Doctors are calling on the federal government to fund access to non-hormonal IUDs to increase uptake of long-acting reversible contraceptives (LARCs).
Intrauterine devices, or IUDs, are among the most effective contraceptives on the market, with an efficacy of between 99.5-99.9 per cent.
By comparison, with typical use, the two most common forms of contraception in Australia — the pill and male condoms — are effective around 91 per cent of the time and 88 per cent of the time.
While the two hormonal versions of the IUD are subsidised by the federal government via the Pharmaceutical Benefits Scheme (PBS), the non-hormonal copper version is not granted any government subsidies, meaning patients have to pay over a hundred dollars just to get one.
This is despite increased access to LARCs being a key benchmark in the government's National Women's Health Strategy from 2020-2030.
Who cops the cost?
While the two hormonal IUDs available in Australia are available on the PBS, that is not possible for the copper version.
This is because it is classified as a medical device rather than a medicine.
But director of the Sphere Centre of Research Excellence in Women's Sexual and Reproductive Health Professor Danielle Mazza says that does not mean there are not other options to make it more affordable.
"They're less commonly used now because of the dual benefit that the progestogen-containing IUD gives, which is bleeding control and management of heavy bleeding as well."
"But if we're going to continue with contraception on the Pharmaceutical Benefits Scheme, then it is unjust that the copper IUD, which is a very necessary option to have as part of our choices in contraception for women, not be made, you know, equally accessible as other products."
Professor Mazza suggests that the federal government could follow the lead of authorities in countries like England where contraception is free.
"Internationally, contraception in many countries is free and that would be one mechanism [to increase access]."
There is also the option of the government partially subsidising the copper IUD as it does with the hormonal versions, just not through the PBS.
"We would need to get advice from government about this and the regulatory processes involved, but I certainly would like to see it more accessible."
Professor Mazza says there is a whole range of reasons why people need to be able to access the copper option.
"A lot of women like it because it doesn't have hormones in it and for women who want to see a period every month, it's often the preferred option," she said.
"Particularly in cultural groups where bleeding on a regular basis has cultural significance.
"And sometimes when women are in difficult relationships, if their partner were to notice that they weren't bleeding, then that may cause problems and so there is also a small group of women who prefer to have the copper IUD for that reason."
Speaking at the Senate inquiry into reproductive healthcare access, Dr Danielle Haller from True Relationships and Reproductive Health said the lack of subsidies for the copper IUD was also having an impact on cancer patients.
"It's hormone-free, so women with breast cancer who need contraception can have a copper IUD, but it's not PBS listed, so they're paying $110 for that up-front, where every other IUD is $40, or $6.30 on the PBS," Dr Haller said.
Cost acts as disincentive for GPs
Dr Haller told the inquiry that along with copper IUDs being more expensive for patients, there were significant barriers to patients accessing any IUDs despite them being one of the most effective contraceptives available.
That is partially because of disincentives for doctors inserting the contraceptive in the first place: the cost of training, equipment and paying a nurse to assist during the procedure, plus the time it takes to insert the device, leaves doctors out of pocket.
"To do the training is four to six hours of doing some online reading, and then they've got to take two days off to come in and practice putting in IUDs," Dr Haller said.
"That's a big ask, most GPs would maybe do 10 a year, so for $700 they've spent all of this time.
"There's the risk as well, things go wrong with IUDs, these are not simple consultations where you provide a script and off they go.
"If they work at a bulk-billing clinic [they] would get $72 for 45 minutes worth of work involving the nurse and having to pay for the equipment to do it."
While the rebate for IUD insertion was increased by the former coalition government in early 2022, medical professionals have been calling for it to go higher, saying it is nowhere near enough to cover costs.
During back-and-forth at the Senate inquiry with its chair, Victorian Greens senator Janet Rice, and Queensland Greens senator Larissa Waters, Dr Haller said the rebate was not enough to cover the cost of the procedure.
CHAIR: Could I ask a question in terms of that ridiculously low amount of the rebate. With the review of the Medicare schedules that was done quite recently, do you have any sense of why these things weren't addressed?
Dr Haller: It actually was, probably two years ago. It went up from $50 to $70.
CHAIR: Right.
Dr Haller: The problem is that you can't bill that item number with any other item number. Even the ability to bill a time-based consultation fee with the IUD insertion fee would resolve the issue, because if it takes—
Senator WATERS: Why do they not let them do that?
CHAIR: Why wasn't that addressed in the MBS review? Because it was blokes doing the review? I don't know.
Senator WATERS: It probably was.
Dr Haller: I don't know. It just doesn't make any sense.
With many doctors unable to provide insertions, it means patients can have a tough time accessing the contraceptive at all.
And alongside cost and availability, pain during insertion can also be a hurdle for patients.
An ABC investigation found many were having painful and upsetting experiences getting their IUDs inserted, saying they were not given enough information about available pain relief options.
Are subsidies on the horizon?
So is the federal government up for funding a new subsidy for the copper IUD?
In response to questions from the ABC, Assistant Minister for Health Ged Kearney, who is in charge of women's health, did not make any promises.
"Long-acting reversible contraceptives are highly effective but we know uptake in Australia is lagging behind other countries," she said.
"We know there are barriers to accessing long-acting reversible contraceptives – whether that be geography, education, provider training gaps or costs.
"I am committed to working with stakeholders, as well as my state and territory colleagues, to look at what we can do to address these issues."
The assistant minister is currently working with the new National Women's Health Advisory Council, which will provide advice to the federal government on issues such as reproductive healthcare and monitor the progress of the National Women's Health Strategy.
