Include Local Anaesthesia for IUD Insertion Procedures in the MBS

Author: Helen Tran and Charlotte Greet | Publish date: 07/08/2025

Problem Identification: 

In Australia, people undergoing intrauterine device (IUD) insertion are currently required to pay additional costs if they choose to receive local anaesthesia during the procedure.

While item 35506 of the Medicare Benefits Schedule (MBS) covers IUD removal under general anaesthesia, item 35503 of the MBS does not cover anaesthesia for IUD insertion procedures.

This means that individuals seeking IUD insertion may face additional costs to access anaesthesia as a pain management method. In 2023, the Standing Committee on Community Affairs stated that this ‘impedes the increased uptake of these effective forms of contraception.’ This is further known to disproportionately impact marginalised and lower-income groups.

Context: 

The MBS refers to a list of healthcare services for which the Australian Government can provide a rebate or a subsidy. This includes a range of gynaecology items like IUD related procedures, endometriosis treatment, miscarriage management and laparoscopic gynaecological procedures. Under section 3C of the Health Insurance Act 1973 (Cth), the Minister for Health can modify existing gynaecology items listed on the MBS.

In Australia, 2 in 3 women aged 18-44 currently use some form of contraception, with 83% having used contraception at some point in their lives. 

IUDs refer to small, T-shaped plastic devices used for long-acting reversible contraception (LARC) and are known to be the most effective form of preventing pregnancy available. IUDs are ‘routinely inserted by GPs, family planning doctors and gynaecologists’. Insertion can be performed while the patient is awake or under sedation. According to Gynaecology Centres Australia, many clinics utilise anesthesia as a pain management option where a local anaesthetic is applied to the cervix. 

An article by the ABC has highlighted that IUDs are more than 99% effective and ‘more failsafe than the more popular contraceptive pill – and can be used to help manage painful conditions like endometriosis and polycystic ovarian syndrome.’ The article further explained that, ‘while there is an up-front cost to purchase the device and have it inserted, in the long-run, IUDs can be up to thousands of dollars cheaper than many other contraceptive options.’ 

However, many women have reported experiencing moderate to severe pain during IUD insertion. The level of pain is known to often exceed patient expectations. One patient reported, ‘I vomited and passed out twice,’ while a health professional stated they were ‘horrified at how played down [the pain] was.’ 

The high cost of injectable or topical local anaesthesia is known to make IUDs inaccessible for many individuals. Sexual Health Advocates and Reproductive Equity (SHARE) have reported that as local anaesthesia is not covered under the MBS, there is a significant financial barrier for individuals seeking LARC methods. For those without a Medicare card, IUD related services, including consultation and insertion fees, may cost up to around $510 when general anaesthesia is involved. SHARE has reported that 61.2% of survey respondents said that the ‘cost of contraception limited their contraceptive choices.’

In 2023, the Community Affairs References Committee stated that subsidising local anaesthesia in IUD insertion procedures could reduce future system costs. They argued that making pain-free insertion of LARCs more accessible could save the Australian Government $20 million over 5 years by preventing abortions and miscarriages in people who weren’t previously using contraception.

SHARE, among others, has called for anesthesia to be added to the MBS for IUD procedures. They have said ‘these upfront costs’ of anaesthesia are not only a financial burden but also affect ‘gender equality, family planning, mental health and physical health.’ Further, Marie Stopes International (MSI) Australia and SHARE have argued that funding for pain relief options is essential where the ‘priority is [their] patients.’ They further called to not ‘ignore or dismiss women’s pain.’ They have said that adding IUD procedures to the MBS could reduce traumatic experiences and enhance patients’ sense of safety.   

Precedent: 

There is domestic precedent for subsidising local anaesthesia during IUD insertion procedures. Currently, under item 35506, general anaesthesia for the removal of an IUD which has been ‘retained or embedded’ can be subsidised through the ‘anaesthetic values amended’ section.

Advice/Solution Identification:

The Minister of Health should leverage section 3C of the Health Insurance Act 1973 (Cth) to amend the 'anaesthetic values amended’ section under item 35503 of the MBS to include subsidised local anaesthesia in IUD insertion procedures.

This could help to promote equitable health access and bodily autonomy by ensuring that all individuals can access pain-free reproductive healthcare without financial or physical barriers. Further, this could lead to cost savings in the long term for both individuals and the Australian Government. 

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Public Support: 

1. Sexual Health Advocates and Reproductive Equity (SHARE) 

2. Community Affairs References Committee 

News Coverage:

• ABC News - ‘Having an IUD inserted can be excruciatingly painful. Why aren't women being warned or given stronger pain relief?’ Patient accounts from over 300 individuals who have reported severe pain during IUD insertion procedures. By: Claudia Long, Ellie Grounds | Mon 31 October 2022 - Read the full article here.

• The Conversation - ‘Considering an IUD but worried about pain during insertion? Here’s what to expect’. What to expect during and after the procedure, and what pain relief options are available. By: Deborah Bateson, Kathleen McNamee | Mon 16 May 2022 - Read the full article here.

• The Guardian - ‘Australian women lagging on use of IUDs due to education ‘failure’, experts say’. Experts say this nationwide ‘failure in public education’ has contributed to low uptake and caused Australia to lag behind other western countries. By: Natasha May | Tue 27 May 2025 - Read the full article here.

• ABC News - ‘Federal Labor promises half a billion dollars for women’s health, including better access to long-term contraceptives’. Medicare rebates would be boosted significantly for women taking up long-term contraceptives (including IUDs), in an effort to lift their uptake. By: Tom Lowrey | Sat 8 Feb 2025 - Read the full article here.

Where to go to learn more: 

• Sexual Health Advocates and Reproductive Equity Preliminary Report - Read more on the cost of contraceptive survey preliminary report and the provided recommendations here.  

• 2023 Community Affairs References Committee Report - Read more on the potential $20million savings over 5 years through increased uptake of contraception and reduced abortion and miscarriage rates here.  

• 2024 Marie Stopes International (MSI) Australia Article: ‘MSI Australia offers new cost-effective pain relief option for women getting IUDs’ - Read more about other affordable, self-administered pain relief options during IUD procedures here.  

• Medicare Benefit Schedule Item 35503 - Read more on the insertion of an intrauterine device (IUD) under general anaesthesia, specifically for cases where the device is retained or embedded ​​here.

Human Perspective: Elysia, a 21-year-old university student living in Melbourne, had finally decided that an IUD was the best long-term contraceptive option for her – effective, low-maintenance and aligned with her future plans. But when she arrived at her appointment, she was told that if she wanted local anaesthesia to manage the pain, it would cost extra – an amount she simply couldn’t afford on her limited income. She went through with the procedure without it, gritting her teeth while waves of searing pain coursed through her body. She left the clinic feeling humiliated, trembling and ashamed. When a friend mentioned she was getting an IUD, Elysia encouraged her to explore other options. To protect the anonymity of those involved, this is a fictionalised account drawn from an amalgamation of real-life stories, experiences, and testimonials gathered during the research process for this brief. Any resemblance to actual individuals is purely coincidental.

Conflict of interest/acknowledgment statement: 

N/a

Support 

If your organisation would like to add your support to this paper or suggest amendments, please email Info@foreaustralia.com. 

Reference list: 

Akintomide, H., McLoughlin, C., Brima, N., & Clement, K. M. (2025, April 16). Implementing Routinely Discussing and Offering Local Anaesthesia for Intrauterine Device Insertions. BMJ Sexual & Reproductive Health. https://doi.org/10.1136/bmjsrh-2024-202672

Australian Women’s Health Alliance. (2024). Why a Universal Access to Contraception Policy? https://australianwomenshealth.org/wp-content/uploads/2024/10/Universal-Access-to-Contraception-Policy-Brief-1.pdf 

Caddy, C., Temple-Smith, M., & Coombe, J. (2025, June 16). Do Women Feel Unprepared for the Experience of an Intrauterine Device Insertion: Findings From an Australian Study. Perspectives on Sexual and Reproductive Health Early View (0), 1-6. https://onlinelibrary.wiley.com/doi/epdf/10.1111/psrh.70023 

Clinic66. (2024). Intrauterine Devices (IUD’s) provide SAFE, RELIABLE and very EFFECTIVE birth control. https://www.clinic66.com.au/iud-intrauterine-devices

Community Affairs References Committee. (2023). Ending the Postcode Lottery: Addressing Barriers to Sexual, Maternity and Reproductive Healthcare in Australia. The Senate. https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000075/toc_pdf/EndingthepostcodelotteryAddressingbarrierstosexual,maternityandreproductivehealthcareinAustralia.pdf

Gynaecology Centres Australia. (2024, March 28). Sedation for IUD at No Extra Cost – GCA’s Unique Approach. Gynaecology Centres Australia. https://gcaus.com.au/sedation-for-iud-at-no-extra-cost-gcas-unique-approach/

Health Direct. (2019, March 14). Intrauterine contraceptive device (IUD). https://www.healthdirect.gov.au/intrauterine-contraceptive-device-iud

Long, C., & Grounds, E. (2022, October 30). Having an IUD inserted can be excruciatingly painful. Why aren't women being warned or given stronger pain relief? ABC News. https://www.abc.net.au/news/2022-10-31/what-can-be-done-to-make-iuds-less-painful/101584670 

Medicare Benefits Schedule. (2022). Item 35503. Department of Health, Disability and Ageing. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=35503&qt=item

Medicare Benefits Schedule. (2025). ‌Item 35506. Department of Health, Disability and Ageing. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=35506&qt=item

Medicare Benefits Schedule. (2025). Note GN.11.29. Department of Health, Disability and Ageing. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.11.29&qt=noteID

MSI Australia (2024, September 26). MSI Australia Offers new cost-effective pain relief option for women getting IUDs. https://www.msiaustralia.org.au/new-pain-relief-options-iuds/

Parliament of Australia. (2023, May). Chapter 2 - Enhancing Access to Contraceptives. Parliamentary Business. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report/Chapter_2_-_Enhancing_access_to_contraceptives

Rääbus, C. (2021, June 30). Insertion and removal of IUDs can be painful and not being prepared can make it all worse. ABC News. https://www.abc.net.au/news/2021-06-30/iuds-can-be-painful-and-doctors-need-to-tell-people-that/100249514

Sexual Health Advocates for Reproductive Equity. (2024). Universal Access to Contraception Now: Cost of Contraceptives Survey Preliminary Report. Select Committee on Cost of Living Submission 234. https://www.aph.gov.au/DocumentStore.ashx?id=a24fd2a7-ef50-4f45-80da-e06a3ea552bf&subId=768941