Study exposes cost barriers to contraception

With an average efficacy rate of 99%, long-acting reversible contraception (LARC) is considered one of the most effective methods of contraception.
 
Now, the results of a new study have shown that, when the cost barrier is removed, it is also the method most women will choose.
 
Published in the BMJ, the study examined a 15-month period in the Canadian province of British Columbia after all forms of prescription contraception were made freely available to women of reproductive age – some 860,000 women.
 
The results showed almost 80% of additional contraception users chose LARC, which confirms that cost is a barrier for people seeking healthcare, said Dr Tim Senior, Chair of RACGP Specific Interests Poverty and Health.
 
‘When people do make decisions according to affordability, and you take that out of the equation, people make decisions based on what’s going to be most effective for them,’ he told newsGP.
 
The Canadian researchers monitored the numbers of prescription contraceptives dispensed in British Columbia between 1 April 2021 and 30 June 2024.
 
In April 2023, the province introduced Canada’s first universal contraception coverage policy, with a public insurer paying 100% of prescription costs for all forms of prescription contraception.
 
This made contraception freely available to all female residents aged 15–49 years, compared to the previous $500 AUD upfront cost of LARC.
 
In April 2021, 3249 LARC prescriptions were dispensed.
 
Immediately after the policy change, monthly LARC dispensations increased by 1050 and saw a steady increasing trend from then on. 
 
Fifteen months after the policy’s introduction, there were an additional 14,268 users of all prescription contraception, with an estimated 11,375 (79.7%) of those choosing LARC.
 
‘Together, our findings suggest that there was substantial unmet need for prescription contraception (especially LARC) before the policy and that costs were an important barrier to contraceptive use and method choice,’ the researchers wrote.
 
‘These results provide clear evidence that provision of universal prescription contraception coverage, at no cost to patients, substantially increased prescription contraception use and, particularly, LARC use.’
 
Dr Senior said this was ‘one of the most interesting things about the study’, in that it showed the ‘universal’ impact of free contraception, as opposed to being means tested.
 
‘You get a population level impact from making it universal. I think that’s a sign that we have these groups that are supposedly indicators of disadvantage, but they’re not perfect indicators,’ he said.
 
‘People’s circumstances change, so people can lose a job or have a drop in income suddenly. It just takes away the worry of the cost for some people.
 
‘There’s the actual cost, but there’s also the concern about what it might cost when that’s removed.’
 
Dr Senior said the study’s evidence supports the argument that ‘funding well-trained GPs to be able to do this at no cost to patients, or very small cost to patients would have a beneficial effect’.
 
‘We know that access to reproductive healthcare, general practice primary care is really important for that, because people want information and want to be able to discuss their choices with someone who they trust, who is knowledgeable and has their best interests at heart,’ he said.
 
‘GPs are ideally placed through that, because we know our patients well and in developing that relationship, we’re able to have trusted conversations that are relevant to the patient.
 
‘I’d be generous and say, “you get good outcomes in a health system by funding general practice well”.
 
‘The evidence is really clear on that, so let’s fund that well.’
 
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