Free contraceptives given to 160k women in first nine months of last year

Advocates call for scheme to be extended to all women of reproductive age

Last year, 8,467 contraceptive implants were dispensed, 5,018 contraceptive injections, and 4,097 vaginal rings, according to Department of health figures.

More than 160,000 young women received free contraceptive products between January and September last year as the State’s programme rolled out.

While advocates and health workers welcomed the radical scheme, they have called for it to be extended to all women of reproductive age, not only those aged 17 to 31, as of January 1.

How things have changed since the Dáil heard contraception described as “ the quare things” almost 50 years ago.

A TD, speculating then about the potential fallout for pharmacists selling these products, said: “There may be the attitude: 'So-and-so handles the quare things but the others who are nice, decent people will not'.” 

The scheme saw 448,326 packs of contraceptive pills dispensed, in addition to 26,146 packs of transdermal contraceptive patches, in those nine months.

Some 8,467 contraceptive implants were dispensed, 5,018 contraceptive injections, and 4,097 vaginal rings. Some 899 copper coils were dispensed, according to figures provided by the Department of Health.

Women can also access the morning-after pill, with 6,697 pharmacy consultations on emergency contraception taking place.

It is not possible to directly compare these numbers, as items such as some coils can last up to 10 years while pills are dispensed in monthly packs.

Pharmacist Laura Dowling: 'Women don’t come in in fear anymore.' Picture: Moya Nolan

Today, pharmacist Laura Dowling provides contraception without fear of judgement.

Ms Dowling, known as the ‘Fabulous Pharmacist’ on social media, was the 2022 Pharmacist of the Year. She feels there is little to no stigma surrounding contraception within suburban Dublin.

“Women don’t come in in fear anymore,” she said.

“The fact that it's free and widely available and the fact that people can get the emergency contraception as well, it means that there is less of a taboo. And then I suppose the more we talk about it, the more it just becomes easier and easier for people [to access].

The Dublin-based pharmacist does, however, still notice embarrassment around the morning-after pill.

Often older women are much more embarrassed than younger girls when asking for this she has seen, although she emphasises: “There’s absolutely nothing to feel embarrassed about."

Side-effects

She also sees negative medical side-effects for many women, but these can be dealt with when talking about concerns is becoming more normalised.

"One of the side-effects of the contraceptive pill would be that it can reduce libido,” she cautioned.

“I find that ironic that something that you're taking because you want to have sex and enjoy it and not get pregnant is on the other side reducing your libido.” 

She explained: “I would have had ladies that went on the pill from when they first became sexually active at the age of 17 or 18, staying on throughout their entire 20s, and only when they went to try for a baby that they actually realised that they had a libido.

“They really wanted to have sex at certain times of their cycle, which is normal.” 

However, she feels side-effects are a small price to pay for an “unwanted pregnancy”, depending on everyone's situation.

Women are encouraged to approach contraception with an open mind and to “almost be a little bit of guinea pig for themselves see what works and what doesn’t”, she said.

Financial barrier removed

Dr Ciara McCarthy, a GP in Blackpool in Cork City, said there was no longer a financial barrier to accessing contraception.

Dr Ciara McCarthy, a GP in Blackpool in Cork City, said while doctors always offered these products, the financial barrier is gone now.

“Some women are still a little surprised to see the cost of their consultation is also covered, I think there is more knowledge the products are covered,” she said.

“What it has meant for us in our discussions is we are no longer having to factor in the cost of certain methods, ruling in or ruling out certain methods, because the barrier of cost has been removed.” 

Dr McCarthy, who is also HSE and Irish College of General Practitioners clinical lead for women’s heath, said up-front costs of long-acting reversible contraceptives such as coils or implants were definitely a barrier.

A coil could cost over €200 to buy and have inserted, for instance, with many women opting for the contraceptive pill instead as this could be paid for monthly.

“When you look over the duration of use and divide the total cost by three or five years, depending on the method, the long-acting methods are actually more cost-effective,” she said.

“[A copper coil] is far more effective than the morning-after pill.

“The really great thing about it is if it is fitted for emergency contraception, the woman can actually leave it in for five to 10 years depending on what coil it is, to give her long-term reliable contraception as well.” 

The scheme is limited to women aged between 17 and 31, having expanded this week.

“Women do require access to contraception from the time they become sexually active until menopause,” she said of the ICGP’s stance.

While we are really delighted women aged 17 to 31 can access contraception free of charge, we would like to see the eligibility expand over the coming years to encompass all women of reproductive age. 

Women can also access help through the Irish Family Planning Association (IFPA) and Well Woman clinics.

IFPA director of advocacy and communications Maeve Taylor said the scheme was “groundbreaking”, with an overwhelmingly positive reaction from its clients.

“It has given doctors the certainty that anyone covered by the scheme can avail of the method of contraception that best suits them at their stage of life, without having to worry about its cost,” she said.

However she is also concerned about age limits.

Age barriers

“Age-restricted access is inherently inequitable,” she said.

“It leaves too many people of reproductive age in precisely the position the policy aims to address; higher risk of unintended pregnancy because they cannot afford the most effective means to prevent it.” 

Contraception is as important for women over 31, she said, as younger women.

Teens can see a catastrophic impact on their lives from an unintended pregnancy, she warned as one example, while women in relationships may wish to plan their family size.

“The IFPA was glad to see funding to include 16-year-olds in the scheme in Budget 2023. However, this hasn’t happened yet,” she said.

“The minister for health has said that the scheme cannot be extended to under 17s without specific legislation. More than a year later, no bill has been introduced.” 

She called on the Government to remove the legal barriers relating to age.

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“The extension of the scheme to guarantee access to free contraception to everyone of reproductive age would be visionary and transformative,” she urged.

“Cost should never a barrier to contraception use by anyone who wants to avoid unintended pregnancy.” 

A Department of Health spokeswoman said: “The minister for health has stated his ambition to expand the scheme, with the aim of providing coverage, in due course, for all those who may need it.”

Catholic attitudes

While Irish attitudes to contraception have changed in recent decades, this is not the experience of every young person contemplating these products.

One young woman said she had not yet availed of the free scheme by visiting her family GP in a rural Munster town.

“I wouldn’t go to my mother to say that I had sex, never mind talk about contraception,” she said.

In her experience, older Catholic attitudes that the purpose of sex is solely for reproduction remain held by some people.

While she does not share her family’s beliefs, their attitudes towards contraception have discouraged her from visiting their GP.

She described how she sees a still strong taboo surrounding casual sex and contraception within rural areas where she and many of her friends live.

“Even my cousins, who have been in long-term relationships for years, are not allowed to sleep in the same bed as their boyfriends when they’re visiting home,” she said.

“Most country mothers are coming around to the idea that this is happening but mine has a bit to go yet.” 

It is understood some women prefer to order oral contraceptive pills from online pharmacies instead.

Dr Ciara McCarthy said doctors offer these products “in a non-judgemental fashion” for patients.

“Now it’s free, it’s hopefully more accessible to young women,” she said.

“I think there is a lot of stigma still, and we talk about breaking down barriers but that is bit by bit. It’s about trying to encourage women and make them feel comfortable.” 

She advised anyone with similar concerns to see if they could talk to a different GP in the practice who does not treat the patient’s family.

“They might be more comfortable talking to a female GP so they can ask to see someone else,” she said.

“In some practices, the practice nurse may offer some of the contraceptive consults, and if again if they would really prefer not to see someone in their own practice, they can choose to attend another GP practice.” 

Women can contact any practice for access to the free programme, but she cautioned: “The limiting factor there will be that many practices are closed to new patients because they are at capacity".

However, she said in smaller towns with fewer female GPs, informal arrangements often exist for inter-practice referrals.

In larger areas there is also the option of Irish Family Planning Clinics or Well Woman clinics, she said.

Free access in North

Isobel Walsh, 24, tested multiple contraception methods before deciding what worked best for her.

Now living in Palmerstown, Co Dublin, she is from Tyrone and began her contraception journey there aged 16, saying this was around the time of her “first proper romantic relationship”.

Isobel Walsh: 'Providing young people with free contraception and quality sex education goes a long way towards enabling them to develop safe and enjoyable sex practices.' Picture: Moya Nolan

This meant she had access to the free contraception scheme provided by the UK from the start.

She said this led to avoiding any guilt or awkwardness arising from her parents having to pay for her contraception each month.

“Stressing over the accessibility of contraception was something that never crossed my young mind,” she said.

“And I wish the same for young people in the Republic who are just starting to get to grips with sex and sexual health.” 

Her journey began with a contraceptive pill before switching to an implant, saying this was for ease of use and its fuss-free nature.

She recalled “a hellish” start to this, however, with feelings of exhaustion, heightened emotions, and constant ‘spotting’ for a few months. These side-effects, however, soon subsided.

Reflecting on her doctor appointments, Ms Walsh remembers an air of “awkwardness” coupled with nerves, as she navigated her sexual health for the first time.

“I’m not sure how much of that can be attributed to my own or the GP’s stigma about contraception,” she said, saying in hindsight she was also herself lacking in confidence and ability to self-advocate about her sexual health at the time.

Now benefiting from the Irish scheme, she feels providing these products for free helps people her age develop safe attitudes to sex.

“Providing young people with free contraception and quality sex education goes a long way towards enabling them to develop safe and enjoyable sex practices which will stand to them for the rest of their lives,” she said.