THE MINISTER FOR Health has been lobbied by a pharmaceutical company and the pharmacy union in recent months, as plans for the promised rollout of free contraception for all women remain unclear.

The access to free contraception was a recommendation made by the Oireachtas Committee on the Eighth Amendment, and something that Simon Harris said he was hoping to introduce this year.

He also indicated that doing so would involve changes to legislation and, with a number of options available for what form this offering could take and the cost attached to it, it’s still not clear how and when women will benefit from such a scheme.

Recommendations

The Oireachtas Committee on the Eighth Amendment made numerous recommendations in relation to termination of pregnancy services, which were followed by the Irish public voting to repeal the Eighth and the government introducing abortion services this month.

The committee also made a number of ancillary recommendations, including on contraception provision.

It said:

“The committee has a particular concern about the cost of contraception and notes that, while it is free for those with a medical card, for those on the cusp of qualifying for a medical card, the costs can be prohibitive.

The Committee recommends the introduction of a scheme for the provision of the most effective method of contraception, free of charge and having regard to personal circumstances, to all people who wish to avail of them within the State.

Minister for Health Simon Harris told TheJournal.ie last September that he was aiming to give all women access to free contraception in 2019.

“In relation to female contraception, I am determined that we address the cost issue there,” he said, adding that he has asked his department officials to work with medical experts on the matter. 

As you know a woman today who has a medical card can access contraception for free. There are two issues – the cost of the doctor’s visit, because generally women need to see a doctor on these matters, and then the actual cost of the contraception, so it is likely to require an amendment to primary legislation, but I am hoping we can make progress on that in 2019.

Lobbying 

German pharma company Bayer wrote a letter to Simon Harris on 18 December last year on the issue of state-funded contraception, which was also addressed to Department of Health chief medical officer Tony Holohan.

In the letter, seen by TheJournal.ie, Bayer said it welcomed the government’s commitment to a free contraception programme, and added it would “align Ireland with good practice in countries such as the UK, as part of the efforts to reduce unplanned pregnancies”.

The letter says the government should offer all forms of contraception under such a programme, but advocates the use of long acting reversible contraception (or LARCs) in particular.

This doesn’t cover contraception such as taking the pill or using a condom.

LARCs can take several forms, including the contraceptive implant put into the arm, the copper coil and a contraceptive injection. Bayer produces a number of forms of contraception including the pill, and some of these LARCs.

The company wrote to the minister:

“One of the main advantages of LARCs is that there is full compliance, i.e. you cannot forget to take it… LARCs require some investment up front, however, over the longer-term most LARCs cost less than shorter-term methods such as the pill.”

Bayer said its data showed that using LARCs could be three times more cost effective than the pill over the course of a five-year period.

As well as the pharma company, the Irish Pharmacy Union has been having its say on the plans going forward, lobbying TDs in and outside the government on the matter.

In a submission to the minister last year, it argued for the centrality of pharmacists in any free contraception scheme.

“The IPU proposes that the Department of Health and Health Service Executive put in place a scheme to enable women to access contraception directly from their community pharmacist without prescription and without charge, regardless of eligibility,” it said.

Supply of contraceptives will include oral contraceptives, patches, rings and injections.

Options

Shirley McQuade is medical director of the Dublin Well Woman Centre. She told TheJournal.ie that there is no one right form of contraception for each woman and many will change what contraception they use over time.

She said there are certain forms of contraception that are more suitable for certain women but a comprehensive programme would give a woman the choice of which she wanted to use, in collaboration with her GP or medical professional.

She also advocated LARCs in terms of their efficacy and cost effectiveness. 

“Devices such as the copper coil can last for up to 10 years, and can be removed at any time,” she said.

At around €230 it’s a lot more expensive than the likes of the pill initially, but far more cost effective in the long run as women have to go to the doctor regularly to update their prescription.

For now at least, it looks like condoms could be the first and only provision of free contraception made available by the government this year. 

In response to a request for comment, a Department of Health spokesperson told TheJournal.ie:

“Work is continuing on planning for the implementation of the ancillary recommendations of the Joint Committee on the Eighth Amendment of the Constitution.

This includes exploring issues associated with enhancing access to contraception, with a view to developing evidence-based policy in this area.

“Preparations are also ongoing for the initial expansion of free access to condoms in 2019.”

With reporting from Christina Finn