Women shouldn't be forced to jump through hoops to access contraception and pay for it out of their own pocket when abortion is free and widely accessible, doctors say.
Access to contraception across New Zealand varies widely and a $6 million funding injection in 2019 did little to help, University of Auckland researchers have found.
"The main issue which came through is that while there were some DHBs and primary health organisations which were really tuned into their local population and made a big effort to find out what their local women would want to access and how they could make it easier for them, there were other health boards which didn't really collaborate or canvass local populations to find out what services would work best," Orna McGinn, GP and clinical director of primary care women's health at Auckland DHB, told Newshub.
Nearly half of all percent of pregnancies in New Zealand are unplanned, and despite only recently being taken out of the Crimes Act, UN data shows New Zealand has an above-average abortion rate when compared to other countries.
"There are no invasive questions asked - women require the service, they go to the right place and they get the service and it doesn't cost them anything," said Dr McGinn. "It should be the same for contraception."
The Ministry of Health says they accept that cost is a "key barrier" to Kiwi women accessing contraceptives and they have put in place new funding to give low-income women access to long-acting reversible options.
In 2019 $4.5 million was allocated to DHBs and $1.5 million to Family Planning to boost access to contraception, which Dr McGinn says has a cost-benefit ratio of more than 1:10. Each DHB was 'left to their own devices" on how to spend the money.
But with no "overarching plan" each DHB did something different, due to their varied policies.
"Women have to, in some areas, disclose that they've got a drug or alcohol problem, or a mental health problem, in order to get funded for long-acting reversible contraception... or they've got to disclose that they're suffering family violence," said Dr McGinn. "That really is unacceptable."
Even in Auckland - a single city - the three DHBs have different policies on who can get free contraception and who has to pay.
Only one DHB - Northland - offered free contraception to women with a "chronic health condition that could be worsened with pregnancy", while others would only hand it over if the patient was currently receiving secondary care for mental health and/or addiction.
"There are currently no other medical services in New Zealand that rely on the application of inconsistent non-clinical criteria in order to access funding," the paper, published in the New Zealand Medical Journal on Friday, says.
A Ministry of Health spokesperson said that the variability between DHBs was "reflective of the principle that DHBs are responsible for the provision, planning and funding of health services for their areas".
"Sub-contracts for services, including pricing, were negotiated between DHBs and their local service providers," they said.
Dr McGinn also expressed concern the funding was aimed at increasing access for a particular "target population", defined as women aged 15-44, who live in areas of high social deprivation, have a Community Services Card and are at "higher risk of unplanned pregnancy and poor health and social outcomes".
"The World Health Organisation (WHO) states that 'contraceptive information and services... should not be discriminatory and should aim at eliminating stereotypes and discriminatory attitudes that lead to forced and coercive practices'.
"Offering free contraception to targeted groups of women may cause them to feel that their pregnancies are of less worth to society as a whole, and they may feel under 'implicit pressure' to choose a particular method."
Dr McGinn says contraception should be free to access at primary care, without having to satisfy stringent criteria or seek out non-governmental providers, like Family Planning. She's also calling for a unified women's health strategy, bringing together contraception and other health issues unique to women, such as the HPV vaccine, cervical smears, menopause and pregnancy care.
"All of these things should be joined up and accessible in one place, rather than women having to seek out different places to go for each service - and at each of those points they have to pay. That in itself is inequitable, even before you get into social inequities suffered by some of our more vulnerable women who have problems accessing health services.
"We're really not making it easy for women."
The Ministry of Health spokesperson said they are not considering developing a national women's health service but are working towards building "the quality, consistency and standardisation of contraception services in New Zealand".
"There is strong evidence that reliable contraception is a highly cost-effective way of preventing a broad range of negative health and social outcomes," they said.
"Barriers to contraception include health literacy, waiting times, being time-poor, service acceptability, as well as workforce familiarity and capability. Cost is known to be a key barrier."
The spokesperson said the cost of around $150 for long-acting reversible contraceptives, the most "effective and efficient" forms of contraception, was one of the reasons they put in place funding to allow greater access for low-income women.