The early LARC catches the sperm: a qualitative and normative exploration of proactive provision of contraception in Aotearoa

New Zealand adolescents are at risk of unintended pregnancy; by not routinely using contraceptives, or using methods with higher failure rates. Adolescents face barriers accessing most forms of contraception, including long-acting reversible contraceptive methods. Addressing the barriers could improve uptake of effective methods of contraception, reducing the risk of unintended adolescent pregnancy. On these grounds, I investigated the concept of proactive long-acting reversible contraception provision, with tiered contraceptive counselling. Before assessing costs and feasibility of a proactive programme, the acceptability of such a programme should be determined. To gauge acceptability, I consulted with New Zealand adolescents (recipients), and New Zealand general practitioners (providers) using a qualitative research methodology. I then conducted a normative ethical inquiry of the ethical issues surrounding proactive contraception provision. I consulted with female adolescents in four focus groups. We discussed topics of sexual health, contraception, and specifically discussed proactive long-acting reversible contraception provision. I performed nine general practitioner semi-structured interviews – these began with discussion of adolescent sexual health, contraception, and then discussed proactive long-acting reversible contraception provision. I used a general inductive thematic analysis approach to analyse transcripts. The focus group and interview participants were generally positive about the concept, emergent focus group themes were reproductive health fear, sex and body shame, adolescents’ requirements for sexual health provision, barriers to contraception, and sexual health knowledge, Emergent interview themes were contraceptive decision making, the general practitioner role, sexual activity, social context, gauging adolescent understanding, and youth. These focus groups and interviews indicated that the concept of proactive long-acting reversible contraception provision is acceptable to both adolescents and to general practitioners. The focus groups and interviews prompted me to shift my position from a proactive long-acting reversible contraception provision model to a proactive contraception provision model which did not focus on long-acting reversible contraceptives alone. This shift was a response to what the findings of the empirical work suggested, as proactive contraception provision should allow for the needs of a wider range of adolescents to be met. To further explore the topic, I undertook a normative ethical inquiry, exploring the benefits and harms of a proactive contraception provision model. From this, I determined that proactive contraception provision could enhance reproductive autonomy, while providing benefits that would outweigh any potential harms. Proactive contraception provision to increase adolescent uptake of effective contraceptive methods is therefore a concept worth pursuing. Such an initiative would improve adolescents’ contraceptive knowledge, and could decrease unintended teenage pregnancy by empowering adolescents to control their fertility in a way that suits them