Government contraceptive fund a flop

Photo: Lynn Grieveson

A half-million-dollar fund to encourage beneficiaries onto long-acting contraceptives has hardly been touched.

A Government scheme aimed at increasing the number of beneficiaries using long-term contraceptives has failed miserably.

The Special Needs Grant was introduced in 2012 to cover the costs of long-acting reversible contraceptives (LARCs), including the cost of transport to appointments and any medical and pharmacy charges.

Any woman on benefits (with or without children), and also any woman aged 16 to 19 who is the dependent of a beneficiary, can receive up to $500 a year to cover the costs of contraceptive injections, contraceptive implants and intra-uterine devices (IUDs).

When introducing the fund, the Government estimated that up to 16,000 women would access the grant, and $500,000 was budgeted for the first four years of the fund.

But in briefing documents released under the Official Information Act, the Ministry of Social Development (MSD) show only 795 grants were made from the fund over its first four years.

In total, just $143,325 was spent over that time, at an annual cost of $35,000.

LARCs have an effectiveness rate of 99 percent, but are only used by four percent of women.

There are several versions available including the copper intrauterine device and the Jadelle subdermal implant, both of which are subsidised.

Implants can cause side effects, with one of the most common being irregular bleeding that is experienced by seven in 10 women.

One of the main reasons MSD wants to push LARCs is to try and reduce teen pregnancy.

But the documents reveal that only eight per cent of grants were for 16 to 19-year-olds.

The documents also note that some doctors felt uncomfortable performing IUD insertions on young women and would refer patients on instead.

“Evidence suggests that some medical practitioners are not confident in inserting intrauterine devices (IUDs) into younger patients, and that those who have not had much experience with LARC insertion will refer patients to Family Planning, rather than undertaking the procedure themselves.”

What went wrong?

A raft of things, according to the documents.

For one, the application process to access the grants were described as “complex” and “time-consuming”, often requiring clients to have multiple appointments with their doctor and Work and Income.

This meant women who lived far away from their clinic or had social or cultural barriers to accessing health care were uninterested.

Attempts to fix this, such as making it possible to apply over the phone and redirecting callers to female staff, had little impact.

Then there was a significant problem in that many doctors had no idea the grant even existed.

Changes proposed by MSD on how to improve the grant were redacted from the documents.

MSD’s service delivery national commissioner Kay Read would not elaborate on those improvements, but says the decision whether to use contraceptives was a personal one.

“The Ministry of Social Development helps New Zealanders to help themselves by reducing long-term welfare dependence and improving outcomes for vulnerable children, and increasing access to effective forms of contraception is one way we can help.”

Social Development Minister Anne Tolley, who requested the briefings from MSD, told Newsroom the initial take-up estimates for the grant were based on early data.

Tolley said it was important awareness of the grant was raised, and she was waiting on advice from officials about how to do so.

“I agree the process to receive financial support for LARCs is too convoluted, and I’ve asked the Ministry to do some work to simplify it,” she said.

An expert opinion

Associate Professor Beverley Lawton, of the University of Otago’s Women’s Health Research Centre, said the grant was a great initiative - with a big problem.

That problem was a lack of public knowledge about the fund's existence, combined with the difficulty, and potential awkwardness, of accessibility.

“If you have to go through the MSD, the comments we were getting back in the field from the women were (that) it was quite hard to talk about contraception with their case worker – it’s a very personal topic.”

Making it possible for a GP to apply for funding online would solve that problem, she said.

Lawton was also positive about fully funding the Mirena LARC, described in the MSD documents as the “gold standard” due to its common side effect of lighter and shorter periods.

“I think we just need to have it all there, we need the whole list so we can help these women.”

Pharmac has a commercial arrangement with the supplier of Jadelle until end of 2017.

Operations director Sarah Fitt says at the moment Mirena was only funded in New Zealand for the treatment of heavy menstrual bleeding.

But an application to consider widening access to include its use for contraception, endometriosis and endometrial hyperplasia was being considered, she said.