‘Vasectomies should be provided free of charge’

For too long, contraception has been viewed as the responsibility of the woman. Now that the Government recently extended its rollout of the free contraception scheme for women, the time is ripe for a mature discussion on who exactly this scheme should be targeting.

It should include men. Vasectomies should be provided free of charge.

Since September, the contraception scheme is available for women up to the age of 30. Before that, only women from the ages of 17 to 26 could avail of the service. While the provision of the pill as a free option is to be welcomed, we should also remember that many women make a sacrifice in undertaking this form of contraception, due to the physical and mental side effects experienced by many.

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So, why are we not demanding the closing of the gender gap when it comes to contraception?

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Through this scheme, the State is perpetuating the anachronistic notion that birth control is the domain of women and that men don’t have to carry the consequences of a pregnancy. This is unfair to women and costly to men, and needs to change.

The prospect of free contraception for women first arose during the abortion referendum in 2018. “It was a kind of... pacifier offered to the semi-doubtful brigade,” argues veteran academic and activist Ailbhe Smyth. She contends that the scheme was agreed to abate fears of a sudden flood of abortions taking place. But where are the men in this equation? Nowhere to be seen. As always with the history of sex in Ireland, the culpability lies with women, not men.

Far from the prospect of free male sterilisation representing an unnecessary cost to the exchequer, it could result in the State saving money in the long run

“It did put all of the onus on women to ensure that theirs was the primary responsibility for contraception in this country,” says Smyth.

Getting a vasectomy in Ireland will set you back somewhere between €450 and €550. It is currently available without charge to men who are medical card holders. This represents about a third of the male population. The other 66 per cent are subject not only to a considerable expense, but also to a procedure that continues to have a stigma attached to it. This approach isn’t consistent with international best practice. Our neighbours in Northern Ireland and Britain offer vasectomies free of charge on the NHS. Vasectomy is also free in Denmark, covered by the public health service.

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“It’s a very minor procedure,” says Smyth. “It wouldn’t be a cumbersome addition to our health service. It’s the kind of step that will only be taken when we decide that contraception should be free for everyone. The most important point about all of this is that there should be an ‘everyone’ in whatever steps are being taken.”

Naysayers will point to the relative inexpensiveness of condoms as an easy alternative to vasectomy. But the men who are seeking this procedure are often in their late 30s and 40s, have had children and are looking for a more permanent contraception solution. Condom use is highly prone to human error, resulting in the births of more children that the State spends considerable finance on supporting. Far from the prospect of free male sterilisation representing an unnecessary cost to the exchequer, it could actually result in the State saving money in the long run. The condom argument doesn’t cut it.

Although vasectomies have been available in Ireland since the 1970s, we still lag behind other countries. The vasectomy rate in Northern Europe is 11 per cent. In the UK it is between 17 per cent and 21 per cent. A staggering 22 per cent of men undergo a vasectomy in Canada, while it is just 8 per cent in Ireland.

Pope Pius XI couldn’t have been more emphatic in 1930 when he ‘outlawed’ vasectomies, declaring that ‘men are not free to destroy or mutilate their members’

Research carried out by Irish Life Health in 2018 showed that 10 per cent of Irish men believe vasectomy involves the surgical removal of the testicles. As funny as this sounds, it points to a broader disconnect in how Irish men understand contraception. We continue to see it as mildly baffling and something that is better left to women to look after. “Even the word [vasectomy] sounds highly technical and surgical... that is very off-putting,” says Smyth. “There is a reluctance to do anything about surgically altering your manhood.”

There are also historical reasons for our national apprehension when it comes to vasectomy. These are directly related to our perceived notions of masculinity and morality. These have persisted in the Irish imagination for decades, stemming from the Church’s position on the procedure. Pope Pius XI couldn’t have been more emphatic in 1930 when he “outlawed” vasectomies, declaring that “men are not free to destroy or mutilate their members”. Even as recently as 1997, Philip Boyce, a bishop in Donegal, described vasectomy as a sin, a “type of mutilation” and a breach of God’s law.

While the pill now rightly exists free of charge and without significant stigma, the vasectomy continues to linger in the shadows

An article in the Sunday Independent in 1976 evokes the legacy of our apprehension over the perceived link between a vasectomy and a man’s sense of masculinity. The article carried an interview with Dr Andrew Rynne of the Irish Family Planning Association. Dr Rynne was the first doctor in Ireland to carry out the procedure. The article read, “If there was any one common quality for men presenting for vasectomy it was their confidence in their manliness, said Dr Rynne.” The article continued, “Thus a good proportion of the men being sterilised were in occupations predominantly male such as the gardaí, fire brigade, soldiers, and farmers. But this was not all that striking, and by no means excluded the ‘softer’ types such as hairdressers, male models and doctors.”

This cultural baggage that we carry has resulted in a nation that too often leaves contraception up to women, rather than encouraging men to take their responsibilities regarding birth control more seriously. The Government’s decision to exclude vasectomies from the free contraception scheme reinforces these historical misconceptions.

[ Why are young women giving up on the contraceptive pill? ]

There is no denying that female contraception has its own torrid history of liberalisation in this country. But while the pill now rightly exists free of charge and without significant stigma, the vasectomy continues to linger in the shadows.

How will we not look back on the current scheme as an entirely sexist enterprise? It excludes men and puts the burden of responsibility on women.

Instead of sustaining the contraception gap, the Government needs to create equality of access.