While contraception is now freely available in Ireland, we still have to pay for it – unlike in other countries, writes FIONA REDDAN
CONTRACEPTION MAY never have been so freely available in Ireland as it is now, but free access does not necessarily equate to free services.
For many, contraception comes with a cost. While medical card holders benefit from free GP visits and prescriptions for most contraceptive devices – apart from the copper coil – for others, costs can play an important role in making decisions. Typically, private health insurance policies will only offer reimbursements on medical practitioners’ fees.
Aviva, for example, offers no cover for any contraceptive measures including implants, coil, contraceptive pill and vasectomies. However, the cost of the intrauterine device and implant is covered under the Drugs Payment Scheme, which means that users will only have to pay €120 when purchasing in a pharmacy.
And those who don’t qualify can be put off from discussing their contraception options by stubbornly high GP fees. After all, one of the most popular forms of contraception, the Pill, can be bought from as little as €7 for a three-month supply, but its use requires frequent GP visits for repeat prescriptions.
As such, consumers would do well to discuss with their doctors their pricing structures for repeat prescriptions, or to seek out a lower cost provider. It’s now possible, for example, to get a repeat prescription for three months for the Pill from online doctor service, drthom.ie. The service costs €30, and a prescription will be sent out in the post to you, but this option may not be suitable for everyone.
Apart from the Pill, more permanent types of contraception can also add up. To get a Mirena coil fitted for example, could set you back €140 as well as €200 for the device itself, while the Implanon implant costs €120 to be fitted. However, while these may sound very expensive, according to Dr Caitriona Henchion, medical director of the Irish Family Planning Association (IFPA), it makes sense to take into account the annual cost of contraception before making a decision. Indeed while more expensive in the short term, more permanent types of contraception can be more cost-effective over long-periods of time.
For example, while a private vasectomy may cost a man €500 up front, the cost of the contraceptive Pill ranges between €160 and €244 a year, when GP fees are factored in, while Depo Provera injections are €260 a year.
Implants on the other hand only come in at about €100 a year, while the Mirena coil is €66 a year, and the copper coil can be as low as €26 a year.
Longer-term contraceptives also cut down on the need and inconvenience of frequent doctor visits, and they can be more effective given that they don’t rely on the user to remember to take their Pill every day for example.
But, the issue for many women in the current economic environment, is that while certain types of contraception may save them more in the long-term, they require more cash up-front.
“Longer acting contraceptives are less expensive, but you need to have the cash for the initial outlay,” notes Dr Henchion.
As such, cost is having a major input into contraceptive choices. While Louisa Miller, welfare officer in the students union at Trinity College Dublin, asserts that students typically aren’t put off using contraception by the associated cost, it does mean that the demand for free condoms has risen.
And contraception is typically still largely a woman’s concern, which means that it is women who are paying for it.
“Some couples would share the cost but it’s very rare,” notes Miller.
Dr Henchion agrees. “The bottom line is that is still almost all women who are coming to the clinics.”
Contraceptive options: what they cost
CONTRACEPTIVE PILL
How it works: Taken each day, the contraceptive Pill stops women ovulating, therefore preventing pregnancy.
Downsides: Not suitable for women with high blood pressure or smokers over the age of 35.
Effectiveness: Over 99 per cent if used properly.
Cost: From about €5-€20 a month for Pill; doctor fees for prescription about €50 every three months
INJECTABLE CONTRACEPTION
(eg Depo Provera)
How it works: An injection, given by a health professional every 12 weeks, releases progesterone to prevent ovulation, and therefore pregnancy.
Side effects: May cause irregular bleeding; cannot be immediately reversed.
Effectiveness: Over 99 per cent if injection is given regularly.
Cost: €15-€20 per injection, plus GP fees.
THE COIL
How it works: A small plastic and copper device inserted into the womb prevents sperm from meeting an egg.
Side effects: May cause irregular bleeding; risk of pelvic infection.
Effectiveness: 98-99 per cent.
Cost: About €200 for insertion.
INTRAUTERINE SYSTEM(eg Mirena)
How it works: A small plastic device is inserted into the womb and prevents sperm from meeting an egg. It is effective for up to five years.
Downsides: May cause irregular bleeding; certain medication can interfere with its effectiveness.
Effectiveness: 99 per cent
Cost: About €140 for fitting; €200 for device; €60 for removal.
IMPLANT(eg Implanon)
How it works: A small rod is inserted just under the skin on the womans upper arm. It releases progesterone which stops ovulation.
Side effects: May cause irregular bleeding; has to be inserted by a specially trained doctor.
Effectiveness: 99 per cent.
Cost: About €120 for insertion; €120 for removal; about €200 for supply in pharmacy.
PATCH(eg Evra patch)
How it works: The woman wears a patch, which releases hormones to prevent ovulation, every day for three weeks, followed by a patch-free week.
Downsides: It may be visible on the skin; certain medication can interfere with its effectiveness.
Effectiveness: 99 per cent.
Cost: GP visit to get prescription (about €50); about €25 for month's supply of patch
VAGINAL RING
How it works: A ring, which releases hormones to prevent ovulation, is inserted by a woman into her vagina for three weeks every month.
Downsides: Certain medication can interfere with its effectiveness; not suitable for women with high blood pressure.
Effectiveness: 99 per cent.
Cost: About €20 a month.
DIAPHRAGM/CAP
How it works: The cap is used, with spermicide, to kill sperm when it is inserted into a woman's vagina before sexual intercourse.
Downsides: It will need to be checked every year; the user must remember to remove it six hours after sex.
Effectiveness: 92-98 per cent with correct use.
Cost: Can be fitted by your GP at usual cost (about €50); the cost of fitting is covered by the medical card scheme, but the device has to be purchased separately.
NATURAL METHOD
How it works: This involves recording the fertile times of a woman's cycle by charting her daily temperature and looking for changes in cervical mucus, and avoiding sex at these times.
Side effects: Limits sexual activity; only suitable for women with regular menstrual cycles.
Effectiveness: 80-98 per cent depending on careful use.
Cost: Approximately €3 for a thermometer.
STERILISATION
How it works: The womans fallopian tubes are tied so the egg cannot travel to meet the sperm.
Downsides: Requires surgery; it is permanent with reversal difficult.
Effectiveness: Over 99 per cent.
Cost: Depends on whether youre a private (€1,500) or public patient (free).
FEMALE CONDOM
How it works: This sheath, which is inserted into a woman's vagina, prevents fertilisation.
Downsides: Insertion takes practice; must be inserted before sex.
Effectiveness: 98 per cent.
Cost: About €4 a condom.
MALE METHODS
MALE CONDOM
How it works: This sheath, which is worn on a man's penis, prevents sperm from entering a womans vagina.
Downsides: Condoms can get damaged; must be used before expiry date.
Effectiveness: 99 per cent.
Cost: Less than €1 a condom.
VASECTOMY
How it works: This surgical procedure provides permanent male contraception.
Side effects: It is permanent with reversals often difficult; it can cause discomfort and swelling.
Effectiveness: Over 99 per cent (one in 2,000 failure rate).
Cost: Free in public hospital; €420 at Coole Surgery, Co Westmeath.
EMERGENCY CONTRACEPTION
How it works: A tablet containing progesterone is taken by a woman to prevent fertilisation. It must be taken within 72 hours of unprotected sex. A coil can also be fitted within five days to prevent pregnancy.
Downsides: There are side-effects such as nausea; it can alter a woman's menstrual cycle.
Effectiveness: 97-99 per cent – the sooner it is used the more effective it is.
Cost: €30 for emergency Pill at the IFPA; €45 at Boots pharmacies; €180 for emergency IUD at Reproductive Choices.
– FIONA REDDAN
