title: Pounamu: E Hine: access to contraception for indigenous Mãori teenage mothers.
abstract: INTRODUCTION Timely and equitable access to contraception enables teenage mothers to make informed choices about their sexual and reproductive health. This study aimed to identify barriers and facilitators to contraception for Māori teenagers who become mothers. METHODS 'E Hine' is a longitudinal qualitative Kaupapa Māori (by Māori for Māori) study involving Māori women (aged 14-19 years), following them through pregnancy (n = 44) and the birth of their babies until their babies' first birthdays (n = 41). This analysis focusses on contraception access pre-and post-pregnancy. FINDINGS Pre-pregnancy most participants accessed contraception or advice. Contraception use was compromised by a lack of information, negative side effects, and limited follow up. All reported their subsequent pregnancies as unplanned. Participants gave considerable thought to post-pregnancy contraception. Despite this many experienced clinical and service delays, financial barriers, and negative contraceptive side effects. There was little focus on contraception initiation and a lack of integrated care between midwives and other primary care services, leaving many participants without timely effective contraception. The system worked well when there was a contraception plan that included navigation, free access, and provision of contraception. CONCLUSION The majority of participants actively sought contraception pre- and post-conception. Despite a publicly funded system, a lack of health sector integration resulted in multiple missed opportunities to meet the needs of these teenagers for effective contraception. Health service funding formulas should define the goal as initiation of contraception rather than advice and provide funding to improve timely access to long acting reversible contraception. KEYWORDS Indigenous teenage pregnancy; contraception; barriers to contraception; Māori mothers.
authors.affiliation: Women's Health Research Centre, Department of Primary Care, University of Otago, Wellington, New Zealand. Email: bev.lawton@otago.ac.nz.
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawton
authors.affiliation: Women's Health Research Centre, Department of Primary Care, University of Otago, Wellington, New Zealand.
authors.forename: Charrissa
authors.initials: C
authors.lastname: Makowharemahihi
authors.affiliation: Director, Katoa Ltd, Auckland, New Zealand.
authors.forename: Fiona
authors.initials: F
authors.lastname: Cram
authors.affiliation: Director, Te Ropu Rangahau Hauora a Eru Pomare, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Bridget
authors.initials: B
authors.lastname: Robson
authors.affiliation: Resource Development, Te W?nanga o Aotearoa, University of Otago, Wellington, New Zealand.
authors.forename: Tina
authors.initials: T
authors.lastname: Ngata
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000208:ethnology*; D049168:Pregnancy, Unplanned / Q000208:ethnology; D011320:Primary Health Care; D036301:Qualitative Research; D055815:Young Adult