting of that and want that too.”
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