Contraceptive use in Australia: evidence from the 1995 National Health Survey.

This paper analyses the patterns of contraceptive use among Australian women, using data from the 1995 National Health Survey. More than 44% of all women aged 18-49 years reported using a method of contraception. Among users, the 2 most commonly reported methods were the pill (60%) and condom (27%); IUD and natural methods accounted for less than 5% each. Sterilizing operations of the women/partner were the most frequently reported reasons for nonuse of contraception in women aged over 35 years, while among the younger women the most reported reasons were pregnancy or trying to get pregnant and not being sexually active. Among pill-users about a quarter were smokers, 20% overweight and 13% reported heart or circulatory disease. These figures were generally lower than in the general population but indicate a need for regular monitoring. The survey demonstrates the continuing evolution in the use of contraception among Australian women.

PIP: This paper presents an analysis of the patterns of contraceptive use among Australian women using the 1995 National Health Survey data. Among the 4.1 million women aged 18-49, 44% were reported to be contraceptive users. The two most commonly used contraceptive methods were pills and condoms, which were used by 60% and 27% of the respondents, respectively. This was followed by the use of IUDs and other methods, which accounted for less than 5% of the subjects. An increasing rate of sterilizations was noted among women aged 45-49, which was nearly twice the rate of vasectomy among their partners. On the other hand, reasons for not obtaining a sterilization among younger subjects included a desire for pregnancy and not being sexually active. Among the women who used oral contraceptives, 25% were smokers, 20% were overweight, and 13% reported heart and circulatory diseases. In a comparison of the 1983 and 1995 health surveys, an increase in oral contraceptive use from 23.2% to 26.7% was noted among women aged 18-49 years. The survey demonstrated the continuing evolution of contraceptive use among Australian women.

Hysterectomy and endometrial ablation in New South Wales, 1981 to 1994-1995.

This study analyses the New South Wales hospital data on hysterectomies from 1981 to 1994-1995, and on endometrial ablations since 1991. The hysterectomy rate declined by about 16% during 1981-1991 and has risen since; the endometrial ablation rate has increased by 28% between 1991 and 1994-1995. Other findings indicate a trend towards older mean age at operation, a swing to vaginal hysterectomy with or without laparoscopy, a shift to private hospitals, and a dramatic decline in length of hospital stay. The majority of endometrial ablations were performed on a day-only basis. Immigrant and Aboriginal women experienced lower hysterectomy rates. Endometrial ablation techniques introduced in the late 1980s, as an alternative to hysterectomy for dysfunctional uterine bleeding, have had a major impact on hysterectomy rates; without these techniques the rates would be much higher.

Female sterilization in New South Wales, 1981 to 1994-1995.

This paper investigates and confirms the dramatic decline in female sterilization in New South Wales over the past decade, a period when male sterilization has remained fairly constant. The most significant decline occurred among women under 30 years of age, which resulted in a rise in the mean age at sterilization. In 1994-1995, 70% of sterilization operations were performed for contraceptive management only, 11% were concurrent with Caesarean section, and 9% with abortion. Incidental findings were an increase in Caesarean section and the proportion of women having concurrent sterilization, and a large decline in intrauterine device removals, more than half of which were accompanied with sterilization in 1994-1995. Currently-married women accounted for 80% of sterilization cases. Immigrant women generally had lower incidence of sterilization compared to the Australian-born.

Family formation patterns among migrant women in Sydney.

A demographic survey among a probability sample of 980 married migrant women was carried out in Sydney in 1988. The sample included 507 Lebanese, 250 Turkish and 223 Vietnamese women. The study revealed differences in family formation patterns within and between the three groups and between them and the general population. Family size had declined among all three groups compared with their family of origin, and it was clear that the younger women would not achieve the same family sizes as the older women. Migrant women tended to marry earlier than the general population and to start their families earlier. While they showed a strong preference for their children to marry within their own ethnic and religious group, nearly one-third said it was up to the choice of the individual. Overall, the future family size of younger migrant women is expected to converge towards the Australian norm. Migrant families are in a state of transition between two cultures which needs to be recognised by health and family planning service providers.

PIP: Data were obtained from a 1988 Demographic Survey among a two-stage probability sample of 980 married migrant women living in Sydney, Australia. Migrants included 507 Lebanese women, 250 Turkish women, and 223 Vietnamese women. Age groups varied among the ethnic groups. All of the Vietnamese migrants arrived after 1975, while 51% of the Lebanese and 55% of the Turkish women arrived before 1975. By 1991-92, the Vietnamese were the third largest group of new migrants, following after the UK and Hong Kong. Educational levels and labor force participation were lower among the Lebanese. Vietnamese women had the highest educational levels, but the lowest levels of skills in English. Only 4% of Vietnamese spoke English compared with 25% of Lebanese and 21% of Turkish women. Vietnamese were primarily Buddhists, while Lebanese were Catholics and Muslims. All Turkish women were Muslim. Over 90% in each ethnic group were married. Separation and divorce was at a low level (under 5%), but higher among the Vietnamese and Turkish women. Most were married only once. The common age at first marriage was 17-19 years among Lebanese and Turkish women and 20-23 years among Vietnamese women. All migrant women married at younger ages than Australian women. All migrant women reported a desire for their sons and daughters to marry later. 97% of Lebanese, 99% of Turkish, and 80% of Vietnamese married men from the same religious group, and 93%, 94%, and 92%, respectively, married men from their own country of birth. Lebanese women had consistently higher fertility at all ages. The average number of live births was 2.61 for the Vietnamese, 2.05 for the Turkish, and 3.83 for the Lebanese. A mother's fertility was not related to a daughter's fertility. Compared with families of origin, family sizes and desires were declining. It is expected that younger migrant women will have a family size that converges with the Australian norm.

Family planning practices among Lebanese, Turkish and Vietnamese women in Sydney.

This paper is based on some of the data collected in a fertility and family planning survey conducted in 1988 among a probability sample of 980 married immigrant women in Sydney. The sample consisted of 507 Lebanese, 250 Turkish and 223 Vietnamese women. This study has revealed differences within and between the 3 migrant groups and the general population. Fertility among the 3 groups, but particularly among the Lebanese, was relatively high. While most women understood about birth control, there was a heavy reliance on traditional methods. Incidence of sterilization and hysterectomy was low compared to the general population. Use of abortions as a method of birth control was quite common among the Turkish women. Most women relied on their doctors for contraceptive advice and there was little knowledge and even less use of family planning and women's health centres. The study revealed an unmet need for culturally sensitive family planning information and services to these women.

Australian teenagers and pregnancy.

PIP: Trends in teenage pregnancy in Australia between 1971-83 and some of the factors which may account for these trends are described. In view of the continuing public controversy surrounding the provision of contraceptive services for teenagers, providers of health education and contraceptive services should carefully evaluate the impact of their programs on teenage pregnancy rates. In the decade prior to 1971, the age-specific birth rate for those aged 15-19 continued to increase while the rate for women between 20-29 years of age declined. The teenage rate peaked in 1971 at 55.2. After 1971, the rate for teenagers began declining, and between 1971-82, the rate declined by 50.3%. In the early 1970's the availability of contraceptive services for teenagers was markedly increased. The trend toward increased services may have followed or paralleled the decline in the teenage birth. The decline in the age-specific birth rate for teenagers was marked between 1971-78 (55.2-28.5). The decline then flattened out between 1978-82 (28.5-27.4). These birth rates must be examined in the context of pregnancy and abortion rates. Abortion data is not routinely collected at the national level. In South Australia abortion reporting is mandatory. Rates for the nation were estimated on the basis of these reports. The estimates indicate that between 1978-82, for those aged 15-19, the number of abortions/1000 females increased from 12.3-21.2 while the number of pregnancies/1000 declined from 66.6-48.5. Two thirds of the decline in the pregnancy rate was attributed to increased contraceptive use and 1/3 to increased reliance on abortion. Between 1971-82, among teenagers, there was a marked decline in the number of maritally conceived pregnancies and in the number of premarital conceptions later legitimatized by marriage. In 1981, among the 28,781 premarital conceptions among teenagers, 49% ended in abortion; 39% in premarital births; and 12% in marital births. Data from South Australia for 1978-83 indicate that for those under 15 years of age, the number of pregnancies and of abortions declined while the proportion of pregnancies which ended in abortion increased. Possible factors which may account for the slowdown in the birth rate decline among teenagers since 1978 are: 1) the increased proportion in the population of those teenagers less likely to use contraceptives, i.e., unemployed and the disadvantaged teenagers; 2) the failure of government expenditures on family planning education to keep pace with inflation; 3) the availability of supporting parent benefit for unemployed teenage mothers; and 4) public opposition toward the provisions of sex education and contraceptive services for teenagers. The marked decline in teenage births which occured in 1971-78 may indicate that family planning programs have thus far reached only teenagers most amenable to family planning. To further decrease the teenage birth rate, program providers may need to increase their efforts to reach the hard core cases.^ieng

Trends in teenage pregnancy in Australia, 1971-1981.

Between 1971 and 1981 the age-specific birth rate among Australian teenagers declined by 49%, faster than in any other age group. This is a reflection of several trends--a decline in the total number of pregnancies indicating better use of contraception, a marked decline in marital births as both the planned births and the ex-nuptially conceived births fell, and a rise in the rates of abortion among teenagers. Since nuptial births declined faster than ex-nuptial births the proportion of ex-nuptial births among teenagers rose from 32% to 57%. However, unmarried teenagers have consistently shown lower rates of ex-nuptial births than other age groups. The options available to young women faced with unplanned pregnancy appear to be changing in emphasis--abortion or single parenthood rather than adoption or forced marriage. The decline may have halted since 1980 and several social factors which may be contributing to the various trends are discussed.