Restricting access to contraception to stop people having sex: haven’t we tried that before?

If I understand him correctly, Peadar Tóibín is worried the State may be encouraging 16-year-olds to encourage other 16-year-olds to have sex. “Peer pressure may well increase for a child, if the State, in a practical sense, is giving licence to underage sexual activity,” he said this week.
Tóibín was giving his view on what should, you might be forgiven for assuming (provided you had only the most fleeting knowledge of the history of Ireland’s obsession with women’s sexuality), be a relatively uncontroversial proposal to extend the State’s free contraception scheme for women to 16-year-olds. Toibín suggested that to do so would be a “material contravention on the issue of consent” by the State, and would “push pressure down the age profile in relation to sexual activity from a very young age”.
Aontú, Tóibín’s party, seems to to be concerned this amounts to a State-sponsored behavioural nudge – a kind of modern take on SSIAs or Eircom shares, only this time involving patches, pills or Mirena coils for 16-year-olds. “This is quite shocking. It would, in effect, give a form of state approval for underage sexual activity,” it said on social media.
Despite the overwrought tone of some of the commentary, this scheme is one of the very good things the State has done for women in recent years – all the more remarkable since it was done with relatively little fanfare. (It’s almost as though there was not universal support for it within Government.)
Hormonal contraception is very safe and widely used, not just for the prevention of pregnancy, but for the treatment of debilitating hormonal conditions, including endometriosis – which affects one in ten girls and women. I’ve taken the Pill myself, at various times in my life, to prevent pregnancy, ease the symptoms of polycystic ovaries and clear up my skin. Hormonal contraception has its drawbacks and doesn’t work well for everyone, but for those it does suit, it is a modern miracle.
In Ireland, half of 17- to 25-year-olds are already availing of the free contraception scheme, Donnelly said last week, which is available for all women up to 35, and up to 44 for those with a medical card. The principal objection to extending it to 16-year-olds hinges on the fact that, while the age of medical consent is 16, the age of sexual consent in most cases is 17 (there is a a “proximity of age” defence for those between 15 and 17, once the age gap is less than two years.)
This leaves doctors and their patients in one of those murky grey areas that have formed the backbone of so much of women’s healthcare in this country. A Law Reform Commission report in 2011 recommended that the law be clarified to establish that, at 16, individuals have full capacity to consent to surgery, mental health treatment and contraception., but this didn’t happen.
Tóibín found an ally for his concerns in the Chief Iman Shaykh Dr Umar Al-Qadri. “My concern is that it basically encourages underage sexual activity by the State,” Dr Al-Qadri said this week.
There are a few things to say about this. The first is that it is very difficult to imagine 16-year-olds egging each other on to have sex just because the State says they can now go to their GP and ask to have an IUD inserted, and not be charged for it. In my experience of teenagers, the State suggesting that something is a good idea (which, to be clear, is not what is happening here) is more likely to have the opposite effect.
Nor does allowing 16-year-olds to access free contraception demand a review of the age of sexual consent, which seems to be the unspoken concern here. On the contrary: it makes sense that adolescents should have access to sexual health services before they become sexually active. Besides, where teenage sex happens, it tends to be outside the realm of either State or parental approval.
Restricting the availability of contraception in an effort to stop people having sex sounds a lot like something we tried before. The trebling of our population figures between 1935 and 1993, when condoms were able to be freely sold, is a testament to how well that worked out for us. The teenage fertility rate peaked in 1980, and has fallen since.
The second point is that, as Minister for Health Stephen Donnelly put it with what seems like unassailable logic: “A young woman aged 16 can walk into her GP today and say she’s pregnant, and she wants to avail of termination of pregnancy services, and they will be provided to her, quite rightly … she should also be able to go into her GP and say I’d like to be able to avail of free contraception.”
The third point is this. For most of our history the State has behaved as though men had nothing to do with crisis pregnancies. Women who ended up with an unwanted or socially unacceptable pregnancy were shamed, denied access to terminations, locked away in institutions, impoverished and sometimes had their babies forcibly taken away. Until 2019, if they wanted a termination, they had to fly to England or to surreptitiously order pills to be taken at home and hope they didn’t end up bleeding out on the bathroom floor. The men who impregnated them got away with barely a side-eye from the neighbours.
Free contraception seems to me to be the very least the State can do for women by way of recompense now. And it should be quickly followed by free HRT – not just because access to hormonal medical treatment shouldn’t be subjected to an upper age-limit, but because there are downstream public health benefits to women going on HRT, including a reduction in dementia, osteoporosis and heart disease.
The free contraception scheme should also be extended to include condoms. This would have the dual benefit of providing protection from STDs and offering an acknowledgment, a long overdue one on the part of the State, that preventing unwanted pregnancy is men’s responsibility too.