Abortion is free but contraception is still out of reach for some

Despite the dawn of a new era of reproductive healthcare, many women can't afford contraception. The Government must now honour its commitment to provide it free of charge

Cost is a major factor in women's decisions about contraceptives, with many resorting to using cheaper but less effective short-acting methods such as condoms and the contraceptive pill. Stock Picture

It’s been over three years since the people of Ireland voted to allow the women of Ireland to receive abortion care in the country where they live. The jubilation was justified. For many of us medical professionals, it was a day of relief.

The provision of abortion care in January 2019 was supposed to herald the beginning of a new chapter in women’s reproductive healthcare — not the end of it.

My colleagues and I now see women who previously would have had to travel for abortion care or buy pills online. Our care of these women has shown us very clearly the link between unplanned pregnancies and the cost of contraception.

An anomaly in reproductive healthcare

It has exposed the anomaly in reproductive healthcare that does not allow us to give women the entirety of care that they need.

The State quite rightly provides abortion care free of charge — but women have to pay for preventative contraceptives. This makes no sense.

Our own research highlights this. Between January and June 2019, an audit of 475 women accessing termination of pregnancy services from START [Southern Task Force On Abortion and Reproductive Topics] GPs found that 66% were using no contraception, 20% were using condoms, and 10% were using contraceptive pills. Only 1% of women using long-acting reversible contraception (LARC), known colloquially as “fit and forget” contraception, had a contraceptive failure. One third of the women were aged 25 and under.

Matching contraception to each woman's needs

Following their termination of pregnancy, 69% of women decided to use contraception.

As medical practitioners, we know that it is not just about using contraception — it is about using the type of contraception that suits each individual woman best and is most effective.

For many women who would like to use long-acting reversible contraception such as the coil, the cost is a significant barrier both before and after accessing abortion care.

This is by far the most effective method of contraception. It is up to 20 times more effective than short-acting methods such as condoms and the contraceptive pill. It is also the most cost-effective. A LARC costs between €300 and €500, and lasts for three to 10 years, depending on the method. The pill costs typically €100 every six months between consultation fees and medication, equating to €1,000 over 5 years.

If a woman opted for a five-year LARC, she would typically pay no more than €500 for a far more effective method of contraception. However, the upfront cost of a LARC to the pharmacy and the physician’s fee is out of the financial reach of many women. This is particularly the case for women under 25 who have very little disposable income.

The reality is that every week we have to send women away following an abortion with the same method of contraception that failed them in the first place because they cannot afford more effective contraception.

There is a commitment in the programme for government to a phased introduction of free contraception for all women starting with women aged between 17 and 25. This needs to happen urgently for all types of contraception including short-acting methods (pills, patches, rings), long-acting reversible methods (coils, implants), and emergency contraception.

Younger and poorer women rely on less effective contraception

Last year, the Dublin Well Woman Centre published research which was undertaken among a nationally representative sample of over 1,000 women aged 17-45 years. Those women in the 17-24 year old age group were most likely to be relying on less effective short-acting methods such as condoms (44%) and the contraceptive pill (34%). These findings were echoed in a study published in June 2021 of more than 1,800 sexually-active students in UCC, where 55% reported that they are relying on the condom and 40% are relying on the pill.

Both studies illustrate clearly that cost is an important factor in choosing a method of contraception. In the Dublin Well Woman Centre research, those aged 17-24 (53%) were the most likely age cohort to claim that the cost of the contraception is important or very important when deciding on which type of contraception to use. The UCC study found that 34% of students would definitely switch, and a further 22% would consider switching method, if cost was removed.

As students move back on campus for the next academic year, this will be accompanied by higher levels of social interaction. We anticipate there will be a greater demand for sexual and reproductive health services including contraception, particularly after the lockdowns.

We need to remove the barriers to contraception use. We need to do it now.

Dr Áine Murphy is a GP in Mayfield, Cork, and with the Youth Health Service. She is a member of START, the Southern Task Force on Abortion and Reproductive Topics, a network of over 250 medical professionals including GPs, obstetricians, midwives, and others with a special interest in women’s health, including termination of pregnancy care and contraception.