The news that Pharmac has agreed to fully fund the Mirena and Jaydess contraceptives from 1 November 2019 has been welcomed by women and family planning practitioners all over the country.

East Auckland GP and College Fellow, Dr Orna McGinn is particularly pleased after launching a petition to bring the issue into the spotlight that attracted more than 4,500 signatures - although the announcement won't see the end of her campaign to give women access to effective, long-term contraception.

"While I am really happy that the Mirena device is now available to all women who request it, it's not the end of the story," says Orna, who has been working to increase access to contraception since her arrival in New Zealand from the UK nine years ago.

"Funding needs to be granted for the insertion of the device as well. We need to ensure that there are no barriers for the women who need it."

The devices have been available in New Zealand for a long time, but at a substantial cost of between $300 and $500 with only those fulfilling specific criteria able to get it for free.

"Reproductive and sexual healthcare service provision is very fragmented; each different health board has a different approach to funding which entrenches inequity in access. A national approach is required so that all women who need contraception can access it, regardless of where they live."

In addition to her general practice work, Orna is also the Clinical Director for Primary Care at Auckland DHB and has carried out research at Auckland University investigating the barriers GPs face when trying to provide comprehensive contraceptive services for their patients.

"When I came to New Zealand in 2010, I was really surprised by the lack of access to contraception here. The World Health Organisation lists the Mirena IUS as one of the essential medicines required to run a health service," she says. "It's one of the most useful interventions we can offer our eligible patients with close to 100% contraceptive efficacy. That's an incredibly satisfying thing to be able to do as a doctor."

The device offers benefits that go beyond just preventing pregnancy - it can also reduce rates of abortion (currently one in four New Zealand women will have an abortion in their lifetime) and endometrial hyperplasia, a condition that can lead to uterine cancer. Currently, New Zealand has one of the fastest rising rates of endometrial cancer in the world, particularly in Pacific women.

"The impact Mirena can have on a woman's quality of life is huge," says Orna.
Orna's interest in women's health has always been a passion and she worked in a family planning clinic in the UK before she moved here with her gynaecologist husband Simon and two sons.

"We first lived in New Zealand 15 years ago when Simon came to Middlemore Hospital as he wanted to work in a busy tertiary hospital with a high level of need. When his contract was over, we returned home but missed the people and the country so much we decided to move back here permanently," says Orna.

Her frustration at what she sees as a lack of action from those who set the healthcare agenda stems from her belief that as a group, GPs want the best for their patients.

"In the main, doctors are an altruistic group," she says. "We feel it’s a privilege to be so involved in other people's lives and we do our best to give our patients the care and services they need.

"While I am really happy that the Mirena device is now available to all women who request it, it's not the end of the story,"

"I was at a conference where I heard Kate Baddock (Chair of the NZ Medical Association) speak and she asked if anyone in the room had reduced their fees for a patient so they could get the treatment they required. It was humbling when every single person there raised their hand.

"But doctors shouldn't be put in this position. The funding announcement is great, but it is at least 20 years overdue and there is much more to be done.

"Reproductive and sexual healthcare service provision is very fragmented; each different health board has a different approach to funding which entrenches inequity in access. A national approach is required so that all women who need contraception can access it, regardless of where they live."

Orna says her campaign work is not something she does alone, acknowledging the support of Professor Leslie McCowan from Auckland University and crediting the NZ Women in Medicine and GP Facebook groups with getting the online petition out on social media, and helping to raise the profile of what is a serious issue.

"Contraception is not just a women's issue, it's a basic public health measure that can make difference to our country in many different ways," says Orna. "The battle isn't over yet."