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| Journal of the New Zealand Medical Association,
30-January-2004, Vol 117 No 1188
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Pregnancy planning by mothers of Pacific infants recently
delivered at Middlemore Hospital
Janis Paterson, Esther Tumama Cowley, Teuila Percival and
Maynard Williams
The rapidly growing population of Pacific peoples living in
New Zealand is partly due to immigration levels but more significantly to the
high fertility rate of Pacific women.1 High
Pacific birth rates have also been described as due to low utilisation of
contraception and a cultural preference for large
families.2,3 There is evidence that Pacific
women in New Zealand have the highest rate of unplanned pregnancies and
abortions across all age groups, with a high number of hospitalisations of
Pacific women due to pregnancy, childbirth and health services relating to
reproduction.2
Ethnic differences in the planning of pregnancy may be due
to women in many communities having aspirations about reproduction and
contraception different from their partners.4,5
A study carried out in Tonga found that contraception was described as a female
responsibility, with limited knowledge and usage among males, and little
discussion between partners.5 There are few
studies of contraceptive practices and values among Pacific families in New
Zealand; however, it is thought that the male partner has the main role in
determining family size.6 Within Pacific
communities, cultural mores are likely to be the biggest obstacle to effective
family planning.7 Asiasiga concluded that
Pacific people regard sexuality and contraception as subjects not spoken of in
the home.7 There is no word for sex in some
Pacific languages,8 a very strong message of no
sex before marriage,6,8 and women are not
encouraged to use contraception.9
Some Pacific women, particularly older women, may use
abortion as a form of contraception,10,11 which
is partly due to the traditional expectations of their
spouses.6 In a recent study tubal ligation was
found to be the preferred contraceptive option for the wives of the older
Pacific men, and older Pacific men were found to be less likely to have
vasectomies than their Palagi (European) counterparts, some claiming
‘traditional cultural reasons’. However, younger, New Zealand-born
Pacific males described contraception as part of a strategy on which both
partners can work together for their future. It has been suggested that this
shift in attitude may be due to the younger males being better informed, better
educated and more acculturated into New Zealand
society.6
The purpose of this paper is to describe pregnancy planning
by mothers of Pacific infants and to examine the maternal and socio-demographic
factors associated with non-use of contraception (unplanned
pregnancy).
MethodsData were collected as part of
the Pacific Islands Families: First Two Years of Life (PIF) Study. The PIF Study
is a longitudinal investigation of a cohort of 1398 infants born at Middlemore
Hospital, South Auckland, during the year
2000. Middlemore Hospital was chosen as
the site for recruitment of the cohort as it has the largest number of Pacific
births in New Zealand and is representative of the major Pacific ethnicities.
All potential child participants were selected from live births at Middlemore
Hospital where the child had at least one parent who identified as being of a
Pacific Island ethnicity and also a New Zealand permanent resident. Recruitment
procedures occurred through the Birthing Unit in conjunction with the Pacific
Islands Cultural Resource Unit, which provided a daily list of Pacific
admissions.
Approximately six weeks after the birth of their child,
mothers were visited in their homes by Pacific interviewers fluent in both
English and a Pacific language. Once eligibility criteria were established and
informed consent was gained, mothers participated in one-hour interviews
concerning the health and development of the child and family functioning. Each
interview was carried out in the preferred language of the mother. All
procedures and interview protocols had ethical approval from the National Ethics
Committee. Detailed information about the cohort and procedures is described
elsewhere.12 Birth mothers were interviewed
about the planning of their pregnancy. Mothers were asked if their pregnancy was
planned, if the pregnancy was unplanned, the form of contraception used, or, if
not used, their main reasons for not using contraception. Maternal and
socio-demographic factors that may be associated with not planning a pregnancy
and not using contraception were assessed by univariate and multivariate
procedures.
ResultsNinety six per cent (n =1590) of
potentially eligible mothers of Pacific infants who had been born between 15
March and 17 December 2000 gave consent to be visited in their homes when the
infant was six weeks old. Of the 1477 mothers contacted and who met the
eligibility criteria, 1376 (93.2%) agreed to participate in the study. A more
conservative recruitment rate of 87.1% would include mothers who consented to
contact and were (a) confirmed eligible, or (b) of indeterminable eligibility
due to inability to trace.
Table 1. Numbers (row percentages) and univariate odds
ratios for non-use of contraception by mothers following unplanned pregnancies
by selected variables
*includes mothers identifying equally with two or more
Pacific Island groups, equally with Pacific Island and non-Pacific Island
groups, or with Pacific Island groups other than Tongan, Samoan, Cook Island
Maori or Niuean
†p <0.01;
‡p <0.001;
§p <0.05
Of the 1376 mothers in the cohort (1.7% gave birth to
twins), nine adoptive mothers and two foster mothers were eliminated. Of the
1365 remaining birth mothers, 47.2% self-identified their major ethnic group as
Samoan, 21% as Tongan, 16.9% as Cook Islands Maori, 4.3% as Niuean, 3.4% as
Other Pacific, and 7.2% as Non-Pacific. The Other Pacific group includes mothers
identifying equally with the Pacific and Non-Pacific groups, or with Pacific
groups other than Samoan, Tongan, Cook Island Maori or Niuean. The Non-Pacific
group refers to mothers of infants fathered by Pacific men. The mean (SD) age of
mothers was 27 (6.2) years; 80.5% were married or in de facto partnerships;
33.0% of mothers were born in New Zealand; and 27.4% had post-school
qualifications.
Forty per cent of the mothers reported that they had planned
their pregnancies. Of the 60% of mothers who had not planned their pregnancy,
70.8% were not using contraception when they conceived. The main reasons given
by mothers for not using contraception were that they never thought about
contraception (46.8%), did not like using contraception (42.5%), decided to take
a chance (39.4%), did not want to risk the associated weight gain (30.4%), and
did not think they could have a baby (17.3%). For mothers who were using
contraception when they conceived (29.2%), the main methods of contraception
used were the pill (15.0%), condoms (6.7%), and the contraceptive injection
(6.1%). There were no maternal reports of vasectomy in male partners and only
three mothers reported having a tubal ligation.
Table 1 lists the variables examined for potential
association with non-use of contraception for birth mothers who had unplanned
pregnancies. For the categories within each variable the numbers and percentages
of mothers who did not use contraception are given, along with the associated
odds ratios. Mothers with no post-school qualifications, who were not born in
New Zealand, who were strongly aligned with Pacific way of life and customs, and
who were not fluent in English were significantly (p <0.05) more likely not
to have used contraception. The variables of maternal ethnic group, age, parity,
religion, social marital status and years lived in New Zealand did not reach
significance in association with the non-use of contraception.
When controlling for the effects of all the variables in
Table 1 in a multiple regression model, factors that remained significantly
associated (p <0.05) with non-use of contraception by birth mothers who did
not plan their pregnancy were lack of post-school qualifications and reporting a
strong alignment with Pacific way of life and customs.
DiscussionA woman’s ability to space or
limit the number of her births has a direct impact on her health and wellbeing.
Effective family planning not only affects the social and economic circumstances
of women and their families, but can also improve the chance of healthy
pregnancy outcomes.13 The high rate of
unplanned pregnancies (60%), the majority of which were due to not using
contraception (70.8%), reported by this cohort of Pacific mothers in New Zealand
is in line with other reports.2,3 In New
Zealand, overall contraceptive use by married women of child-bearing age is
reported to be 75%, compared with 34% in Samoa and 63% in the Cook
Islands.14 Although the present study is not a
Pacific contraceptive-use prevalence study it does highlight that a large number
of women in this cohort did not plan their pregnancy and did not avail
themselves of the various contraceptive services available to them. The poor
access to, or use of, family planning indicated by these findings adds to the
general picture of poor access to effective healthcare for Pacific
peoples.15–17
The overcoming of cultural barriers towards the use of
contraception was described a decade ago as a major hurdle facing Pacific-health
workers.9 The taboo around talking about
sexuality and contraception within Pacific families has been well documented by
Pacific writers.6–8 Such barriers appear
to persist, with significant numbers of mothers reporting that they did not
think about contraception, did not like using contraception, and did not think
they could have a baby. The reasons for not using contraception appear to be
linked to lack of information or awareness about family planning services or
methods.
Although the findings of the PIF Study demonstrate that
information about effective family planning has not reached a number of Pacific
women, it is suggested that with the increasing number of Pacific people born
and educated in New Zealand contraception use and planned pregnancies may
increase in the future. The factors significantly associated with non-use of
contraception in unplanned pregnancies were not having a postgraduate education
and reporting a strong alignment with Pacific way of life and customs. Other
variables, although significant only at univariate level, were non-fluency in
English and being born in a Pacific Island. Taken together, these findings
reflect a similar profile to that suggested by Anae et
al,6 and show that mothers who have more
resources to support their lives in New Zealand (eg, higher education) are more
likely to use contraception. The findings showed that the women in this cohort
did not avail themselves of the various contraceptive services available to
them. It is likely that the importance of family planning is low in Pacific
communities. An investigation into the dynamics of contraceptive use and the
accessibility and acceptability of family planning services needs to be
undertaken to ensure that services are delivered in a way that maximises
fertility choices.
Author information:
Janis Paterson, Associate Professor, Co-Director; Esther Tumama Cowley, Pacific
Development Manager, Pacific Islands Families: First Two Years of Life Study,
Auckland University of Technology; Teuila Percival, Co-Director, Pacific Islands
Families: First Two Years of Life Study, Auckland University of Technology and
Kidz First Children’s Hospital and Community Services, South Auckland
Health; Maynard Williams, Senior Research Fellow and Statistician, Faculty of
Health Studies, Auckland University of Technology, Auckland
Acknowledgments: The
PIF Study is supported by grants awarded from the Foundation for Research,
Science, and Technology, the Health Research Council of New Zealand, and the
Maurice and Phyllis Paykel Trust. We thank the families who have participated in
the study, the Pacific Peoples Advisory Board, and other members of the research
team.
Correspondence: Dr
Janis Paterson, Faculty of Health Studies, Auckland University of Technology,
Private Bag 92006, Auckland. Fax: (09) 917 9877; email: janis.paterson@aut.ac.nz
References:
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