Various forms of contraception are now more accessible in Ireland than ever before, and yet for many it remains difficult to find what works best for them. When it comes to contraceptive devices, one size most certainly does not fit all, and various barriers from cost to pre-existing medical conditions do not make the choice any simpler.
So there’s the male condom, which typically is the first form of contraception anyone learns about thanks to its wide availability without prescription, and it’s 98% effective to boot! With protection from both STIs and pregnancy, what more could you want? Sounds perfect, until it comes to actually putting the thing on. The HSE suggests that proper use of the male condom requires practice and patience. The condom, if used incorrectly, may break or slip during usage, potentially exposing you to those risks related to unprotected intercourse. For this reason, many will use the condom alongside another contraceptive device.
Typically, that other contraceptive device will be the oral contraceptive pill. Whereas the condom can just be bought in a shop or a pharmacy, the oral contraceptive pill does require a prescription, which makes it that little bit more costly. There are two types of the pill available on the market: the combined oral contraceptive, which contains both oestrogen and progestogen and is what we usually refer to as just ‘the pill’, and the progestogen-only pill, commonly known as ‘the mini pill’. These two options will alter the user’s body chemistry in different ways, but if taken at the same time every day, the combined oral contraceptive can guarantee 99% protection from pregnancy. In the case of the progestogen-only pill, that figure drops slightly to 96-99%. If you’re typically a forgetful person, however, the pill may not be a great option for you. Additionally, the pill is proven to have health risks for those suffering from high blood pressure. At your consultation, your GP will ask you various questions regarding your health and possibly your sexual history and current relationship status to decide whether or not the pill is the best option for you. The pill can interfere severely with the user’s hormonal levels also, and for that reason many of those attempting to use the pill will try various different brands, which each contain different hormone levels. For some, the pill just does not work, as it interferes too strongly with certain symptoms associated with Premenstrual Syndrome (PMS).
These downsides associated with using the pill have pushed many with uteruses towards LARCs (or long-acting reversible contraceptives), that is, intrauterine devices (IUDs) and the implant (which you may know as the bar). With LARCs, the worry of ‘taking it’ on time is eradicated, greatly decreasing the failure rate. IUDs are inserted and removed by a trained doctor directly into the womb, where it does three things: it stops sperm from meeting the egg, it delays the egg from getting to the womb through the fallopian tubes, and it prevents the egg from implanting in the womb. IUDs are available in different materials: copper IUDs, and Mirena IUDs, the latter of which is made of plastic. while usage for the two devices is identical- both are implanted and removed by a doctor- other factors, such as their longevity and side effects on the body, do vary. For example, the copper IUD is said to be safe to remain within the body for up to 10-12 years, whereas the timespan of the Mirena IUD is advertised closer to 5 years. The copper IUD can be used as emergency contraception, whereas Mirena cannot. Whereas Mirena can decrease severe menstrual pain and heavy bleeding, and is therefore often prescribed to those dealing with endometriosis, the copper IUD may actually increase menstrual pain and bleeding in some users.
The implant, or the bar, unlike its aforementioned LARC counterparts, is inserted in the arm, not the uterus. From there, like an IUD, it releases progestogen into the body, stopping the body from producing an egg and thickens the fluid in the neck of the womb. The bar can last up to three years before it needs to be removed by a doctor. Like all other forms of contraceptives, the bar comes with its own list of potential health risks, particularly that the user may be allergic to some of its components. Generally, LARCs boast an effectiveness rate greater than 99%.
For many, the greatest barrier to getting and using contraception is the cost. So which option is the cheapest in the long run?
I currently use Elvinette as my primary form of contraceptive. Elvinette is a generic branding of Yasminelle, which I used to use until one of the GPs here in UCD suggested that I swap to the cheaper alternative. Elvinette is the combination pill,and whereas it was generally accepted for years that it was best to take a 7 day break between each pack, I was more recently advised to only take a 4 day break. First, to be prescribed the pill via UCD Health, you pay €25. Fortunately, your repeat prescription which comes every 6 months can be done by a nurse, which costs €15. The Procare pharmacy in the student centre offers Elvinette in bundles of up to 6 months at a slight discount. One six month bundle costs €42.70. If, rhetorically speaking, I were to spend 3 years studying in UCD and continued using my current prescription without needing another GP appointment related to my contraceptive, I would spend €371.20 on the pill. How does that price point compare to LARCs?
The only LARC that UCD Health offers is Implanon (the bar). Again, the doctor consultation costs €25. Your vaccine prior to insertion costs €125 if you can provide a PPS number, or €184 without a PPS number, and the fitting itself costs €50. UCD Health does not provide any removal services of the bar, so supposing one then went to the Dublin Well Woman Centre where removal and removal with same-day re-fit both cost €150, the cost of the bar for its 3 year lifespan comes out between €350-€409.
Similar costs, but it’s important to bear in mind how they’re even higher for those not benefitting from discounted services.
When it comes to choosing birth control and contraceptives, there is no obvious answer. Particularly for those of us with cervixes. From looking at the data, I think it’s important to have an open and comfortable conversation with your doctor or nurse regarding your needs, and to observe your family health and contraceptive history.
Eva Earner – Features Writer