New Zealand has become the latest country to make hormonal intra-uterine devices free, but Australia's uptake of the contraceptives — beloved by women's health professionals — still lags.
New Zealand's pharmaceutical management agency today confirmed it would next month fully fund two hormonal IUDs, Mirena (for which Australian women still pay hundreds of dollars), and Jaydess, (which is unavailable in Australia).
The hormonal IUD is inserted into the uterus, where it releases a small amount of progestin (a synthetic version of the naturally occurring hormone, progesterone) which thickens the cervical mucus, making it a hostile environment for sperm, so they can't get up there to reach the egg. It can provide contraception for multiple years, which makes it what is called a long-acting reversible contraceptive (LARC).
LARCs are a group of methods that include IUDs (copper and hormonal), contraceptive injections and implants, which are all more than 99% effective. The failure rate of Mirena, specifically, is very low. Clinical trials put the cumulative failure rate at 0.21% after one year.
Australia’s major hospital, health care and family planning organisations have long called for increased access to LARCs as the nation’s uptake is lower than other Organisation for Economic Co-operation and Development countries.
Hormonal IUDs make up just 1.9% of the contraceptives prescribed by GPs in Australia, while oral contraceptives account for 68%. The Australian Healthcare and Hospitals Association reported in 2016 that 43% of women who had unintended pregnancies were on the contraceptive pill.
The government has outlined an "increase in the availability and uptake" of LARCs as a "key measure of success" in its national women's health strategy but provides no explicit indication of how that would be achieved.
Labor made an election promise to review the Medicare rebate for LARCs and support the training of more GPs to insert them, but lost the election.
A Department of Health spokesperson said as part of the work being undertaken by the Medicare Benefits Schedule Review Taskforce, the Gynaecology Clinical Committee considered 141 Medicare Benefits Schedule items and made recommendations to change many of them — including the items associated with intra-uterine devices.
“The government is currently considering the recommendations made in this report,” the spokesperson said.
The hormonal IUD prescription should cost $6.40 with a health care card and $39.50 without one. But because so few GPs do insertions, some women are left paying hundreds of dollars to see their gynaecologist and have the IUD inserted.
Family Planning NSW medical director Deborah Bateson said at the moment GP training for IUD insertions is a cost borne by the doctor.
"We should have a system where that training is part of general practice training and the [current] rebate doesn't take into account the level of training that is required to acquire this skill," Bateson told BuzzFeed News.
This cost was often passed on to the patient, Bateson said.
“You can potentially get a bulk-billed Mirena but that would be quite rare and we charge around $80 for an insertion, but we know it can be hundreds and if you have a sedation that will drive up the cost,” Bateson told BuzzFeed News.
Bateson said there was an increasing demand for IUDs in her clinics.
"There's still a lot of misinformation [about the risks of IUDs] but there is an increasing awareness," she said.
There have been 968,000 Mirenas inserted over the past 10 years in Australia, with 754 adverse affect reports to the Therapeutic Goods Administration, of which 205 were pregnancy-related reports.
Strategies to increase LARC uptake have been supported by the World Health Organisation and are a health priority for governments in the United States and United Kingdom.
IUDs are free, even for people under 16, in the UK from GP surgeries, contraception clinics and sexual health clinics.
New Zealand's plan will benefit an estimated 21,000 women and has been welcomed by family planning groups who say this will "improve equity and access to healthcare".
It isn't the first LARC made available for free in New Zealand: in 2010, a progesterone-only implant was fully funded, which New Zealand Family Planning chief executive Jackie Edmond said led to increased demand.
"We expect the same thing to happen when Mirena and Jaydess become a no-cost option,” Edmond said in a statement on Monday morning.
Jaydess, which is like Mirena but is changed every three years instead of five, is not available in Australia, even for those willing to pay. There are only two types of IUDs available in Australia, the Mirena and the copper IUD.
The copper IUD is free for New Zealand residents. In Australia, it is not covered by Medicare and can cost between $70 to $120 outside a public hospital setting.