By Leisha Toory, General Member
According to The Canadian Contraception Policy Atlas The Canadian Contraception Policy Atlas by Action Canada for Sexual Health and Rights, if you're seeking convenient access to birth control in Canada, residing in British Columbia or Quebec might be your best bet. These two provinces are the only ones to score above 75 percent in the atlas, which ranks provinces based on government policies affecting both access to and information about contraception.
At the bottom of the list is Newfoundland, scoring only 41.8 percent. While many health experts argue that providing prescription contraception to those in need should be straightforward—especially considering estimates suggesting that every dollar invested in contraception access could save up to nine dollars in the public sector—the considerations regarding who receives subsidized birth control and how it's provided are more intricate. Let's delve into both access and information.
Cost is indeed a significant concern, as highlighted by the atlas. Financial barriers remain the primary obstacle to contraceptive access across Canada. One key reason for British Columbia's leading position in the atlas is its groundbreaking policy of offering free prescription contraception, a first among Canadian provinces.
Yet, access encompasses more than just financial considerations. The project evaluated not only the extent of financial coverage offered by each province but also the range of supplies covered, the authorization of practitioners to issue prescriptions, and the necessity of prescriptions for emergency contraception.
On a positive note, all provinces and territories now permit pharmacists, midwives, registered nurses, or a combination of these healthcare professionals to prescribe birth control, alongside general practitioners and nurse practitioners.
However, a significant drawback remains: fewer than half ( 46 % ) of provinces and territories extend financial coverage for prescription contraception to all or most of their population.
Having access to readily available and affordable contraception is undoubtedly beneficial – as long as you're aware of its availability and how to obtain it. One would assume this aspect to be straightforward, given the strong online presence of each province and territory, offering extensive information to citizens. However, surprisingly, not all of them provide information about contraception.
Citizens of New Brunswick, Newfoundland, or Yukon, for instance, do not have access to a government-produced website providing information on contraception. Even among those provinces and territories that do have such websites, the discoverability, quality of information, and links to reliable external sources vary considerably. Furthermore, only four provinces offer information solely in English, with Ontario being the sole province to include a cautionary note about misinformation.
While all provinces and territories incorporate contraception information into their school sexual education curriculum (although this is elective in Nunavut), nearly a quarter (23 percent) of provinces and territories lack a website produced by a provincial health authority or a major public health authority that offers information on contraception.
Although some of the oversights revealed in the Canadian Contraception Policy Atlas may seem incredulous, there is promising progress underway.
The newly elected government of Manitoba has reaffirmed its commitment to fulfill its campaign pledge of offering free prescription contraception.
Furthermore, in a recent session of the Ontario legislature on November 29, 2023, the opposition NDP brought attention to the issue, advocating for a change in the existing policy. Currently, birth control is covered exclusively for women under 25 years old, contingent upon their lack of coverage under a private plan. The NDP proposed extending this coverage to include free prescription contraception for all Ontario residents in need.
Paying for contraception out-of-pocket can be financially burdensome, with costs potentially reaching up to $10,000 over an individual's reproductive lifespan, based on a monthly expense of $25 for hormonal pills. Additionally, the insertion of an IUD can incur a cost of $400 , rendering these expenses prohibitive for some individuals.
Notably, the provision of free prescription contraception not only benefits citizens directly but also carries significant financial advantages. Dr. Wendy Norman, the lead author of the Contraception Cost-Effectiveness in British Columbia study, emphasized that the cost of managing unintended pregnancies surpasses the expenses associated with subsidizing contraception. She highlighted that B.C.'s policy of providing free prescription contraception could potentially save the province $27 million annually.
Liz Thompson, the Advocacy Team Lead for Ontario's non-profit organization Cover ContraceptiON, underscores the fundamental disparity between proactive and reactive healthcare approaches. She notes that substantial sums are spent on reactive care due to the lack of access to contraception, underscoring the importance of proactive measures.
On April 1, 2023, British Columbia implemented universally accessible contraception, sparking hope in Liz. She observes that with the removal of financial barriers, a significant number of people have opted for IUD insertions, leading to waiting lists for the procedure in BC. Liz sees this as a positive challenge.
Manitoba is set to follow suit with universal access to contraception in 2024 .
However, in Ontario, where Liz is actively involved in the Cover ContraceptiON campaign, the November 29 debate did not yield the desired outcome. Despite hopes for increased funding for contraceptive accessibility, Liz notes that no new commitments were made. This means hundreds of thousands of Ontarians who do not qualify for free prescription contraceptives will continue to strain the healthcare system with emergency visits and treatments.
Despite setbacks, Liz remains determined. She emphasizes the need for further education among Members of Provincial Parliament (MPPs) about the health benefits of contraception for various medical conditions, including uterine cancer. Liz and her team of Cover ContraceptiON volunteers plan to engage with government members over the coming months to highlight the advantages of contraception.
Leisha Toory is the founder of the Period Priority Project, the Sexual and Reproductive Health and Rights Director with the Young Canadians Roundtable on Health, and an Honors in Political Science undergraduate at the University of Ottawa.