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Contraception: making empowered choices about fertility and parenthood

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Dr Caitríona Henchion

Medical Director, Irish Family Planning Association

Most people who come to the Irish Family Planning Association (IFPA) want to have a fulfilling sex life; many want to be parents at some stage. Planning — whether regarding when, how and with whom — is a major life decision.

With the Government’s free contraception scheme, people aged between 17 and 30 can choose the most effective — rather than the least expensive — contraceptive for their stage of life, current lifestyle and plans for the future.

Information is key to contraceptive choice

People between the ages of 17 and 30 who choose to access free contraception can enjoy sex and avoid getting pregnant unless they want to. If they have an abortion, the reason won’t be because they couldn’t afford contraception. However, unless everyone knows about all available contraception methods, understands how they work and can weigh up the pros and cons, the scheme will not fulfil its potential.

No contraception method gives 100% protection

Long-acting reversible contraceptives (LARCs) are the most effective way of avoiding pregnancy[A1] . Post-coital emergency contraception (EC) can be effective for 3 to 5 days after sex, and it can be taken as often as needed. However, the failure rate is higher than with daily pills or any of the ‘fit and forget’ methods. EC is more effective the sooner it is taken after unprotected sex.

Long-acting reversible contraceptives (LARCs)
are the most effective way of avoiding pregnancy.

Some people prefer to avoid hormonal contraception and use fertility awareness apps, which are designed to predict ovulation based on previous menstrual cycles. However, their effectiveness varies from person to person. Ovulation times can vary, even with regular periods. Not all apps are effective for women who have recently given birth or are breastfeeding, for young teenagers, perimenopausal women or those whose cycles are irregular.

As fertility awareness apps and methods involve a significantly higher risk of becoming pregnant, their use needs to be an informed choice. Myths and misinformation about the side effects of long-acting contraception, however, can deter people from using reliable, modern methods of contraception.  

Rights-based, equitable and pragmatic health policy

Unintended pregnancy can catastrophically disrupt a person’s plans and derail their career or education. Ongoing public health awareness campaigns and comprehensive sexuality education are essential to the contraception scheme’s success.

Investment in capacity building for healthcare professionals is critically important. We need more GPs, nurses and midwives with expertise in contraception, including the insertion and removal of coils and implants.

Critically, the scheme must be extended so that cost is never a barrier to contraception use by anyone of reproductive age living in Ireland.  

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