Young love: No cost barrier to practising safe sex 

Women aged 17-25 will no longer have to pay for contraception but experts say a public health awareness campaign is needed

Various studies show festivals to be an ideal environment for casual sex and risky sexual behaviour has been linked to alcohol and substance abuse. Pic: iStock.

Festival season is in full swing after a three-year hiatus and the government has pledged to make contraception free for females aged 17-25. Will this mark the beginning of a new era of safer sex?

As part of a €31m women’s sexual health package, the cost of medical consultations, prescription medication, and the fitting and removal of long-acting reversible contraceptives (LARCs) such as the coil and hormonal implants will be covered for women in this age group from September of this year.

Sexual health clinics and activist groups have welcomed the move. Niall Behan, CEO of the Irish Family Planning Association (IFPA), describes it as “a truly significant step forward”.

“It will have a real impact on sexual health and wellbeing,” he says. “We’re very happy it’s going to cover all forms of contraception and associated costs such as the fitting and removal of long-acting reversible contraceptives. This will empower those who want to use contraception and choose a method based on its effectiveness and suitability for them at their stage of life, rather than deciding on the basis of affordability.”

Youth information website SpunOut.ie has also responded positively to the news. “Having free access to contraception means that young people can be in control of their own reproductive health, and it can alleviate the financial burden that paying for contraception places on them,” says Rebekah Connolly, SpunOut’s content editor for gender, sexuality, and relationships.

Traditionally, many young people assumed their contraceptive choices were limited to the contraceptive pill or condoms. According to research by the Dublin Well Woman Centre in 2020, these are still the two most commonly used contraceptive methods in Ireland, with 28% of women relying on the pill and another 27% relying on condoms.

Yet, while these may be widely available and relatively affordable, they may not be the most effective options. International studies show that condoms have a failure rate of 17% and the pill a rate of 9%. Irish studies are just as conclusive. In 2020, a survey of more than 1,000 women aged between 17 and 45 found that almost a third had experienced contraceptive failure, 73% with a condom, and 21% with the pill. 35% cent of these women had become pregnant as a result.

Myth and misinformation

Long-acting reversible contraceptives are much more reliable, with studies finding that they are more than 99% effective in reducing the risk of unplanned pregnancy. They are also the most cost-effective option although they do require a significant investment upfront to cover the cost of purchase and fitting.

Considering that the women who participated in the Dublin Well Woman Centre research cited cost as one of the most significant barriers to accessing their preferred type of contraception, this may explain the low uptake of long-acting reversible contraceptives among young women.

“This is why we think a major public health awareness campaign is essential to accompany this scheme,” says Niall Behan. “There’s a lot of myth and misinformation about contraception and the young people who are eligible for this scheme need information about all available methods of contraception, their pros and cons, and where and how they can access them.”

This isn’t the only misgiving that the IFPA and other activist groups have expressed. Many believe the scheme doesn’t go far enough.

“The high upfront costs of the most effective contraceptives can be out of reach for many over 25s,” says Niall Behan. “Data from NUI Galway also shows that 22% of young people aged 15 to 17 are having sex, yet under 17s won’t be eligible for free contraception until further legislation is enacted.”

Sarah Behan, welfare vice president at the Union of Students in Ireland agrees. “Minister Donnelly says that 17- to 25-year-olds have been prioritised because this cohort of young people is often still financially dependent on parents or guardians,” she says. “However, this excludes many who may need free contraception but fall outside this age bracket. Contraception is essential healthcare that should be available free of charge to everyone who needs it, whatever their age.”

In June, Minister Stephen Donnelly secured free contraception for women aged between 17-25 years in Budget 2022. Picture: Andy Gibson.

STIs

While free contraception should reduce the number of unplanned pregnancies, is there a possibility that it might lead to an increase in the spread of sexually transmitted infections (STIs)?

Only if there’s a lack of education, saysSarah Behan. “The methods of contraception that are envisaged to become freely available — such as IUDs — do not protect against STIs,” she says. “It’s crucial that any young person who avails of free contraception under this new Government plan is educated on this matter and other concerns relating to sexual health. The government already provides free condoms on college campuses and in sexual health clinics. It’s vital that adequate information on preventing the spread of STIs is available.”

Connolly is equally adamant that young people need to be informed about safe sex. “Condoms and dental dams are extremely effective at reducing the risk of getting an STI,” she says. “However, even they cannot protect against genital warts, genital herpes, or pubic lice. Providing information that highlights not only the importance of condoms but also of regular STI check-ups and open communication with partners about your sexual health history is essential to reducing the rates of STIs in Ireland and giving young people control of their own sexual health.”

Pre-pandemic figures from the Health Protection Surveillance Centre show that work may need to be done in this regard. The rate of STIs rose between 2018 and 2019, with infections such as chlamydia up 15.6% and gonorrhoea up 17%.

Awareness is essential

Connolly hopes that this new scheme will provide opportunities for medics to inform young people of risks and the precautions they can take.

“Young people having more regular interactions with sexual health practitioners should increase the opportunities for them to receive sexual health advice,” she says. “All conversations about contraception should be accompanied by information on STI protection. At SpunOut, we feel that increased access to destigmatised sexual health information and services can mean better overall health outcomes for young people as their knowledge, choice and access to sexual health interventions expands.”

Concerns have also been expressed that providing young women with free contraception may have the unintended consequence of making them feel as if they should be having sex.

Connolly believes this is a false argument. “If we want to ensure that young people feel confident to say no to sex, denying their access to contraception is not a way to achieve this,” she says. “Age-appropriate sexual health education from a young age — teaching young people about consent, healthy relationships and setting boundaries gives them the tools to make informed choices when it comes to their sexual and emotional relationships. By addressing these issues, we can help support the emotional health of young people and their bodily autonomy.”

The general consensus around free contraception being offered to women aged 17 to 25 is that it is only one element in ensuring that young people enjoy healthy sex lives.“There is an urgent need for more and better sex education so that before they are sexually active, young people have a good understanding of informed consent, and how they can protect themselves from unintended pregnancy and STIs,” says the IFPA’s Behan. “Information and awareness are just as essential as access.”

What do young people have to say about the new scheme offering free contraceptives to women aged 17 to 25?

Orla Patton, a 23-year-old education officer living in Athlone, thinks it could help her. She was prescribed the pill at the age of 15 to regularise her periods. When she became sexually active, she found it difficult to talk openly about contraception. “I didn’t ask for advice,” she says. “I thought the pill was what everyone took so I relied on that, and we used condoms too.”

At the time, the cost of the pill was covered by her medical card and condoms were freely available once she went to university.

It hasn’t been quite as easy since she graduated. “Condoms are not as readily accessible and I rarely have one when I need it,” she says. “And because I came off the pill last year, I haven’t always practised safe sex as I should.”

Cost has played a role in this. “I was unemployed for a while and it’s only recently that I’ve had enough money to think about getting the implant,” she says. She wishes that the scheme had been available when she was younger. “It would have normalised conversations around contraception and made information more accessible,” she says. “I was clueless about the methods I was using.”

Aisling Maloney is a 19-year-old student living in Dublin. She currently benefits from having access to the free condoms available from her students’ union but believes the new scheme will benefit those who aren’t so fortunate.

“It will ensure that there is no cost barrier to practising safe sex,” she says.

However, she would like to see young people being given all of the necessary information when it comes to choosing the contraceptive method that best suits them. “We should be told about the advantages and disadvantages that each one has, and we should weigh those up before coming to a decision, rather than simply picking whatever is most convenient for us at the time,” she says.

Michael Edgar is a 23-year-old software engineer living in Tralee. As someone who is worried about climate change and the danger it poses to the planet, he is eager to avoid an unplanned pregnancy.

“The way the world is right now, I don’t want to bring children into it,” he says. “That’s why my partner uses a contraceptive implant, which we combine with condoms for STIs.”

He started using condoms when they were handed out for free in college and believes that extending free contraception to more people is a positive step. “Anything that aims to help protect young people is a good idea,” he says. “Healthcare, as it relates to sexual health, should be free and accessible to everyone.”