How Contraception Dominated the $5 Co-Payment Fee Debate

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28 June 2023

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There is always a constant focus on our health system but with the 2023 election just three months out, the focus becomes particularly strong.

Emphasis on health was a central part of Labour’s 2023 budget, where it was announced that the $5 co-payment fee for prescriptions would be removed to make prescription medication more affordable and accessible. Having recently been removed as of July 1, co-payment fees for contraception are no longer, and it is this particular form of medication that became a major talking point.

This is because National responded with the announcement that they would reinstate the co-payment fee if elected. A “targeted approach” would instead be adopted, with support given to Gold Card holders, those with Community Services and those with “high medical needs”. Support, however, would not extend to those who need monthly contraception prescriptions. When asked whether reintroducing a fee for contraception users was fair, Luxon stated that it was a “different issue”.

Contraception Christopher Luxon
If elected, Luxon’s “targeted response” would reinstate a barrier that Labour has only recently removed.

The World Health Organization (WHO) and United Nations (UN) have both affirmed that access to safe and effective contraception is a fundamental human right. Contraception can be used for various reasons. When taken for birth control purposes, the use of contraception simply gives women (and their partners, by extension) the ability to choose if and when they become pregnant. It also supports socioeconomic plans and decisions that might otherwise be impacted by falling pregnant and having children.

However, the relationship women have with healthcare is intricate and complex, especially when it comes to reproductive healthcare. Access to, and interaction with, healthcare systems becomes even more restrictive for the LGBTQI+ community. The affordability and accessibility of contraception is one major health barrier (among several) for women globally, where access to contraceptive methods is “insufficient and uneven”. In Aotearoa, this barrier is more apparent for low income earners and Māori and Pasifika women.

Here in Aotearoa, the most common method of contraception is oral contraception, often known as ‘the pill’. Different levels of funding, however, cause prices to vary. Before July 1, the most common contraceptive pill in Aotearoa – Levlen – was fully funded, where a three-month supply would have cost someone $5. At the other end of the spectrum is Yaz, a completely unfunded pill that would have cost someone $70-$85 for the same three-month supply.

When different levels of funding are given to oral contraceptives, the costs between Levlen and Yaz can produce two entirely different experiences. Figuring out what kind of contraception works best is a journey that many women know all too well, and it is an experience that is known as ‘fertility work’.

When the path to finding a suitable contraceptive is not as straightforward as staying with the first prescribed pill, women suffer the consequences. Women experience not only physical side effects when taking contraception, but also mental and financial burdens – such as mood changes, depression, paying for GP visits and the associated time and travel for such appointments – for a practice that, in heterosexual relationships, is largely deemed their responsibility.

Fertility work can also take different forms depending on one’s access to reproductive healthcare. For example, the varying costs of oral contraceptives can produce inequity between individuals, as those on lower incomes are limited to a small list of funded options. At an even more basic level, the presence of co-payment fees for contraception widens the gap between those who can and cannot access birth control.

While a $5 a co-payment fee may not impose a burden on every New Zealander, research has shown that such a removal reduces the number of hospital admissions (saving an estimated $2.65 billion a year), increases well-being by supporting individuals in managing their health concerns and helps ease the cost of living crisis. Naturally, the removal of co-payment fees for contraception would produce similar benefits, particularly around accessibility and easing the impacts of a gendered health tax.

Luxon’s “targeted response” would reinstate a barrier that Labour has only recently removed. As a result, contraception is not viewed as a necessary medical need, and the stigma surrounding sexual and reproductive health is reinforced that causes it to be seen as different from ‘general’ healthcare; maybe reproductive healthcare should be treated differently from general healthcare, though not in a ‘lesser than’ way.

While contraception has dominated the health discussions post-budget, debates arguably do not dive deep enough into the more structural issues around how contraception is treated in policy and by the public. However, perhaps the recent spotlight contraception has received could lead to more robust discussions about the several barriers women face when it comes to reproductive healthcare that go beyond the $5 co-payment fee.

Related Article: The 2023 Budget Unpacked

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