Key Points
- Canada will soon cover the full cost of common contraceptives for women, including intrauterine devices.
- Contraceptives aren't free anywhere in Australia, and only some states have removed the need for GP prescriptions.
- Experts and advocates are calling for changes to make contraceptives more universally accessible.
The Canadian government announced on Saturday that it will soon cover the full cost of common contraceptives for women —
Chrystia Freeland, Canada's deputy prime minister and minister of finance, highlighted the financial cost of contraceptives as one of the largest barriers to access and said the federal government's universal pharmacare plan aimed to lower that bar for more than nine million Canadian women, whether for reasons of family planning or medical treatment.
Canada now joins the United Kingdom, Ireland and France as jurisdictions providing free access to prescription birth control.
Meanwhile, in Australia, reproductive experts and sexual health advocates are calling for similar change.
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, works closely with colleagues in Canada and has been looking on "enviously" as they’ve rolled out changes.
"What they've managed to do in Canada is make a very strong economic argument around free contraception," she told SBS News.
Mazza explained that Australia and Canada have very similar healthcare systems, with family physicians playing a large role in contraceptive provisions — and said Australia should "absolutely" be following Canada’s lead on the issue.
"Women in Australia, not only do they have to pay for the contraceptive product but they also have to pay for the consultations associated, and the insertion procedures that are required for those intrauterine devices."
What's the situation in Australia?
The cost of contraceptives varies in Australia depending on the method.
A three-month supply of contraceptive pills can cost anywhere between $10 and $30, while a copper IUD can cost up to $250, plus as much as $300 out of pocket for the insertion. A vaginal ring, which lasts about three weeks, typically costs about $30, plus as much as $115 per consultation.
This is significantly cheaper than places like the United States, where a one-month supply of contraceptive pills can cost anywhere between $0 and $75, plus the cost of a doctor’s appointment to get a prescription. Those with health insurance, however, can usually get the pills free, and most insurance plans cover doctor's visits that are related to birth control.
A growing chorus of advocates is also questioning why Australia can't imitate the free contraceptive model adopted by places like the UK and France.
"We [in Australia] have very low rates of long-acting reversible contraception [such as IUDs] compared to other equivalent countries," Mazza said, explaining that cost is a major factor.
"Our current rate of uptake is about 11 per cent — in the UK it’s sitting at about 19 per cent, and in Sweden it’s sitting at about 30 per cent."
"So there have been calls particularly to make IUDs and implants more accessible."
There are some measures in place in Australia to improve accessibility, such as a subsidy that reduces the price of contraceptive pills to $7 per three months if the person has a Low Income Health Care Card.
But experts suggest such schemes don’t go far enough to meaningfully reduce the cost barrier.
In a 2023 article for The Conversation, Deborah Bateson, professor of practice at the University of Sydney, and Kathleen McNamee, adjunct senior lecturer in Obstetrics & Gynaecology at Monash University, noted that "inadequate remuneration for insertion procedures act as a deterrent" for people in Australia to get long-acting reversible contraception, such as IUDs.
"An IUD takes 30 minutes of inserter and assistant time, and the equipment costs around $25 per insertion. Yet the Medicare rebate is just $72.05," they wrote.
"Costs may be higher in rural areas," they added, "due to higher set-up costs and reduced access to things like sterilising services for procedural equipment."
Bateson and McNamee also flagged the need to address a so-called "postcode lottery," where individuals' ease of access to long-acting reversible contraception is influenced by where they live and how wealthy they are.
Where is it becoming easier to access contraceptives?
Certain jurisdictions are making changes to lower these barriers.
In September 2023, the NSW government rolled out a scheme that allows eligible women between the ages of 18 and 35 to get a resupply of oral contraceptive pills directly from one of 900 pharmacies across the state, without needing a prescription from their GP.
Victoria followed in October, while in November the ACT became the latest jurisdiction to let pharmacists prescribe the oral contraceptive pill directly to patients – albeit in a more restricted way than other states and territories. Patients must have been prescribed the medication for over two years.
Women in South Australia will be able to obtain a resupply of their oral contraceptive pill from trained community pharmacies without a prescription from May, while Queensland will allow trained pharmacists to prescribe hormonal contraception to women across the state from July 2024.
Northern Territory, Tasmania and Western Australia all still require patients to have a prescription from a doctor or health service to access contraception.
What needs to change?
A parliamentary enquiry in May 2023 recommended a range of options to make contraception more universally affordable and accessible. Among them was the subsidisation of copper IUDs, as well as adequate remuneration for GPs, nurses and midwives to insert and remove them, and efforts to improve access to workforce training.
The Royal Australian College of General Practitioners welcomed the recommendations, particularly for abortion access in regional Australia and affordability of contraception.
The group's president, Dr Nicole Higgins, said cost-of-living pressures were making the purchase of contraception "a particularly salient issue".
"Anyone should be able to choose the contraceptive options that best suit them without having to worry about their hip pocket. The recommendation for a separate Medicare Benefits Schedule item number for contraceptive counselling and advice will help achieve this if it is set at a level that reflects the work involved."
Mazza reiterated the need to ensure that cost is not a barrier to accessing contraceptives, as well as the need for workforce training.
"We need a lot of investment in training so we have the workforce to be able to deliver all forms of contraception and truly give women their choice."
—— With additional reporting from AAP
