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Family Formation: Family planning
In 1934 Australia's crude birth rate was at a level lower than ever previously experienced. From this low point in the middle of the great depression, the birth rate increased through the war years and the baby boom years that followed, stabilising in the 1950s. The total fertility rate followed a similar pattern, reaching its highest point in 1961. From that time both rates declined, and during the 1980s and 1990s were at levels well below the rates of 1934 (see Australian Social Trends 1996, Trends in fertility).
Other changes occurred in family formation patterns. In 1934 about 18% of married mothers who gave birth in that year had already had at least four children. In 1951 the proportion had halved, but increased again in 1961. By 1981 the proportion of women giving birth who were having a fifth or higher order child was insignificant.
The timing of first births also changed over the period. The median age of married mothers when they had their first babies was lowest in 1961 and 1971, then increased markedly between 1971 and 1981, and again to 1991. Delays in starting child bearing are undoubtedly associated with the increasing participation by young women in education and labour force activities.
Source: Australian Demography; Births, Australia (cat. no. 3301.0).
Development of birth control in Australia
Evidence given to the 1903-1904 NSW Royal Commission on the Decline of the Birth-Rate in NSW showed that a wide range of birth control methods was being used at the time, including withdrawal, douches, sponges and pessaries, and condoms1.
The diaphragm, an important female-controlled method, was introduced into Australia in the 1920s. Another significant influence on contraceptive practices was the Papal Encyclical of 1930, Casti Connubi, which identified periodic abstinence as the only licit form of contraception.1 (This remained an important influence as there has always been a significant proportion of Roman Catholics in the Australian population, ranging from 20% at the 1933 Census to 27% in 1996.)
The introduction of the oral contraceptive pill in 1961 and the new versions of the intra-uterine device (IUD) available from the mid-1960s brought about major changes in contraceptive practice. Use of many of the older methods declined markedly.
The technological revolution
The oral contraceptive pill was approved for distribution in Australia in 1961, upon the written prescription of a medical practitioner. Access was therefore under the control of doctors, and dependent on their attitudes, particularly with regard to prescribing for unmarried women.2
The oral contraceptive has two distinctive features: the actual use of the pill is controlled by the woman taking it, and the protective effect is continuous. The IUD also provides continuous protection. However, both methods can be accompanied by possible significant side-effects, which may discourage long-term usage.
Another development of the 1970s and 1980s was the increasing use of voluntary sterilisation procedures. Developments in surgical techniques, and the resolution of legal and ethical issues associated with sterilisation, made these procedures more widely acceptable.3
Although public acceptance of contraceptive use seemed well established, there was little official government action in this field until the 1970s. In December 1972 the Federal government removed the sales tax on all contraceptives, then standing at 27.5%, and included the pill on the Pharmaceutical Benefits Schedule, thus reducing the cost markedly. In addition, restrictions on advertising contraceptives were removed in the ACT, under Federal administration at the time. In following years Federal financial support was provided for a range of family planning information and education programs. State governments provided varying levels of support in their jurisdictions. State-based restrictions on advertising contraceptives and family planning services were gradually liberalised. Family planning was generally recognised as a major preventive health measure.2
USE OF CONTRACEPTIVE PILL
Taking the pill
Data from the 1971 Melbourne Family Formation Survey indicated that overall 26% of wives aged under 45 years were using the pill as their main method of contraception during 1970-71.4
In 1977, data from the first national health survey showed that 20% of women aged 18-49 years had taken birth control pills in the two days before interview. (This figure would be an underestimate of total use because of the reference time period; the medication regime at the time provided pills for three weeks, leaving the fourth week of the cycle without any intake).
In 1983, 24% of this age group had taken contraceptive pills in the previous two weeks. In 1989, 28% reported they were taking oral contraceptives (for any reason); in 1995 the proportion was 27%. Over the entire period, the highest proportion of pill users was the 20-24 year age group, followed by those aged 25-29 years.
The proportions of younger women taking the pill increased markedly between 1977 and 1989, particularly among those aged 18-19 years. Part of the increase is likely to reflect the increasing willingness of doctors to prescribe the pill for unmarried women.
In 1977, among women aged 30 years and over, the proportions taking the pill were lower than for the younger age groups; although there was some increase in use over the period it was not so great as for the younger women. A small increase occurred between 1989 and 1995 for older age groups, whereas pill use by younger women declined.
Contraceptive use in the 1990s
As part of the National Health Survey in 1995, information was collected about use of the contraceptive pill and other temporary contraceptive methods by Australian women aged 18-49 years (or their partner where appropriate). Women were also asked why they were not using these temporary methods; such reasons could include trying to get pregnant, not being sexually active or permanent protection provided by sterilisation operations.
Overall, two thirds of women aged 18-49 years either were using one of the temporary contraceptive methods or they or their partner had undergone a sterilisation operation. A further 12% were not sexually active, and 6% were pregnant or trying to get pregnant. The remaining women gave a variety of other reasons, or no reason was recorded.
The contraceptive pill remained the primary method reported by 40% of contraceptive users. Around a third had permanent protection through tubal ligation, hysterectomy or their partner's vasectomy and 18% used condoms. Use of some older methods, such as the diaphragm and withdrawal, had diminished.
TYPE OF CONTRACEPTION USED BY WOMEN AGED 18-49, 1995
Patterns of use and age
The use of contraception now appears well established in all age groups between 18 and 49 years. The group aged 18-19 years, who reported the lowest usage, at 50%, also had the highest proportion not sexually active (34%).
In the younger age groups contraception was mainly restricted to the pill or condoms. The level of use of the latter method may also be related to the additional function of condoms in controlling the spread of infections, and the emphasis given to this in information campaigns.
Overall about the same proportions (3%) of women relied on periodic abstinence ('natural' or rhythm methods) and IUDs. Nearly half (47%) of those using IUDs were aged 40 and over, whereas the users of abstinence methods were more likely to be in their 30s.
Use of sterilisation is closely related to age/life-cycle stage, as such operations are generally considered irreversible. Women undergoing hysterectomies performed for various medical reasons also acquire permanent contraceptive protection. This operation is also more common in older age groups.
The proportions of women protected by female or male sterilisation operations increased rapidly after age 30. In the age group 35-39 years the proportion using the two major temporary methods, the pill and condoms, was almost the same as the proportion sterilised. In the older age groups the proportion with partners who had had vasectomies remained relatively stable. However, with the increasing numbers of hysterectomies reported in the older age groups, the proportion with female sterilisations increased to 50% of contraceptive users aged 45-49 years.
A large proportion of those aged under 25 reported they were not sexually active, and not using any contraceptive method. Among the group aged 25-34, 11% were pregnant or trying to get pregnant and therefore not using contraception.
Patterns of use and single women
In the past thirty years a revolution has taken place in community attitudes relating to sexual activity outside registered marriage. It has been accepted for some time that 'no account of contraceptive practice can any longer concentrate wholly on the married'1.
In 1995 the majority (62%) of women aged 18-49 years were living with a partner, with or without children, and another 10% were single parents living with their children. 12% were daughters (or other relatives), not themselves married, living with their parents, and 13% were single women living by themselves or with non-relatives.
Half of the young women living with their parents used some form of contraception; 69% were using the pill and 27% condoms.
Of the single women living alone or with non-relatives, 61% were using contraception. Again, the majority were using the pill (61%) and 24% used condoms.
This pattern of use is probably related as much to age as to marital status. Women living with a partner used a wider range of contraceptive methods, and a substantial proportion were protected by sterilisation operations.
Termination of pregnancy
Termination of pregnancy is rarely used as a regular contraceptive method. It is generally a response to unintended pregnancy resulting from contraceptive failure or unplanned sexual activity.
In the year ending June 1996 there were around 95,200 terminations of pregnancy, as recorded in claims on Medicare and public patient hospital admission records.5 Approximately 27% of known pregnancies ended in termination during the period. (The total of known pregnancies does not include those ending in miscarriage or still-birth.)
1 Economic and Social Commission for Asia and the Pacific, 1982, Country monograph series
no 9: Population of Australia, United Nations, New York.
2 Siedlecky, S. and Wyndham, D. 1990, Populate and Perish, Allen & Unwin Australia Pty Ltd, Sydney.
3 Santow, G. 1991, Trends in contraception and sterilization in Australia, Australian & New Zealand Journal of Obstetrics and Gynaecology, vol.31, no. 3.
4 Lucas, D. 1983, Australian family planning surveys: some problems of comparability, Journal of Biosocial Science: vol 15.
5 Department of Health and Family Services Medicare Statistics; Australian Institute of Health and Welfare, National Hospital Morbidity Database, unpublished data.