Table 1 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 |