Pharmac funding does not cover the cost for insertion or removal of the IUD if there are complications, which has been an issue for many kiwi women. Photo / Getty Images
At the end of 2019, Pharmac announced its funding for the Merina and Jaydess IUD to make contraception more accessible for women.
But this didn't cover the cost for insertion or removal of the device if there are complications, which has been an issue for many Kiwi women.
26-year-old Abby Symon from Wanaka had her first Mrina IUD inserted by her GP in November 2019 and said it was the "most painful thing" she had ever experienced.
She was bed-bound for two days after the insertion and experienced bleeding every month for a year, which her IUD was designed to prevent.
"I paid $55 around 4-5 times to go and see my doctor as to why I was still having such horrible problems."
In November 2020 Symon paid $250 to have an ultrasound through private practice as she "urgently" needed it and found her IUD had moved, tearing one of her ovaries.
She had it removed and replaced the same day by a doctor, costing her a further $110.
"I hated that I had to pay to be told to give it more time and then after a year, being told it was in the wrong place probably from the beginning. I've probably paid nearly $900 in total."
A spokesperson from the Ministry of Health said some healthcare services, including the insertion and removal of long-acting reversible contraceptives (LARC), are not funded by the Government and these fees will be set by the healthcare provider.
"The ministry provides a limited amount of funding to district health boards to improve contraceptive access including LARC insertion and removals."
They said the eligibility criteria to access this funding includes individuals with a community services card, those living in high deprivation areas and others who are at high risk of poor health.
"DHBs can adjust the criteria in order to manage the available budget."
26-year-old Anna* had a copper IUD fitted in October 2019 and said the insertion was "uncomfortable", but the procedure went well.
Six months later, Anna fell pregnant and booked in for an ultrasound which revealed the IUD had been misfitted because Anna had a complete septate uterus.
This is a rare condition where the uterus has a septum or "wall" that divides the inner portion of the uterus.
"An IUD should have never been fitted for a person with a uterus like mine. I then needed to remove the IUD, at which point I suffered a miscarriage."
Anna also had to have a saline infusion ultrasound to "assess the severity of [her] condition" which cost $500, $250 of which was covered by her health insurance.
"My condition has proved to be incredibly expensive and I have little financial support."
She said it should be "mandatory" for ultrasounds to be performed before insertion of IUDs so health practitioners can "be sure of the anatomy" to avoid complications.
"It was heartbreaking going through what I went through, and if a scan could have saved me from a birth control failure and a subsequent miscarriage then I would have wanted it."
Christchurch obstetrics and gynaecology specialist Dr Emma Jackson said implementing mandatory ultrasounds before insertion could act as a barrier for women due to extra costs.
She said if a health practitioner came across any difficulties when inserting an IUD, they should stop and examine the uterus through an ultrasound to check for possible issues.
Jackson said the cost for IUDs can be "quite cheap" through the low-cost consultation fee but she "doesn't know" how well women are accessing this.
"In an ideal world, I think contraception should be free for everybody. We were very delighted as a group of consultants when funding did improve [for IUDs]."
30-year-old Jane* was on her third IUD and had good experiences, until she wanted it removed to have another baby six years ago.
She went to Family Planning to get it removed but was told her Mirina IUD was "embedded into [her] uterine wall" so she would have to get it surgically removed.
This is called uterine perforation, an uncommon complication that can happen during the insertion procedure, occurring when an IUD migrates into the body.
Jane went to a doctor and was told it would cost her $5000 to have it removed surgically, otherwise, he could give her a relaxant pill and pull it out himself.
"There was no way I was going to be able to afford it. The hospital said it wouldn't be covered," Jane said, so she had it removed by the doctor.
"Two people pinned me down and he had to rip it out of my uterine wall. Thinking back, that could have done so much damage. It was brutal."
The experience was enough to put Jane off IUDs for good despite her previous positive experiences.
"I've never gone to get another one. I'm never, ever doing that again."
Jackson said an IUD can sometimes move and migrate into the body with a risk of perforation.
"I've seen IUDs that have shifted in women. The highest rate of this happening is within the first year of insertion."
She said if a woman has a migrated IUD that needs to be removed there will be no charge if she is referred through the public system.
Jackson said complications such as an IUD becoming embedded in the uterine wall was rare, and the IUD was still a "fantastic" option and could be a "lifesaver" for women struggling with troublesome periods.
"I would definitely recommend that women consider an IUD if they want a good form of contraception."
30-year-old Auckland Phee Nicks had 3 Mirina IUDs fitted by a gynaecologist and said the process has been "very beneficial".
"It would be a complete lie to say it doesn't hurt, but the few minutes of pain seems minor compared to the years of pain from PCOS [polycystic ovary syndrome]. I would never get a Mirina from someone who isn't specialised."
PCOS is a hormonal condition causing enlarged ovaries with small cysts on the outer edges. Mirina IUDs can be recommended to protect the uterine lining from abnormal thickening, which can occur for a woman with PCOS.
If women have concerns about their IUD procedure, they can lodge a complaint with the Health and Disability Commissioner (0800 11 22 33).
If they have concerns over an injury caused from IUD insertion or removal by a registered health professional, they can make a claim through ACC (0800 101 996).
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