Family Planning

1936 –

Family Planning

1936 –

Theme: Health

Known as:

  • Sex Hygiene and Birth Regulation Society
    1936 – 1939
  • New Zealand Family Planning Association
    1939 – 2008
  • Family Planning
    2008 –

This essay written by Penny Fenwick was first published in Women Together: a History of Women's Organisations in New Zealand in 1993. It was updated by Jackie Edmond in 2018.

1936 – 1993

The organisation which became the New Zealand Family Planning Association (NZFPA) in 1939 was founded in 1936 by a group of Wellington women, including Elsie Locke, as the Sex Hygiene and Birth Regulation Society. Its initial membership was 37. Many of the founders had encountered unhelpful or moralistic advice when they asked their doctor for contraception. As one of them recalled, 'I went to the doctor who, when he finally realised what I was trying to tell him, because I was so inhibited, stood up, opened the door and said, "Madam, you are a wicked woman, leave my surgery."' [1]

This doctor's response illustrated the pro-natalist policies and attitudes of the time, which regarded it as women's duty to have children. Moreover, eugenicist ideas fuelled concern that the children of the 'unfit' would soon outnumber the 'fit' if the latter practised birth control.

In 1937 the McMillan inquiry into the comparatively high incidence of maternal death in New Zealand pointed to the rate of septic abortion among married women. The resulting report recommended that the government establish clinics in public hospitals where doctors could refer patients for instruction in contraceptive methods. [2] In the face of government disinterest in implementing this recommendation, the lobby for family planning strengthened and the organisation grew steadily, to reach over 1000 members at its peak in the 1960s.

Most members were women, but in a few instances men played a prominent role. Those most actively involved were middle class women, though a smaller number of working class women were initially attracted by the services and stayed to become staunch supporters. By 1993 NZFPA had approximately 300 members, over 80 percent of them women.

The aims of the original Sex Hygiene and Birth Regulation Society, as stated in its 1936 constitution, later came to seem conservative: 'to educate and enlighten the people of New Zealand on the need for birth control and sex education, and to promote the provision of facilities for scientific contraception so that married people may space or limit their families in accordance with the requirements of health and economic circumstances'. Establishing its own clinics was not policy at that time. Early efforts concentrated on providing information: as well as the pamphlet Planning for Parenthood, the organisation published Painless Child Birth—Safe and Possible, and the report Houses for Families, including some model floor plans for low-cost housing.

From 1939 on, as the NZFPA, the organisation broadened its aims to include: 'to co-operate and give support where possible to the establishment of women's health centres'. In addition to advice on scientific contraception, the centres were originally intended to offer assistance with sterility, gynaecological ailments and marital difficulties. Assisting in the 'sex education of youth' was also added to the aims at this point.

From its founding, the organisation had seen itself as part of an international movement. It was affiliated to the British Family Planning Association from 1939, and in 1955 became a member of the International Planned Parenthood Federation (IPPF), founded in 1952. It maintained accreditation through five-yearly reviews from 1955 on, which involved meeting a number of criteria to ensure compliance with IPPF standards and responsibilities. A member of IPPF's East and South East Asia and Oceania region, NZFPA later conducted training programmes in the Marshall Islands and Tonga.

In its first twenty years, NZFPA focused on encouraging doctors to become sufficiently knowledgeable about contraception to provide an effective service to married women. At that time no training at all was provided at medical schools, and there were numerous examples of doctors prescribing caps and diaphragms 'over the counter' without any fitting. Despite the generally antagonistic attitude to NZFPA among doctors, a few in each centre were prepared to take referrals, and their names were provided to members of the association on request. However, as one early member recalled, '. . . when a woman went to a doctor that we had recommended and got pregnant, it was not the doctor who got the blame, but NZFPA. So very early in the piece we realised that we had to work very hard to get our own clinics in operation.' [3] In November 1953, the organisation opened its first clinic in Remuera, Auckland. Others opened in Christchurch in 1956, and in Wellington and Dunedin in 1959.

Opening clinics put NZFPA, a lay organisation, into direct competition with general practitioners and led to more overt opposition from them. Doctors had in fact improved little in their provision of contraceptive services since NZFPA was founded. A member recalled encouraging new mothers to ask the hospital doctor about family planning in 1956. 'We'd watch them pluck up the courage and then his indifference and he'd give them no help.' [4]

Matters came to a head in 1959, when the ethical committee of the New Zealand branch of the British Medical Association (BMA), as it then was, considered complaints about NZFPA. In February 1960 it advised its members that it was 'unethical to refer patients to clinics' and that the establishment of clinics by lay associations 'seems to us to come very close to "covering"'. [5]

In June 1960 Dr Alice Bush, a prominent and progressive Auckland doctor, was elected president. She stated, ‘I have accepted the position . . . because I think that this will enable me to act as a liaison officer between NZFPA and the BMA.' [6] Early in 1961 Dr Bush and others met with a special sub-committee of the BMA to put their case, and in July that sub-committee recommended that the ethical committee's former ruling was 'too sweeping and too strict'. It noted with favour that a majority of the members of NZFPA’s national executive were doctors, and that a Medical Advisory Committee had been formed on which a representative of the BMA would be welcomed. [7]

Jean Dawson and Elsie Locke

Two of the Family Planning Associations most prominent pioneers, pictured in the late 1980s. Jean Dawson (left) became the national president in 1939; Elsie Locke (formerly Freeman) convened the first meeting to discuss birth control. New Zealand Family Planning Association.

Thus NZFPA skilfully negotiated its survival in the face of a powerful, organised threat, learning lessons that were to stand it in good stead for the controversies to come. By the 1990s there was general acquiescence by doctors about its activities, and little overt hostility. However, this negotiated survival undoubtedly strengthened the position of doctors within NZFPA, and a lay/ professional tension still ran through the 1980s and 1990s history of the organisation.

There was also underlying tension about whether contraceptives should be made available for the purpose of population control, or to enhance individual choice. In the 1970s and 1980s the organisation continued to adapt its medical, education and counselling services to the changing moral, social and economic climate, and to resolve difficult issues such as the provision of services to unmarried women, and its role in abortion referral. Concerns about the safety of some of the contraceptives that it supplied, including Depo-Provera, led to criticism from feminist health groups. The need for culturally appropriate services for Māori and Pacific women also came under scrutiny. In 1990 Te Puawai Tapu was formed; an autonomous group of Māori women within NZFPA, it focused on the provision of sexuality education and fertility management to Māori. The Christchurch-based Whanau Whakatipu programme involved training Māori women selected by iwi to provide advice in the workplace. A similar programme for Samoan women was under way by 1993.

Penny Fenwick

1994 – 2018

By the early 1990s NZFPA was a health promotion organisation which continued to provide a quality clinical service. It had a $4 million a year contract with the government for the provision of contraceptive services, advertised on television, and operated confidential off-air phone lines on FM stations in Auckland, Wellington and Christchurch. It was also moving proactively into sexuality education programmes for young people, emphasising the responsibilities of young men as well as young women; for example, it ran a rap group taking the safe sex message to Auckland secondary schools, under the joint sponsorship of a pharmaceutical and a record company. However, it was finding that its stance on the basic human right to education about one's sexuality was slower to gain acceptance than the right of access to contraception.

In 1994 President Christine Taylor was on the New Zealand delegation for the landmark International Conference on Population and Development (ICPD) in Cairo, where, for the first time ever, sexual and reproductive rights were affirmed to be human rights. From that time the organisation was a constant presence at ICPD meetings and reviews, working to ensure that these rights were protected and enhanced.

ICPD was a turning point both globally and within the organisation, prompting the establishment in 1996 of an international programmes unit. Some early programmes were undertaken across Asia; however, a particular strength was the focus on the Pacific, which, despite its geographical size, was often absent from global discussions on population and development. From 1996, the organisation worked with and within Pacific countries on population and development issues, including in Kiribati (since 2012) and Vanuatu (since 2018). This region’s issues—high rates of unplanned and teen pregnancy and gender-based violence—were compounded by its scale and the practical difficulties of working across the world’s largest body of water.

The international programmes unit also provided secretariat support to the New Zealand Parliamentarians’ Group on Population and Development (NZPPD), a cross-party political group set up soon after ICPD. Established in 1998 under the leadership of Hon. Katherine O’Regan, this group worked to increase New Zealand’s official development assistance (ODA) for the Pacific region, collaborated with parliamentarians from neighbouring countries to create solutions for these persistent problems, and represented New Zealand on these issues internationally. The group hosted evidence-gathering open hearings on critical Pacific topics: maternal health, adolescent sexual and reproductive health and rights (SRHR), and engaging men and boys in SRHR. By the time NZPPD celebrated its twentieth anniversary in July 2018, with a membership of thirty New Zealand parliamentarians representing four main parties, it was focused on the Sustainable Development Goals (SDGs) set by the United Nations in 2015.

As a result of health sector reforms in the early 1990s, central funding was replaced by funding from regional health authorities and the Public Health Commission, which decided to grant NZFPA funding for its education work separately from funding for its clinic delivery. Although the Commission was disbanded in 1996, this separate funding continued.

A national Sexual and Reproductive Health Strategy (SRHS) was announced by the Ministry of Health in 2001, with a supporting resource book in 2003, outlining the government’s vision for positive and improved sexual and reproductive health for all New Zealanders and how this could be achieved. In 2018 implementation and funding of this and subsequent strategies remained frustratingly incomplete.

In 2002, NZFPA was one of the first organisations to introduce screening for domestic violence: where possible, every female client attending a clinic was to be asked if violence or coercion was an issue, in response to recognition of the impacts of domestic violence on a woman’s ability to use or choose to use contraception – particularly for those seeking a termination. Research found that women who had ever experienced intimate partner violence were more likely to have used contraception than women who had not experienced this, indicating that these women might be more aware than others of the importance of avoiding unintended pregnancy and sexually transmissible infections. A family violence policy and resource manual were developed to support staff to roll out this screening.

Current Family Planning logo

By 2008, NZFPA had dropped ‘Association’ from its name, and became known simply as Family Planning, or Family Planning New Zealand. In March 2009 it announced its intention to become a provider of abortion services, in addition to its ongoing work as a referral agency. Early medical abortion (EMA)—the use of medication to end a pregnancy—had become an option for New Zealand women in 2001. In 2009, Family Planning announced it would provide this service; but the complexities of New Zealand’s abortion legislation meant that this did not become an actuality until 2013, when the organisation gained a licence to offer an EMA service from its Tauranga Clinic.

Family Planning also became more outspoken in its call for a change to abortion laws that had been developed in the 1970s, well before EMA was a possibility and without women at the centre of the process. In May 2018 it made a submission to the New Zealand Law Commission supporting the Labour-led government’s 2018 landmark proposal to treat abortion as a health issue. Family Planning submitted that abortion legislation, under the Crimes Act 1961 and the Contraception, Sterilisation and Abortion Act 1977, was no longer fit for purpose in 2018, from a best practice health care perspective as well as a human rights perspective, and recommended that abortion be removed from the Crimes Act.

By the 2000s, contraceptive options had expanded dramatically since 1936. Long acting reversible contraceptives, or LARCs, included both hormonal and non-hormonal IUDs, as well as the contraceptive implant, with failure rates of less than 1 percent. Family Planning called these devices ‘fit and forget’ – once in place, the user did not need to do anything else, removing the risk of user error. However, women could be put off by the cost. Family Planning pushed for the Jadelle implant to be made available free of charge; in 2010, the government added it to the schedule of subsidised contraception, shifting the cost for many women from hundreds of dollars to zero. The uptake immediately increased, showing how great a barrier cost could be; by 2018 Family Planning clinicians were inserting more than 3000 a year, compared with 400 previously.  Family Planning continued working to get the hormonal IUD added to the subsidised schedule.

Sexuality education was part of the organisation’s work from its inception, and it published its first brochure on this, Where Did I Come From?, in 1942. Sexuality education in schools had been challenging for decades. In 1977 the report of the Committee on Health and Social Education (the Johnson Committee) endorsed the recommendation by an earlier committee that human development and relationship programmes be incorporated into primary schools and be compulsory in secondary schools. In 1980, Education Minister Mervyn Wellington overruled the committee, stating that there was no place in the primary school for group or class instruction in sex education.

The organisation’s position remained consistent and clear: comprehensive sexuality education—covering consent, relationships, anatomy, pornography—was essential to ensure that young people developed the skills, behaviours, knowledge and attitudes to keep themselves safe and to have satisfying and healthy relationships. Sexuality education was introduced in the school curriculum in 1999, and the organisation became a big provider of curriculum-aligned teaching resources. Research increasingly indicated that the most effective sexuality education came from teachers within the school with whom the young person had an ongoing relationship. In 2018, while Family Planning continued to do some direct teaching within schools, its health promotion work was increasingly focused on teacher development and support and working with school communities on consultation. Broader health promotion work was also developed for high-needs young people who were not in education, employment or training.

Over eighty years after its establishment, contraceptive consultations still dominated Family Planning’s clinical services workload. As the largest single provider of sexual and reproductive health services in New Zealand, its 34 clinics provided services through 161,311 client visits. Just over half of all clinic consultations had a contraceptive component. Family Planning clinicians were also able to offer testing and treatment for sexually transmissible infections, pregnancy testing and referral, early medical abortion, cervical screening and much more. While traditional face-to-face appointments dominated the clinical case load, increasingly, phone consultations, self-testing and mobile options were expanding access to services.

From the time of its founding in 1936, the organisation had focussed on issues of access and choice. Starting in 2016, its strategic plan also included a specific focus on equity—a framework called Whakamanahia. This concept of equity, across gender, ethnicity, and geography, increasingly informed its work. Its clinicians developed and implemented expanded options such as phone consultations, so that some clients no longer needed to make a clinic visit, or could come in less frequently. One new offering, self-testing for sexually transmissible infections, made it possible to start clients on the road to treatment without needing to see a clinician.

In 2018 Family Planning was also testing the utility of a web video as a device to capture client consent, reducing the need for multiple clinic visits to access a contraceptive implant. Expanded drop-in clinic hours and the ability to ask for an appointment via a web form were all enhancements specifically designed to address equity, creating easier and more client-focussed access to services. Family Planning continued to work to promote a positive view of sexuality and to enable people to make informed choices about their sexual and reproductive health.

Jackie Edmond

Notes

[1] Fenwick, 1977, p. 118.

[2] AJHR, Vol. III, H31A, 1937-38, p. 19.

[3] Fenwick, 1977, p. 123.

[4] Fenwick, 1977, p. 125.

[5] New Zealand Medical Journal, No.59, 1960, p. 114.

[6] Evening Post, 20 June 1960.

[7] New Zealand Medical Journal, No. 60, 1961, p. 252.

Unpublished sources

Fenwick, Penny, 'The New Zealand Family Planning Association: Its Growth and Development', MA thesis, University of Canterbury, 1977

Hercock, Fay, '”No Talents Wasted . . . No Time Misspent”: An Account of the Early Life and Career of Alice Mary Bush', MA thesis, University of Auckland, 1988

New Zealand Family Planning Association miscellaneous papers, 1931-1946, ATL

New Zealand Family Planning Association Annual Report, 1 July 1990-30 June 1991, NZFPA, Wellington.

Published sources

Fenwick, Penny, 'Fertility, Sexuality and Social Control in New Zealand', in Bunkle and Hughes (eds), 1980, pp. 77-98

Hercock, Fay, 'Professional Politics and Family Planning Clinics', in Linda Bryder (ed.), A Healthy Country: Essays on the Social History of Medicine in New Zealand, Bridget Williams Books, Wellington, 1991, pp. 181-197

Houston, Perdita, The Right to Choose: Pioneers in Women's Health and Family Planning, Earthscan, London, 1992

New Zealand Family Planning Association, That Certain Thing, fiftieth anniversary video, 1986

Smyth, Helen, Rocking the Cradle: Contraception, Sex and Politics in New Zealand, Steele Roberts, Wellington, 2000

Further Resources:

Family Planning website: http://www.familyplanning.org.nz/

Te Ara Story: Contraception and sterilisation

Family Planning Leaflet: https://teara.govt.nz/en/interactive/27007/family-planning-means

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