As parts of Europe and Canada start to provide free access to contraception, women's rights and sexual health advocates are trying to build momentum toward a similar change in Australia.
Last month, British Columbia became the first Canadian province to make prescription contraception free for all residents.
It joined the United Kingdom, Ireland and France as jurisdictions providing free access to prescription birth control — either for all residents or certain age groups.
But sexual health doctors say cost remains a barrier to accessing contraception in Australia.
According to Women's Health Matters, contraceptive pills covered by the Pharmaceutical Benefit Scheme (PBS) cost up to $30 every three months, or around $7 if the person also has a low-income Health Care Card.
But newer pills not covered by the PBS can cost between $70 and $90 for a three-month supply.
Subsidies not adequate, professor says
Mirena, a hormonal intrauterine contraceptive device (IUD), costs around $30 for Medicare card holders, in addition to the cost of relevant consultations.
Medicare then covers $70.90 for the insertion procedure in non-hospital settings such as GP clinics, and from $41.80 to $62.55 in hospital settings.
That cost can be reduced to about $7 with a Health Care Card.
But the cost of insertion can vary between clinics with one Perth clinic charging a $150 gap fee.
Copper IUDs are not subsidised and cost $110.
A contraceptive implant lasts three years and costs about $30 with a Medicare card, or $6.40 with a Health Care Card, in addition to consultation and insertion costs.
Professor Danielle Mazza, head of general practice at Monash University and director of the Sphere Centre of Research Excellence in women's sexual and reproductive health, said Australia's public health care system was not adequately subsidising the costs associated with contraception.
"Services that have previously been provided in public hospital settings or community health through funding schemes outside of Medicare have been pushed out into the community to be accessed through private general practice," Professor Mazza said.
"The cost of contraception has increased, because a lot of the contraceptive products are not actually on the PBS."
A Senate inquiry into universal access to reproductive healthcare heard from doctors and pharmacists in February that the cost of contraception was a barrier to women accessing newer pills with greater benefits.
Cost a 'huge barrier' for some
Nicole Filar, the acting deputy medical director at Sexual Health Quarters in Perth, said it was her observation as a practising GP working in sexual health that cost was a "huge barrier" for some patients.
"What can then happen is then they forego contraception then potentially there's the risk … of an unplanned pregnancy," Ms Filar said.
"Depending on what that person chooses they may go on to have an abortion which has a much bigger impact on the health economy than if they had initially just had contraception at the beginning."
Ms Filar said the types of contraceptive pill covered by the PBS were not always appropriate for all patients, who had to take a range of factors into account.
"You take [into account] their medical history, what medications they're on, what they're looking to be on the pill for," Ms Filar said.
"So whether it is contraception, period control, acne, or to help manage certain medical conditions like [polycystic ovarian syndrome], endometriosis and … heavy bleeding during your period."
Ms Filar said the cost of accessing an IUD in particular was a barrier for some women, especially those in rural and remote areas.
"You're not only necessarily paying for the contraceptive device, but also the insertion cost, which was really poorly subsidised by Medicare," she said.
"And therefore, clinicians essentially get to decide how much they charge for that insertion … which is really variable."
Ms Filar supported the idea of making contraception free, but was not aware of any major efforts to make that happen in Australia.
'It's easy to remove obvious barriers'
Last year the Victorian Greens announced a plan to make contraception free as part of their election campaign in the lead up the state election in November 2022.
At the time, the Greens said covering the cost of contraception beyond the PBS would cost the state around $10 million over three years.
Population health spokesperson for the Victorian Greens Tim Read said he was not aware of any other efforts to eliminate costs of contraception in Australia.
"Removing barriers to contraception, for those who want to use it, is actually a relatively easy thing to do," Mr Read said.
"It's hard to change behaviour, but it's easy to remove obvious barriers."
Mr Read said there should also be additional training and encouragement for GPs to insert IUDs.
Professor Mazza said she believed Australia had not followed the lead of countries making contraception free as political discussion around unplanned pregnancies had traditionally been more conservative in this country.
But she said there were efforts to change that, including from her own research teams.
Roe v Wade effect
"Now, especially with the Roe v Wade precedent being overturned in the US, it's kind of galvanised people because it's made people understand the fragility of the legal system in terms of supporting women's rights and contraception," Professor Mazza said.
"I think there's quite a large and growing voice from key stakeholders and experts in the area, calling for free contraception."
She outlined two ways to make free contraception a reality in Australia.
The first would involve the states setting up specific clinics to provide free contraception.
The second would involve the federal government making policy changes to reduce GP costs through reimbursement and making prescription contraception free through the PBS.
"I think these kinds of solutions need to be worked out in consultation with the health sector to find out what would work best," she said.
