The Times Australia
The Times World News

.
The Times Real Estate

.

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

  • Written by Deborah Bateson, Professor of Practice, University of Sydney
Want long-term contraception? There are more effective options than the pill. But they can be hard to find

Australians’ access to a range of contraceptive options depends on where they live and how wealthy they are. A recent parliamentary inquiry[1] 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.

With fewer than one in 100 users[2] becoming pregnant in a year while using them (compared to up to seven[3] in 100 contraceptive pill users) these are the most effective[4] contraceptives available. Once they’re inserted into the body, you don’t need to remember to carry a condom, take a daily pill or fill a new script.

So why are they so hard to access in Australia? And what needs to change?

Read more: Australian women's access to abortion is a postcode lottery. Here's what needs to change[5]

How do they work?

The contraceptive implant[6] (known as Implanon NXT in Australia) is a small flexible rod, inserted just under the skin of the upper inner arm. 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[7] by thickening the cervical mucus and preventing sperm from swimming up into the uterus. There are two types of hormonal IUDs: Mirena and Kyleena. Both last up to five years. Kyleena is slightly smaller and contains a lower dose of hormone than Mirena.

Copper IUDs[8] are hormone-free and last up to ten years. They work through their toxic effect on sperm and the egg to prevent fertilisation.

They have additional benefits for some users

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[9]. This can improve people’s quality of life and reduce the need for a hysterectomy[10].

Clinician talks to patient
IUDs can have other benefits. Shutterstock[11]

Hormonal pills (containing estrogen) and the vaginal ring can’t be used by people with certain conditions, such as migraine with aura, or by people aged 35 years or older who smoke. This isn’t the case for long-acting reversible contraception methods, which most people can safely use.

Copper IUDs are an essential option[12] for people who cannot or prefer not to use hormones. This includes people with hormone-driven cancers such as breast cancer, for whom any hormonal contraceptive would be considered unsafe.

Why aren’t they more available?

Access to long-acting reversible contraception is not universal in Australia.

Cost can be a considerable barrier[13] to uptake for some people. While the implant and hormonal IUDs are subsidised by the Pharmaceutical Benefits Schedule (PBS), this is not the case for copper IUDs, which can cost up to A$120 for the device.

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.

Read more: Considering an IUD but worried about pain during insertion? Here’s what to expect[14]

On the supply side, too few health professionals provide these essential services.

Inadequate remuneration for insertion procedures act as a deterrent[15]. An IUD takes 30 minutes of inserter and assistant time, and the equipment costs around A$25 per insertion. Yet the Medicare rebate[16] is just A$72.05. Costs may be higher in rural areas, due to higher set-up costs and reduced access to things like sterilising services for procedural equipment.

Insertion and removal of long-acting reversible contraception also requires practical training. This can be costly for GPs and nurses, especially for IUD training, which also means taking around three days off work to achieve the necessary number of supervised IUD insertions. This can be even longer and more costly for rural practitioners, with additional travel time and accommodation costs.

This lack of trained inserters contributes to inequities for people who have chosen a long-acting reversible contraception but can’t find a local practitioner to insert their IUD or implant.

Doctor types on laptop
Doctors are deterred by inadequate remuneration for IUD and implant insertion. Unsplash/National Cancer Institute[17]

Nurses and midwives could ably fill this gap[18]. There are multiple successful models[19] 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[20] for this highly skilled workforce to provide these services.

What are the recommendations for reform?

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.

The government also needs to fund every Primary Health Network (which plan services) across Australia to identify local gaps and ensure the contraceptive needs of the communities they serve are met equitably, affordably and transparently.

While one size does not fit all, and people must be provided with sufficient and accessible information to make an informed choice, no one who wants an IUD or implant should be denied this choice based on where they live and how much they can pay.

Read more: How effective is the pill?[21]

References

  1. ^ parliamentary inquiry (www.aph.gov.au)
  2. ^ one in 100 users (www.nejm.org)
  3. ^ seven (theconversation.com)
  4. ^ most effective (www.nejm.org)
  5. ^ Australian women's access to abortion is a postcode lottery. Here's what needs to change (theconversation.com)
  6. ^ contraceptive implant (www.tandfonline.com)
  7. ^ mainly work (pubmed.ncbi.nlm.nih.gov)
  8. ^ Copper IUDs (pubmed.ncbi.nlm.nih.gov)
  9. ^ reduces heavy menstrual bleeding (pubmed.ncbi.nlm.nih.gov)
  10. ^ reduce the need for a hysterectomy (www.ncbi.nlm.nih.gov)
  11. ^ Shutterstock (www.shutterstock.com)
  12. ^ essential option (www.fsrh.org)
  13. ^ considerable barrier (bmcwomenshealth.biomedcentral.com)
  14. ^ Considering an IUD but worried about pain during insertion? Here’s what to expect (theconversation.com)
  15. ^ act as a deterrent (pubmed.ncbi.nlm.nih.gov)
  16. ^ Medicare rebate (www9.health.gov.au)
  17. ^ Unsplash/National Cancer Institute (unsplash.com)
  18. ^ ably fill this gap (pubmed.ncbi.nlm.nih.gov)
  19. ^ successful models (pubmed.ncbi.nlm.nih.gov)
  20. ^ additional barriers (bmcwomenshealth.biomedcentral.com)
  21. ^ How effective is the pill? (theconversation.com)

Read more https://theconversation.com/want-long-term-contraception-there-are-more-effective-options-than-the-pill-but-they-can-be-hard-to-find-206503

The Times Features

Understanding the Dangers of Ignoring a Gas Leak

Gas leaks are silent threats lurking within both homes and workplaces. A gas leak occurs when natural gas or any other gaseous substance escapes from a pipeline or containment. T...

Can You Sell Your House Privately in Queensland? Here’s How

Selling a house privately in Queensland is entirely possible and can be a cost-effective alternative to using a real estate agent. While agents provide valuable expertise, their co...

Itinerary to Maximize Your Two-Week Adventure in Vietnam and Cambodia

Two weeks may not seem like much, but it’s just the right time for travelers to explore the best of Vietnam and Cambodia. From the bustling streets of Hanoi to the magnificent te...

How to Protect Your Garden Trees from Wind Damage in Australia

In Australia's expansive landscape, garden trees hold noteworthy significance. They not only enhance the aesthetic appeal of our homes but also play an integral role in the local...

Brisbane Homeowners Warned: Non-Compliant Flexible Hoses Pose High Flood Risk

As a homeowner in Brisbane, when you think of the potential for flood damage to your home, you probably think of weather events. But you should know that there may be a tickin...

Argan Oil-Infused Moroccanoil Shampoo: Nourish and Revitalize Your Hair

Are you ready to transform your hair from dull and lifeless to vibrant and full of life? Look no further than the luxurious embrace of Argan Oil-Infused Moroccanoil Shampoo! In a...

Times Magazine

"Eternal Nurture" by Cara Barilla: A Timeless Collection of Wisdom and Healing

Renowned Sydney-born author and educator Cara Barilla has released her latest book, Eternal Nurture, a profound collection of inspirational quotes designed to support mindfulness, emotional healing, and personal growth. With a deep commitment to ...

How AI-Driven SEO Enhancements Can Improve Headless CMS Content Visibility

Whereas SEO (search engine optimization) is critical in the digital landscape for making connections to content, much of it is still done manually keyword research, metatags, final tweaks at publication requiring a human element that takes extensiv...

Crypto Expert John Fenga Reveals How Blockchain is Revolutionising Charity

One of the most persistent challenges in the charity sector is trust. Donors often wonder whether their contributions are being used effectively or if overhead costs consume a significant portion. Traditional fundraising methods can be opaque, with...

Navigating Parenting Arrangements in Australia: A Legal Guide for Parents

Understanding Parenting Arrangements in Australia. Child custody disputes are often one of the most emotionally charged aspects of separation or divorce. Parents naturally want what is best for their children, but the legal process of determining ...

Blocky Adventures: A Minecraft Movie Celebration for Your Wrist

The Minecraft movie is almost here—and it’s time to get excited! With the film set to hit theaters on April 4, 2025, fans have a brand-new reason to celebrate. To honor the upcoming blockbuster, watchfaces.co has released a special Minecraft-inspir...

The Ultimate Guide to Apple Watch Faces & Trending Wallpapers

In today’s digital world, personalization is everything. Your smartwatch isn’t just a timepiece—it’s an extension of your style. Thanks to innovative third-party developers, customizing your Apple Watch has reached new heights with stunning designs...

LayBy Shopping