Plain English summary
Background
Methods
Eligibility criteria
Information sources
Search strategy
Study selection
Data items
Quality assessment
Narrative synthesis
Cultural guidance
Results
Characteristics of included studies
First Author | Aim | Design | Location | Participants | Key Findings & Limitations |
---|---|---|---|---|---|
Bryant 2011 [27] | Explore condom use in the context of sexual risk behaviour and STI transmission | Quant (survey) | NSW (34% from regional, remote or rural areas) | 293 Aboriginal men and women, aged 16–30 years | • Majority of participants were sexually active but condom use was inconsistent, intermittent or non-existent • Potential bias due to non-probability sampling, public recruitment and self-reported data |
Cox 1972 [28] | Explore contraceptive practices, and acceptability of contraception | Qual (NRa) | SA (one remote community) | 108 Pitjantjatjara women | • Overview of contraceptive practices and attitudes in community, and recommendations for culturally appropriate care • Study methodology and participant demographics not reported |
Gray 1987 [29] | Explore the family planning practices among women, in the context of (reported) fertility decline among Aboriginal people in the 1970’s | Qual (NR) | NSW, SA, WA, QLD (five communities) | 251 Aboriginal women, aged 15–50 years | • Most women were aware of the contraceptive methods available to them • Over half of the women approved of contraceptive use in some circumstances, such as to space apart children • Clear differences of opinion seen between five distinct communities • Substantial number of women claimed no opinion in relation to one of the specific or general uses of family planning, highlighting sensitivity of the topic area • Little information regarding the methodology employed and participant demographics not adequately reported |
Griffiths 2016 [5] | Assess the use, effectiveness and acceptance of prescribed contraception in three communities (focus on LARC) | Mixed (Retrospective file review, semi-structured interviews) | WA (three remote communities) | Health records of 191 Aboriginal women, aged 12–50 years 20 additional women were interviewed | • High rates of LARC uptake, continuation rates comparable to those reported elsewhere, suggesting the acceptability of these methods. • Contraceptive use potentially under-reported in these communities • Women not using contraception were not represented |
Helmer 2015 [23] | Examine sexual behaviour and decision making in the context of everyday life experience and aspirations of Indigenous and non-Indigenous Australians | Qual (Group discussions, body mapping, interviews) | NT, WA, SA (urban and rural sites) | 171 total participants, 88 of which identified as Indigenous, aged 16–25 years | • Sex education provided in schools did not meet the needs of young people studied • Findings limited to the context of sex education • Condoms were the only form of contraception discussed in the paper |
Ireland 2015 [30] | Explore and describe young women’s behaviour and knowledge in relation to sexual health | Qual (Ethnography) | NT (one remote community) | 12 Aboriginal women aged 16–33 and 19 Aboriginal women aged 40–90 | • Lack of sexual health knowledge and risky sexual behaviours reported • Women dissatisfied with the physical consequences of their contraceptive method were unaware of alternative choices • Lack of generalisability to the broader population (little participant demographic information reported) |
James 2018 [31] | Examine the factors influencing postpartum contraception | Qual (semi-structured interviews, focus groups) | QLD (one urban Community-Controlled Health Organisation) | 17 Aboriginal women aged ≥16 years, who were less than 12 months post-partum | • Most participants reported a desire for postpartum contraception, but reported barriers to accessing and using their preferred methods • Sample did not include Torres Strait Islander women and had limited representation of women from remote areas |
Johnston 2015 [26] | Describe the views of sexual health service providers on access issues for young people and consider them with the views of young people themselves | Mixed (semi-structured interviews, survey) | QLD (four towns, regional and rural) | 32 service providers (2 Aboriginal health workers) and 391 young people aged 15–24 years (11.3% Aboriginal and/or Torres Strait Islander) | • Attitudes of service providers and their relationship with youth are more significant to young people than currently perceived by service providers themselves • Only briefly reported on factors influencing contraceptive use for Aboriginal and Torres Strait Islander youth. Sampling strategy purposive, may be some selection bias |
To explore the attitudes to pregnancy and parenthood among a group of Indigenous young people To gain an understanding of the attitudes and behaviours of Indigenous young people regarding relationships, contraception and safe sex | Mixed (Survey, focus groups) | QLD (Townsville) | 186 Indigenous people aged 12–18 years, and 10 Indigenous women with children or pregnant | • Many held idealised notions of parenthood • Motherhood was considered transformative, and an opportunity to make positive lifestyle changes for the sake of the baby • Small number of interview participants (N = 10) limits generalisability, limited reporting of survey (N = 186) and focus group results (N = 59) • Nearly half of participants were sexually active • In survey responses, 60% of participants reported condom use, and 26% reported hormonal contraceptive use • Barriers to use were reported • Self-reported data, sample not representative or generalisable | |
Mooney-Somers 2012 [24] | Examine how young Indigenous Australians keep themselves healthy and protected against STIs | Qual (Interviews) | QLD (Townsville) | 45 men and women aged 17–26 years who self-identified as Aboriginal and Torres Strait Islander, at risk of or experiencing homelessness | • Health behaviours are complex, and not static over time • Condom use contingent on sexual partner, relationship, context and access • Focus of the paper is homelessness, and findings should be interpreted within this context |
Review the attitudes of Aboriginal women towards family size, spacing and planning, and explore attitudes towards childbearing and family planning | Qual (Interviews) | Northern Australian community | 92 Aboriginal women, aged ≥15 years | • Lack of culturally appropriate services in community • Many participants had positive attitudes towards contraception, and reported preferences for family size and spacing • Little methodological information provided | |
Roberts 1997 [32] | Investigate the attitudes of Aboriginal women towards the use of condoms to prevent HIV and other STIs | Qual (Interviews) | NT (Darwin) | 12 Aboriginal women, aged 19–44 | • Although participants were aware of condoms and their protection against STI’s, few used them, and they were generally considered unfavourably • Small study of limited generalisability. All participants were students in university preparation courses |
Explore family planning and contraceptive practices among Aboriginal women | Qual (Semi-structured interviews) | QLD (Brisbane) | 236 Aboriginal women | • Oral contraceptives were the most popular method used, although many reported unintended pregnancies in the context of contraceptive use • Experiences of side effects impacted continuation rates • Little methodological information provided and participant demographic information lacking | |
Scott 2015 [25] | Explore sexual risk and healthcare seeking behaviour among Aboriginal and Torres Strait Islander youth | Quant (Survey) | QLD (Townsville) | 155 Aboriginal and Torres Strait Islander people, aged 16–24 years | • Three quarters of participants reported carrying condoms at least sometimes, and 82% had used a condom in their last casual sexual encounter • Men were more likely to report condom use than women. • Non-random selection of sample not generalisable to broader population • Peer interviewers known to participants, which may have impacted responses to the interviewer-administered survey • Data self-reported, which may be subject to recall bias |
Stark 2007 [33] | Examine current levels of knowledge regarding STIs and their transmission, perception of risk of STIs, patterns of, access to and experiences with negotiating condom use | Qual (Interview) | NT (one remote community) | 24 Aboriginal women, aged 18–35 years | • Poor knowledge of STI transmission, limited condom access and limited condom use was reported • Sexual activity in the context of alcohol use, reduced ability and/or desire to negotiate condom use • Small sample limits generalisability. • Participant responses may have been impacted by relationship with the researcher (a non-Aboriginal woman and nurse in the community), cultural and linguistic misunderstandings in questions and answers, and sensitive nature of the face-to-face interviews |
Williams 2015 [34] | Describe the sexual health behaviour, alcohol and other drug use and health service use among young people | Quant (Survey) | WA (Perth, and south-west WA) | 244 Aboriginal men and women, aged 16–30 years | • Participants initiated sexual activity at a young age • Men reported carrying condoms more often than women, and men also reported use at last casual sex more often than women • Data should be interpreted cautiously, as there were high non-response rates to questions about sexual behaviours |
Willis 2003 [35] | Report on the culture-specific barriers that masculinity poses to preventing HIV transmission among Pitjantjatjara men. | Qual (Ethnography) | NT (remote communities) | Pitjantjatjara and Yankunytjatjara men | • Significant cultural barriers to condom use were reported • Little methodological information provided, and participant demographics lacking |
Quality assessment
Factors influencing contraceptive use
Social Ecological Model Level | Theme | Factors influencing non-use | Factors influencing use |
---|---|---|---|
Intrapersonal | Knowledge | • Misperceptions/misinformation about implant [5] • Lack of knowledge about sexual and reproductive health generally [18] • Do not know where to access condoms in community, how much they cost, or know where but not how [32, 33] • Overwhelming information on internet, difficult to identify reliable information [31] | • Able to identify sources of credible information regarding sex and contraception in the community [25, 31] • Knowledge of advice regarding safe sex and contraception [34] • Know condoms are preventative against HIV [32] • Knowledge about some available contraceptive methods [30] |
Shame, embarrassment | • Women felt ashamed and shy about accessing condoms [30] • Embarrassment and shame prevents buying or accessing condoms [24] • Shame and embarrassment in talking about family planning and contraception with health care providers, parents, sexual partners, in school settings, etc. [18, 26, 33] • STI’s not considered shameful in a South-East Northern Territory community, as genital infections are common among men who have undergone the ritual subincision of the penis [35] | • Women reported being able to access and carry condoms without stigmatisation [24] | |
Female specific | • Women typically not responsible for condoms [32] • Desire to not use contraception [31] | • Desire to use contraception [31] • Clear fertility intentions and plans for (future) pregnancy [31] | |
Male specific | • Men assume condom use is women’s responsibility [23] • Men refuse to wear a condom [24] | • None reported | |
Contraceptive specific | • Condoms considered protection for men only [32] • Women typically not responsible for condoms [32] • Men assume condom use is women’s responsibility [23] • Condoms impact men’s sexual pleasure (and sometimes women’s) [32] • Condoms primarily considered for STI, not pregnancy, prevention [32] • Negative experiences or unwanted side effects with hormonal contraception, leading to discontinuation or ‘taking a break’ [5, 21, 22, 30] • Dissatisfaction with available methods [31] | • Positive experiences with contraceptive implant [5] • Positive side effects, including lighter periods [5] | |
Interpersonal | Sexual relationship | • Shame about talking about condom use with partner [33] • Condoms not used because partner’s sexual history is known [34] • Men refuse to wear a condom [24] • Partner refused to wear a condom because he wanted a baby, or pressured woman to stop using hormonal contraception for same reason [5, 33] • Do not use contraception because pregnancy is desired [18] | • Couples discuss condom use [33] • Some emphasised importance of condom use and would abstain from sex if one was not available [24] • Proactively picking up free condoms when sex was anticipated [24] |
Healthcare providers/ educators | • Given advice regarding safe sex and contraception [34] • Positive interactions with health care providers, facilitating contraceptive information provision [31] • Aboriginal nurse aid accompanying women to appointments [28] | ||
Family/friend relationships | • Shame and embarrassment talking about family planning and contraception with health care providers, parents, sexual partners, in school settings, etc. [18, 26, 33] • Misperceptions, misinformation, and negative experiences of family and friends [31] | • Ability to talk to family and friends about contraception and reproductive health [31] • Mothers supportive of daughters contraceptive use (and even taking them to the clinic for contraception) [5] • Support of extended family (e.g. Aunties) in accessing or using contraception [18] • Mothers report the importance of women not having babies when they are too young [5] | |
Community members | • Condom use not sanctioned by community Elders [35] | ||
Context of sex | • Not using contraception in the heat of the moment as noted by both male and female high school students [18] • Never carry condoms with them [27] | • Couples discuss condom use [33] • Carrying condoms to be prepared for unplanned sex [24] | |
Local | Access | • Do not know where to access condoms in community, how much they cost, or know where but not how [32, 33] • Overwhelming information on internet, difficult to identify reliable information [31] • Cannot afford cost of IUD [28] • Free condoms sometimes run out [24] • Homelessness exacerbates issue of condom access [24] • Lack of a suitable general practitioner, or other trusted person to provide family planning advice [29] • Lack of culturally appropriate information about contraceptive options, or information provided which assumes a higher level of health literacy than is present, and health care provider does not provide information without judgement [31] • Timing of postpartum contraceptive advice [31] | • Women reported being able to access condoms without stigmatisation [24] • Able to identify sources of credible information regarding sex and contraception in the community [25, 31] • Given advice regarding safe sex and contraception [34] • Condoms accessible in community, including free condoms [24] |
Cultural appropriateness of services and information | • Lack of culturally appropriate promotion of contraception and sexual and reproductive health information [29, 30, 35] • Unease in clinical environment [28] • Explanations of contraception and STIs within a western medicine paradigm are not consistent with traditional understandings of the body [30] • Readily available access to condoms at women’s centre not seen as culturally appropriate by women of one remote community [33] | • Aboriginal nurse aid accompanying women to appointments [28] | |
Stigma | • Women faced stigmatisation for carrying condoms [18] • Embarrassment and shame prevent buying or accessing condoms [24] • Shame of stigma around sexual assault, as well as condom negotiation, experienced by women of a remote central Australian community [33] | • Women reported being able to access and carry condoms without stigmatisation [24] | |
Societal | Economic factors | • Homelessness exacerbates issue of condom access [24] • Cannot afford cost of contraception [28] | • Condoms accessible in community, including free condoms [24] |
Cultural norms | • Cultural norms among women from four allied communities in the Northern Territory regarding the female body; women do not expose their pelvic region to strangers, especially men [19, 20] • Cultural norms regarding first pregnancy; women do not use contraception to delay first pregnancy [29, 30] • Within a community in the South-East Northern Territory, cultural norms (e.g. the subincision of penises as a transition to manhood and women not being involved in male health, including penises) limit who is permitted to access condoms, where condoms are able to be distributed, how condoms are perceived, and therefore whether or not they are actually used [35] • STIs are not considered shameful in a South-East Northern Territory community, as genital infections are common among men who have undergone the ritual subincision of the penis [35] • Cultural understandings of the female reproductive body; explanations of contraception and STIs within a western medicine paradigm and not consistent with traditional understandings of the body [30] • Reproduction is highly valued and pregnancy and childrearing acceptable, natural and desirable [30, 31, 35] • ‘Transformative potential of motherhood’ [17] • Cultural and gender constraints prevent women from engaging in condom negotiation [33] | • None reported |