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Free contraception recommended for young women only, due to cost

Making contraception free for everyone could be “an ineffective use of scarce resources”, a report has found.

Image: Shutterstock/WindNight

THE DEPARTMENT OF Health has been advised that instead of giving everyone free access to contraception, that a State-funded scheme should be focused on providing free contraception to young women first.

The government established the working group in April this year to consider policies and legislation around improving access to contraception after the Oireachtas Committee on the Eighth Amendment recommended free contraception. 

The report, published today, found that local access, cost, embarrassment, inconvenience and lack of knowledge were among the barriers to accessing contraception.

How the State makes contraception available is not solely about reducing the number of crisis pregnancies, the report also emphasised, but about “providing women with the opportunity to safely and effectively manage their reproductive health and wellbeing”.

Despite calls from activists and opposition TDs for contraception to be made available for free, the Working Group “cautioned” against assuming that this would reduce the number of crisis pregnancies or promote more effective contraceptive methods.

There is a very real risk that, as a standalone measure, removing the cost barrier will simply displace private expenditure (including that of wealthier individuals) and thus will represent an ineffective use of scarce resources.

Instead, the report gave three policy options to the government, with a preference for targeting a free-contraception programme for younger women to begin with (Option C).

The report argues that this “initial focus” on young women “is based on the premise that the evidence suggests that younger age groups are most at risk for crisis pregnancy and are more likely to find cost a barrier to contraception”. 

If such a scheme were introduced and focused on women aged 17-24, the report estimates that this would cost the State around €18 – €22 million a year.

“The main drawback to this option,” it continues, “is clearly that it does not address any cost barrier that may exist for older women and is likely to attract criticism on those grounds while it may also be administratively and legally more complex.”

Of course, rather than being seen as a standalone measure, the provision of free contraception to younger women could be seen as the first stage of a phased, long-term approach to steadily improve access to contraception to all.

If the state were to introduce a universal, State-funded contraception scheme (Option A), it would cost between €80 – €100 million a year (depending on uptake and clinical costs).

Option B suggests expanding the General Medical Services scheme in relation to ‘long-acting reversible contraceptives’, or LARCs.

This would cover the consultation and insertions costs associated with LARCs and would cost in the region of €30 – €40 million a year depending on uptake rates.

“Such a scheme could be justified as the evidence indicates that LARCs are the most effective form of contraception yet are also associated with upfront clinical and product costs that may be a factor in discouraging their use,” the report said. 

“However, the targeting of specific contraceptive solutions in this manner cuts across the rights arguments advanced earlier and was opposed by most stakeholders who wish to retain individual choice, especially in recognition of the fact that women will have different contraceptive needs and preferences at different stages in their life.”

Whatever option is chosen, the report recommends that the National Condom Distribution Service should be expanded, and “measures to improve accessibility by enabling oral contraceptives to be available on a 12-month prescription basis with pharmacist consultation at six-month renewal”.

Responding to the report, Minister for Health Simon Harris said: “This report provides us with a clear overview of the challenges involved in providing free contraception but also a clear pathway to doing so. I strongly believe cost should not be a barrier to accessing contraception.”

The Irish Family Planning Association (IFPA) Chief Executive, Niall Behan said that the organisation welcomed the serious examination of access to contraception and said the IFPA supports “a universal, State-funded contraception scheme”.

In our clinics, we continue to see women who wish to take up a long-acting method of contraception, but are impeded by cost barriers.

“However, as the report makes clear, the removal of cost barriers alone is insufficient to fully realise access to contraception for all who need it. A comprehensive and coherent policy approach is needed and any new scheme must include measures in the area of sexuality education, public information, and provider training and education to ensure all barriers – such as lack of local access and lack of knowledge – are addressed.”

The report also found that the challenges with expanding access to contraception are “a microcosm” of the wider challenges facing the health service – including government funding, eligibility, integrated care, primary care staffing and workforce capacity.

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