Free contraception should start with young women, report recommends

A working group report into access to contraception has warned that free contraception for all women would cost the State €80-€100 million per year and has recommended that young women receive free contraception as a first stage in changing the system.

The report, due to be published on Tuesday, follows a commitment made by Minister for Health Simon Harris earlier this month to make contraception free for everyone by 2021.

In its report, the working group, established in April, suggests three approaches to expand access to contraception.

The first is the introduction of a universal, State-funded contraception scheme, which would cost €80-€100 million per annum.

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Long-acting contraceptives

The group also suggests funding the consultation and insertion of long-acting reversible contraceptives (LARCs) such as IUDS and implants, found to be the most effective form of contraception. This would cost €30-€40 million per year, but would not reflect the fact that women have different contraceptive needs and preferences, the working group report acknowledges.

The group’s third suggestion, the most cost-effective at €18-€22 million per year, would be a State-funded scheme initially focused on younger women aged 17-24, based on evidence that younger groups are more at risk of crisis pregnancy and more likely to be unable to afford contraception.

While this option would not address cost barriers faced by older women, it could be the first stage of a “phased, long-term approach to steadily improving access to contraception to all”.

Simply making contraception free for users would not necessarily reduce the number of crisis pregnancies or help promote the uptake of more effective contraceptive methods, the group warns. There is a “very real risk” that removing the cost barrier would simply displace private expenditure and represent an “ineffective use of scarce resources” without actually modifying behaviour or improving health benefits, it notes.

However, even a “relatively marginal improvement in access and contraception use” would have some health advantages in terms of avoiding the negative consequences of crisis pregnancies, it adds.

Cost is not simply about barriers to contraception but about whether it prevents people from accessing the most effective form of contraception, according to the report.

It found many women choose not to use LARCS as contraception because of the up-front costs of consultation and insertion.

Resources must also be devoted to education and information campaigns and boosting the capacity of healthcare professionals, the report says. And any policy changes in this area must address accessibility as part of an overall policy on sexual and reproductive health, it says, adding that confusion around the use of contraception continues to be a problem.

Barriers

The working group cites lack of local access, cost, inconvenience and lack of knowledge as the main obstacles to accessing contraception in Ireland. However, contraception use in Ireland is "high and stable" and difficulty accessing contraception is a challenge only "at the margins in overall population terms". Increased funding, changes to the prescription status of oral contraceptives, workforce training and education initiatives would enable the Government to remove these barriers, according to the group.

Embarrassment continues to be a barrier with research showing young women are afraid to reveal they are sexually active. The report also notes that younger men hold a more negative attitude than older men towards women carrying condoms as a precautionary measure.

Vulnerable or disadvantaged people, including asylum seekers, young people in care, those with an intellectual disability, members of the Traveller and Roma communities, other ethnic minorities and those experiencing homelessness face specific issues around access to contraception, the group says.

Efforts must also be made to ensure people who identify as trans or non-binary are not excluded under any scheme and an awareness of the needs of women in controlling relationships or at risk of sexual abuse is also needed.