What do the changes to IUD access mean for Australian women?

Ahead of the government’s response this week to a Senate inquiry into access to reproductive health care in Australia, the government has announced new measures to make it easier to get an intrauterine device, or IUD.

Payments to doctors and nurse practitioners to insert and remove these devices will increase. The government will also set up eight centres to train health-care professionals in IUD insertion, and ensure they are skilled and confident.

The Coalition has vowed to match this commitment if it wins the federal election.

So what are IUDs? And how might these changes impact Australian women?

‘Set and forget’ contraception

IUDs are small devices that are implanted in the uterus to prevent pregnancy. There are two types: “hormonal IUDs”, which contain the hormone levonorgestrel, and “copper IUDs”.

Another long-acting reversible contraceptive, the contraceptive implant, is about 4cm long, made of plastic and inserted just under the skin in the arm.

Hormonal IUDs (known by brand names Mirena and Kyleena in Australia) and the contraceptive implant are subsidised under the PBS, costing A$31.60 ($7.70 concession). Copper IUDs aren’t, and cost around $100.

However, women may face significant out-of-pocket costs to have IUDs and implants inserted.

IUDs are types of long-acting reversible contraception. They are often called “set and forget” because once inserted, nothing more needs to be done. Long-acting reversible contraceptives are the most effective way to prevent pregnancy (over 99%).

This compares with the commonly used contraceptive pills containing estrogen and progestogen, which need to be taken every day. These have a failure rate of 8-9% with typical use.

The hormonal IUDs’ contraceptive effect lasts for eight years, while a copper IUD can last up to ten years, depending on the type. The contraceptive implant protects against pregnancy for three years.

The levonorgestrel in hormonal IUDs acts locally inside the uterus to thin the lining of the womb, so much so that after about six months of use, many women experience very little, if any, bleeding.

This reduction in menstruation can prevent or reduce conditions such as heavy menstrual bleeding, iron deficiency and period pain.

Like all contraceptives, there are potential side effects. IUD insertion is painful, there is a small risk of expulsion of IUDs and they may not be positioned correctly at the time of insertion.

Copper IUDs may cause heavier bleeding than usual.

And the contraceptive implant is associated with unpredictable (although mostly tolerable) bleeding patterns.

Australian women are less likely to use them

Just 6% of women use an IUD and another 5% use the contraceptive implant.

This compares with Sweden, where 30.9% use a long-acting reversible contraceptive, and in England, it’s over 30%.

Part of the reason is many women don’t know much about these contraceptive options, especially about IUDs.

But our research found that women were more likely to choose an IUD when their doctor incorporated information about how much more effective long-acting reversible contraceptives were during contraceptive consultations, and could refer women to get an insertion done quickly if they didn’t provide insertions themselves.

Women often struggle to find a GP who can insert an IUD and face long waiting times to get one inserted.

Despite a small increase to the Medicare rebate in 2022, the current rebate doesn’t reflect the costs or time needed by GPs to conduct the insertion. This has put a lot of GPs off from providing this service.

It can also be difficult for GPs to take time off from their clinical work to do the training, with courses costing around $1,500 and GPs not earning any income while attending.

What did the Senate inquiry recommend?

To overcome these issues, a Senate inquiry into barriers to reproductive health care recommended:

• appropriate remuneration and reimbursement for GPs providing IUD and implant insertion and removal services, including through increased Medicare rebates

• improved insertion and removal training to support the increased use of IUDs and implants in Australia.

How does this announcement stack up?

The new women’s health package directly addresses these issues by:

• increasing the clinician rebate for inserting and removing IUDs and implants

• providing Medicare rebates for nurse practitioner insertions

• providing GPs with an incentive to bulk bill insertions so women will not face any out-of-pocket costs

• funding eight centres across Australia to train clinicians to ensure they’re trained, skilled and confident in IUD insertion.

These measures complement announcements made last year to provide training scholarships for GPs and nurses to train in IUD insertion and to fund an online “community of practice” to support practitioners to provide these services.

With the increased rebates rolling out from November 1, and the training centres in the next year or two, we should see many more GPs skilled up and providing IUDs in the next few years.

This should make it more affordable and much easier for women to find a clinician to insert it.

Another reproductive health issue remains unaddressed

The government is expected to table its response in parliament this week to the reproductive health care access Senate inquiry.

While there have been many improvements in access to medical abortion, particularly the ability for women to receive a medical abortion via telehealth through Medicare, key challenges remain in ensuring all Australian women can access surgical abortion.

Policymakers will need to focus attention on training a new generation of clinicians to undertake surgical abortions, and developing transparent local pathways for women to access care.