The free contraception scheme for women aged 17 -25, ordinarily resident in Ireland, was launched on 14th September, 2022. Its remit has been expanded gradually to include women aged from 17 to 31 inclusive, from January 1st, 2024. Approximately €43.9m has been allocated to support the scheme in 2024 and approximately 2,400 GPs, primary care, family planning and student health centres and 2,050 community pharmacies have contracts with the HSE to provide services under the scheme.
The scheme covers the cost of consultations with GPs, primary care, student health and family planning centres and prescriptions for the wide range of contraceptive options available on the HSE Reimbursement List, including long-acting reversible contraception (LARCs: injections, intrauterine devices and systems (coils) and implants) and emergency contraception in addition to the contraceptive Pill, patch and ring. LARC fittings, removals, injections and check-ups are also free of charge under the scheme. Women who have had coils, IUDs, IUSs or implants inserted while eligible under the scheme will remain eligible for subsequent checks and free removal of any devices inserted prior to their 32nd birthday, to ensure continuity of care.
There is no public health related reason to limit the scheme by age, up to the age of 55 (after which, prescription of contraception is not clinically recommended). The phased introduction of the scheme was recommended for a number of reasons, as follows:
As per the recommendations of the Report of the Working Group on Access to Contraception (published in 2019 and available on the Department’s website), it was decided to commence the scheme with younger age cohorts, as they are most likely to experience unplanned pregnancy and least likely to be financially independent. A significant number of people in the 17-25 age cohort are still in full time education and dependent on parents and guardians for income, some of whom may not be willing or, indeed, in some cases, able, to fund prescription contraception. Access to contraception, for younger age cohorts in particular, is likely to be exacerbated by the current cost of living crisis.
The Report of the Working Group on Access to Contraception also highlighted concerns around the capacity to fit LARCs; at the time of publication in 2019, this was estimated at about 1,000 GPs. A phased approach permits additional GP training in line with service expansion, minimising the risk of significant waiting lists arising. The ICGP have been funded under the scheme, following launch in 2022, to provide additional LARC training, and the numbers of GPs able to fit and remove LARCs has been increased.
Coils and implants can also be used to treat peri-menopausal symptoms such as irregular periods and heavy bleeding (menorrhagia); anecdotally, demand for these devices is often higher in women aged from their late 30s to early 50s, making it imperative that numbers of GPs trained to fit LARCs are increased in tandem with eligibility for the scheme.
Budgetary and financial planning guidelines recommend that demand-led schemes which are likely to incur significant Exchequer costs, such as this one, should be subject to pilot testing and/or phased implementation, as the potential risks of implementing full access to a demand led scheme without testing real world costs could be considerable. However, it should be noted that this scheme has been operating within its allocated budget in 2022 and 2023.
Expansion of the scheme to 16 year-olds is under active consideration, and has been subject to consultation across relevant Government Departments and agencies. Legal advice on the matter is expected from the Office of the Attorney General shortly. Should legal advice confirm there are no legal impediments to extending the scheme to 16 year olds, legislative change would be required.
Any decision relating to further expansion of the scheme will be a matter for the Estimates process in advance of Budget 2025.
It is important to note that prescription contraception, while being very effective at preventing unplanned pregnancy, does not protect against sexually transmitted infections (STIs). The National Condom Distribution Scheme supports both STI prevention and accessible contraception for men and their partners. Free condoms can be accessed through the national network of STI clinics, participating charities and NGO partners and on participating 3rd level campuses. Since 2023, free condoms have also been supplied with orders for free home STI testing kits.
