Want long-term contraception? There are more effective options than the pill. But they can be hard to find

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Australians’ access to a range of contraceptive options depends on where they live and how wealthy they are.

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Thursday, June 1, 2023

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Australians’ access to a range of contraceptive options depends on where they live and how wealthy they are.
A recent parliamentary inquiry recommends ways to end this “postcode lottery” for people who want to use long-acting reversible contraception.
There are several types of long-acting reversible contraception: the hormonal contraceptive implant, the hormonal intrauterine devices (IUD) and copper IUDs.

It releases a progestogen hormone which prevents monthly egg release from the ovary for up to three years.
IUDs are small T-shaped devices which are inserted into the uterus.
Hormonal IUDs contain a progestogen hormone and mainly work by thickening the cervical mucus and preventing sperm from swimming up into the uterus.

As well as better protection from pregnancy, some long-acting reversible contraception methods have other benefits.
The hormonal IUD, Mirena, for example, reduces heavy menstrual bleeding.
This includes people with hormone-driven cancers such as breast cancer, for whom any hormonal contraceptive would be considered unsafe.

Out-of-pocket IUD insertion-related costs can also vary from zero to hundreds of dollars if people don’t have access to publicly funded services.
Here’s what to expect
On the supply side, too few health professionals provide these essential services.
There are multiple successful models of nurse-led long-acting reversible contraception services and postpartum insertion of implants by midwifes nationally and internationally.
However, most nurses aren’t able to access Medicare remuneration, which creates additional barriers for this highly skilled workforce to provide these services.

The Senate inquiry has recognised these barriers and recommends making contraception universally affordable, and specifically, subsidising copper IUDs.
It also recommends adequate remuneration through Medicare for GPs, nurses and midwives to provide long-acting reversible contraception insertion and removal, and collaborative efforts between the government and medical colleges to improve access to workforce training.
While the recommendations are welcome, they now need to be turned into actions through adequate funding.