Position statement: Access to sexual and reproductive health services

Sexual Wellbeing Aotearoa generally offers the following sexual and reproductive health services: contraception, sexually transmitted infection (STI) testing and treatment, menstrual and menopause management, pregnancy testing, abortion, cervical screening and investigation of some cancers. While some sexual and reproductive health services treat illness or health problems, most are preventative and promote good health and wellbeing. They prevent cancers, unintended pregnancy, and infection. Sexual and reproductive health care is essential health care.

Sexual and reproductive health services are necessary for people to exercise their human rights including self-determination, bodily autonomy, tino rangatiratanga and mana motuhake. Sexuality is a part of human life, and people have a right to enjoy their sexuality including deciding things like if and when to have a child and taking steps to prevent sexually transmitted infections (STIs). Sexual and reproductive health services help people to have a good quality of life and to make decisions about their bodies and their future.

Some services are particularly important to promoting gender equality in society. For example, ensuring women, girls, and people with diverse gender identities can plan and space pregnancy and effectively manage their periods is necessary for equal participation in society and to ensure equitable social, economic and health outcomes.

People use sexual and reproductive health services over the course of their lives. As young people explore their sexuality, they may need access to sexual and reproductive health services so they can make positive, informed decisions about their own sexual and reproductive health. As young people develop, they increasingly take on greater responsibility for their own decisions. Young people in New Zealand have a legal right to confidential reproductive and sexual health care, as long as they are able to fully understand the risks and benefits and can give informed consent.

Unfortunately, in Aotearoa there are many known barriers to sexual and reproductive health services. Barriers include cost, the location of services, low health literacy, misinformation, and poor coordination between services. There is a lack of health providers who are trained to provide a full range of sexual and reproductive health services, including all types of contraceptive options and non-judgemental STI testing. These barriers contribute to poor and inequitable sexual and reproductive health outcomes, including high rates of sexually transmitted infections (STIs) and unintended pregnancy.

Stigma and discrimination are also big barriers. For example, a young person may not want to ask for contraception because of fear that they will be judged for being sexually active. A person may not want to ask for an HIV test because they might fear being judged about their sexual behaviour.

Barriers are not experienced evenly, with Māori and Pacific peoples, young people, women and girls, refugee and migrant communities, transgender, non-binary, gay, lesbian, queer and intersex people, rural people, people experiencing violence, and disabled people facing the greatest disparity in access to sexual and reproductive health services. This results in unjust and unfair differences in health outcomes.

As the only national provider specialising in sexual and reproductive health services in primary care and health promotion, Sexual Wellbeing Aotearoa plays an important role in Aotearoa. Our services are free to young people under age 22 years, and most of our clients identify as women and girls. We are a leader in contraceptive care and STI testing and treatment. In addition to offering a full range of contraception, Sexual Wellbeing Aotearoa provides non-judgemental testing and treatment, including self-testing. We promote safer sex practices including access to condoms and dental dams to reduce sexually transmitted infections including HIV. We provide training to other health practitioners.

Sexual Wellbeing Aotearoa is a courageous advocate for policy that promotes equity in sexual and reproductive health and rights. Sexual Wellbeing Aotearoa is committed to Te Tiriti o Waitangi and equitable sexual and reproductive health and rights outcomes for Māori.

Sexual Wellbeing Aotearoa advocates for a health system that ensures universal access to sexual and reproductive health services in every community in Aotearoa. To achieve this, there must be expanded access to training for doctors and nurses, services should be free or affordable, easy to get, and should be provided in a way that is culturally safe, confidential and youth friendly. People should have choice of provider, including a specialist sexual and reproductive health care provider in primary care. There should be no shame or stigma with seeking sexual and reproductive health services, which are essential for a good quality of life.

• Sexual and Reproductive Health and Rights – United Nations
• Sexual and Reproductive Health – Te Whatu Ora
• Contraception: Findings from the 2014/15 New Zealand Health Survey
• New Zealand sexually transmitted infection data - ESR
• Medical Council Statement on Informed Consent, including young people