The introduction of free contraception in Ireland

Minister for Health Simon Harris is currently planning to make contraception free and readily available. This is apropos of a recommendation by the Oireachtas Committee on the eighth amendment. Minister Harris claims that “if our underlying principle is that abortion should be safe, legal and rare, then we must do all we can to reduce the number of crisis pregnancies and to support women in every way.”

“we must do all we can to reduce the number of crisis pregnancies and to support women in every way”

As it stands, free contraception in Ireland is only available to holders of medical cards, but Harris is hoping that before the year is out this will have changed. A working group is being established to look into the various barriers to contraception, such as financial and legislative issues, and to advise Harris on how best to implement his ideas.

The Irish Pharmacy Union (IPU) has come out in support of contraception being freely provided and it is their opinion that pharmacists should play a key role in such a scheme. They argue that the government should make it legal to obtain contraception from pharmacies without the need for a prescription or the approval of a GP. Currently, hormonal contraception pills, patches, rings and injections all require a prescription, but the IPU believes that pharmacists, after being provided with appropriate training, should be able to provide them to clients directly. However, the Irish Medical Organisation (IMO) objects to this. It argues that it would undermine the efforts of GPs to provide comprehensive sexual healthcare to their patients and may create a conflict of interest for pharmacists between tending to patients and profiting from sales. German pharmaceutical company Bayer has also been lobbying the minister about contraception and sent Harris a letter on the 18th December 2018 in support of his ambitions to have it freely accessible.

The President of the European Society of Contraception and Reproductive Health, Dr. Mary Short, thinks that access to free contraception has the potential to make a significant impact on the number of crisis pregnancies here in Ireland, provided that two key problems are addressed. Firstly, she believes that the government should include the use of long acting reversible contraceptive devices (LARCs) heavily in their plans. Secondly, Dr. Short advises that a proposal for effective and informative sexual education for young people be implemented alongside the plans for contraceptives.

Condoms when used correctly are considered to be 98% effective at preventing pregnancy, however in practise this number drops to 85%. Likewise the female contraceptive pill is theoretically considered to be 99% effective, but again in practise the number falls to 91%. The pill can also be costly in the long run as its users must pay for an initial doctors’ consultation, purchase of a month’s supply of the pill, as well as a renewal of their prescription every 6 months. In comparison, LARCs are considered to be 99% effective and once applied correctly by a healthcare professional the user does not need to worry about forgetting to take it or using it incorrectly.

The Irish College of General Practitioners welcomes any proposal to make contraception more accessible but thinks that they must be coordinated to ensure the highest possible uptake of LARCs, or they may actually increase crisis pregnancies due to birth control being improperly used. Some of the most popular types of LARCs include the intrauterine device or IUD, the birth control implant (nicknamed ‘the bar’) and the birth control injection which lasts for 12 weeks. LARCs are cost effective as once they are paid for and applied by a trained professional, they do not need to be renewed. Furthermore, certain types of LARCs can last for up to 10 years. It is important to note however that while being effective at preventing pregnancy, LARCs do nothing to protect against sexually transmitted infections. When asked for their thoughts on the issue, the Irish Family Planning Association (IFPA) responded; “When free contraception is rolled out, it's especially important to include LARCs in the programme”. They believe that LARCs “are by far the most effective forms of contraception - more than 99% effective - and because they last for up to ten years they're the most cost-effective over time. But right now if you don't have a medical card, the upfront cost can amount to several hundred euro. That's simply not affordable for many people.”

The current curriculum for sexual education in Ireland is 20 years old and is in drastic need of change. These updates should reflect the “significant and welcome changes” that have occurred in the past two decades, according to a recent report by the Oireachtas Education Committee. The Department of Education is also set to look into the power that religious schools have to use their ethos as a barrier to informative sexual education for their students, as recommended by the committee. Other recommendations included in their report include regulating outside providers of sexual education, to ensure each student is receiving the same standard of education and placing a greater emphasis on consent as an integral part of all sexual activity.

The report also mentions contraception and how our sexual education needs to improve its approach to the subject; “to reflect international best practice.” According to experts, if free contraception is to make a difference to crisis pregnancy rates in this country, the importance of effective sexual education can not be understated. Countries like Norway and Finland have started implementing a more holistic approach to sexual education in recent years, that emphasises consent, responsibility and self-esteem issues as well as the biology, and this has been shown to reduce their abortion rate. Sexual education in these countries is also a continuous process from primary school onwards, rather than a once-off approach.

If a free contraception scheme is to be introduced with the intention of lowering crisis pregnancies, the use of LARCs and a much-needed update to our sexual education programme should therefore be included for it to have the greatest possible effect. The IFPA believe that “this is a public health issue” and that “over the last couple of decades, the rate of unintended pregnancy in Ireland has dropped significantly, and that's tied directly to the better availability of contraception. But there is still an unmet need for contraception in Ireland and that won't be solved until cost is no longer a barrier.”