C: iStock & Gianna Care

Astronomical’ cost of Hyperemesis medication causing stress, driving women towards abortion

The failure of the Irish Government to fund medication for Hyperemesis Gravidarum is driving some pregnant women towards abortion, an organisation providing support to women with difficulties arising in pregnancy have said.  The drug treating the severe and potentially life-threatening levels of vomiting can cost between €1,500 and €3,000 during the course of a pregnancy. 

Gianna Care, a pregnancy support group with branches in Dublin, Kerry, Limerick, Galway and Offaly, says that the condition can become very severe and that medication should be provided for free for women in pregnancy.

The organisation says the failure to make the medication available on medical card, or even through the drugs payment scheme, evidences a lack of understanding (or perhaps a desire to try to understand) the severity of the illness. Unlike regular regular pregnancy sickness which affects around 70-80% of pregnant women to some degree and is considered a normal, if an unpleasant, part of pregnancy, Hyperemesis is not normal, and it can potentially be life threatening without adequate treatment, according to Hyperemesis Ireland.

Between one in every 100 and one in 200 women suffers from Hyperemesis Gravidarum or HG, an illness which can be profoundly debilitating – and where women experience extreme levels of nausea and vomiting.

Around 1 in 100-150 pregnant women will be admitted to hospital due to the dehydration and malnutrition that hyperemesis can cause. Many more women will need to take time off work because of nausea and vomiting in pregnancy induced by the condition. Hyperemesis Ireland says that living with severe levels of nausea and/or vomiting for any length of time can have a profoundly negative impact on a person’s physical and mental health and well-being. 

Kate Middleton, the British Duchess of Cambridge suffered the extreme effects of  hyperemesis gravidarum during each of her three pregnancies, even being hospitalized for treatment for a time. 

Gianna Care says the refusal of the Government to fund the costly medication is unacceptable, and is placing undue stress and pressure on pregnant women, particularly those in crisis pregnancy situations. They say that their work assisting women with unexpected or difficult pregnancies has shown them at first-hand that the high cost of the medication is causing some women to consider abortion. 

However, Health Minister Stephen Donnelly last week insisted that the State won’t reimburse the cost of the drug – Cariban – which can cost between €1,500 and €3,000 during the course of a pregnancy –  to treat severe pregnancy sickness despite calls to do so from campaigners. 

This is in contrast to Donnelly’s stance while he was in opposition, where he said that Cariban should be made available on the drugs payment scheme or the medical card. His most recent comments addressing the plight of women who have to pay for the high-cost medication come as a blow for those who have campaigned for years on this issue.

Gianna Care say they are disappointed and somewhat baffled by the State’s refusal to reimburse the cost of the drug. A spokeswoman says the decision was “disgraceful”.   

They say that the support organisation has assisted women with the cost of the medication for Hyperemesis Gravidarum in recent years, since women were driven “to the point of despair” by facing huge medical bills for care in pregnancy, especially if they were already in a crisis situation. 

Gianna Care’s spokeswoman says that women – and support volunteers – are often ‘shocked’ to realise the hugely expensive medication was not available on the drugs payment scheme in Ireland. Gianna Care has spoken to pharmacies on the issue. 

Pharmacies say that they are seeing women failing to pick up repeat prescriptions; rationing the medication because they can’t afford it every week, according to Gianna Care. This is despite the fact the drug needs to be taken multiple times a day and at set times in many cases. 

“Some pharmacies are seeing so many women coming in who will purchase the medication on a weekly basis, and they might not come back for two or three weeks because they can’t afford to pay for it weekly.”

The organisation says seeing the situation unfold before their eyes is deeply frustrating as well as upsetting, especially in view of the fact it is an issue that can be remedied.

“For us dealing with women in crisis, it’s so frustrating for us, because these are things that we can fix as a nation to support women. This medication should be available to everyone, but the cost is astronomical, to be expected to be able to fund it every week.”

“Why are we placing extra pressure on people?” Gianna Care asks.

The organisation says that women across Ireland deserve better, and the decision to choose life in a crisis situation should be a choice that is facilitated. At present, Gianna Care feels the Government “doesn’t seem to want to hear” the voices of those speaking up on the barrier to adequate maternity care, and an active and avoidable barrier is being placed in the way of women feeling they can continue with their pregnancies to carry their babies to term.

“Women deserve better in this country. They’re not getting the care they deserve.”

MINISTER STEPHEN DONNELLY’S U TURN

Minister Donnelly’s ambivalence on the issue is evidenced when his remarks in 2018 are contrasted with his most recent addressing of funding for the medication. 

In October 2018, Donnelly told the then health minister Simon Harris that all costs related to maternity care should be universally available – including, appointments, specialised care, drug treatment and hospitalisation. 

In an answer to a recent parliamentary question on the matter from Kerry TD, Pa Daly, Donnelly said the Health Products Regulatory Authority (HPRA) has advised that Cariban is currently not licensed for use in Ireland. On this point, Gianna Care highlights that Cariban is prescribed and available in the Coombe, Rotunda and Holles Street maternity hospitals, and has been for many years. 

Secondly, Gianna Care asks: “What’s Minister Donnelly’s alternative? Where is he offering tangible support for women?” A spokeswoman said that Minister Donnelly, in their view, is essentially saying, ‘Ok, we know you’re sick, but we’re not giving you the medication’. 

That in itself is an alarming approach and language for a health minister to be adopting, the organisation says, and evidences a perceived lack of care on Minister Donnelly and the State’s behalf.

“Why doesn’t he offer women an alternative, because there’s no alternative here? As far as we can see, there are no alternatives for women.”

Gianna Care believes the government’s failure to act on the issue is a symptom of an absence of life-affirming options for women in Ireland, including adequate maternity care. This approach is denying women real options. “It’s shocking,” the support group said. 

Minister Donnelly said that two similar drugs to treat Hyperemesis Gravidarum, Xonvea and Navalem  have been licensed for use in Ireland. He added, however, that these two medicines are not readily available to women.

“The companies holding the authorisations/licences have not marketed the products in Ireland to date, and the HPRA cannot compel a company to market a medicinal product,” he said. 

“To be considered for a licence in Ireland, the company marketing the product would need to make an application to the HPRA. After a thorough evaluation of all the supporting evidence, and if the benefits of the product outweigh the known and potential risks, a licence may be issued,” he added.

Donnelly said the responsibility for the clinical use of unlicensed medicines lies with the prescriber, and they must ensure as far as possible that any treatment, medication or therapy prescribed for a patient is safe, evidence-based and in the patient’s best interests.

“This applies equally to licensed and unlicensed medicinal products,” said Donnelly. 

On Wednesday, following Minister Donnelly’s remarks, the Irish Pharmacy Union (IPU) told The Journal that it is calling on the manufacturers of Cariban to apply for a product authorisation on the Irish market so that the HSE is in a position to reimburse it in the normal way through the medical card and drug payments schemes. 

It added: “In the meantime, pending an Irish product authorisation, the HSE should put in place exceptional arrangements to fund the drug in individual cases.”

The Journal also reported that charity Hyperemesis Ireland has stated that several pharmacists have contacted it to say a drug can be unlicensed and reimbursed by the State. 

MENTAL HEALTH IMPACT

Gianna Care say there must be an increased awareness of the mental health implications of Hyperemesis Gravidarum. A 2020 study published in the British Medical Journal (BMJ) found that Hyperemesis Gravidarum can cause depression in some women, and this is something Gianna Care has witnessed multiple times.

The most recent study regarding the psychological implications of the sickness was carried out by researchers at London Imperial College and Imperial College Healthcare NHS Trust. The study found that nearly half of women with hyperemesis gravidarum suffered antenatal depression and nearly 30% had postnatal depression.

Specialist Registrar in Obstetrics and Gynaecology and Lead Author of the study, Dr Nicola Mitchell-Jones, said: “Our study shows that women with HG [hyperemesis gravidarum] are around eight times more likely to suffer antenatal depression and four times more likely to have postnatal depression.

“Some women in the study even had thoughts of self-harm while suffering HG. These figures are shocking and should be reflected in the treatment the women receive. We need to do much more than simply treat the physical symptoms of HG; assessment for mental health support should also be routine for any woman with the condition.”

Of the women with hyperemesis gravidarum, 49% experienced depression during pregnancy compared with 6% of women in the control group. 7% of the control group had postnatal depression in comparison to 29% of women with hyperemesis gravidarum.

Gianna Care says they have supported women who have struggled with the mental health implications of the condition, which often makes women unable to leave their homes because of violent sickness. 

Women who become dehydrated and need to be treated in hospital multiple times are faced with huge struggles, including those who are tying to juggle family life or are single parents struggling to take care of their children while sick. Helping to relieve the financial burden and providing the medication, as well as putting in supports like counselling, have made a world of difference to women and families they’ve worked with, say Gianna Care.

However, they say, the knock-on effect of not funding the medication, and the pressure this is putting on families, is unacceptable.

FEAR OF CONTINUING A PREGNANCY

The organisation also worry that women who have had Hyperemesis in a previous pregnancy often end up feeling pressured into abortion, which presents itself as a type of ‘panic button’ in such situations because they couldn’t afford the medication the first time around.

“You can imagine the fear women experience if they get pregnant again. They think, ‘How am I going to get through that again? How am I going to afford the medication? How am I going to look after my kids at home?’” 

Gianna Care says it has seen an increase in women contacting them in crisis, who have found themselves pregnant and have suffered from Hyperemesis in a previous pregnancy, and now do not know how they can continue with that pregnancy. That fear is based on financial struggles which mean not being able to afford the medication, and also the sickness element that they experienced the first time around. The organisation fears that many women and families are struggling in silence.

‘SUPPORT IS THE KEY’

The organisation says that there are often several factors preventing women from feeling they can continue with their pregnancies, but basic access to medication should not be a factor. 

“We must get the basics right. Basic access to medication, in maternity above all, should be something that is accessible to all regardless of your financial stature. At present, we’re not supporting women, and change needs to happen,” they said. 

Hyperemesis, at present, ‘is not getting the art attention it deserves’ as a severe and debilitating illness.

A change could save lives, the organisation believes. 

“Support is the key, but the Government is doing nothing on this issue to support women. That’s wrong on every level.

“Women are struggling in silence and having abortions on this basis. Lack of support is causing women to feel they have no choice but to end their pregnancies. Lives could have been saved if the medication was more widely accessible to women. “

Share mdi-share-variant mdi-twitter mdi-facebook mdi-whatsapp mdi-telegram mdi-linkedin mdi-email mdi-printer mdi-chevron-left Prev Next mdi-chevron-right Related
Comments are open

Do you agree with Senator Keogan that people on long-term unemployment benefit should have to do community service for the money?

View Results

Loading ... Loading ...