Opinion

The need for no-cost contraception

For a country that takes pride in its universal health-care system, we fall short as the only one within the OECD with universal health insurance but no prescription pharmaceutical coverage.

Two years ago, Prime Minister Trudeau’s platform promised to “take the critical next steps to implement national universal pharmacare so that all Canadians have the drug coverage they need at an affordable price.” However, the Liberals have not followed through on this promise while in power and the topic has largely disappeared from their recent election campaign platform. They have at least committed to expanding access to reproductive and sexual services. The Green Party and New Democratic Party campaigned on a universal pharmacare plan that would include access to free contraception for all. Yet in British Columbia, although the New Democratic Party ran its 2020 campaign on a commitment to free prescription contraception for all, this has yet to be fulfilled.

These empty promises have resulted in continued barriers to prescription pharmaceutical access for many Canadians, including limited access to contraception. Now that Canada has re-elected a minority Liberal government, we must ensure that promises to expand access to reproductive and sexual health services include free contraception for all. 

In Ontario, last year, health-care providers sent an open letter to Premier Doug Ford and Health Minister Christine Elliot asking for universal contraception coverage. The letter gathered more than 1,000 signatures from health-care providers across the province and was endorsed by five professional and non-profit organizations. However, Ford and Elliot have not responded to these calls for action from the health-care community.

The COVID-19 pandemic has made it clear that Canadians need universal, no-cost contraception. Throughout the pandemic, women have continued to disproportionately experience the burdens associated with intimate partner violence, reproductive coercion and unplanned pregnancies. At the same time, a reduction in health services has meant reduced access to contraception. Sexual health clinics across Canada limited operations for months, leaving many patients unable to access contraception. 

Canada is the only country in the OECD with universal health insurance but no prescription pharmaceutical coverage.

We are part of CoverContraceptiON, a grassroots, non-partisan, volunteer-run campaign with the goal of providing universal, no-cost contraception to all those in Ontario. If one of our founders, a resident physician, has found it difficult to access an intrauterine device (IUD) in Ontario, we worry about access for patients who are racialized (particularly Black and Indigenous patients), who live in rural communities or who have limited income. Cost is the greatest barrier to contraceptive access in Canada. Options, which include the pill, intrauterine device (IUD), patch or ring, can cost hundreds of dollars per year. For example, in Ontario, IUDs cost between $60 to $500 without insurance. For patients under 25, OHIP+ provides coverage, but this is not accessible to patients whose parents have private coverage (which may not reimburse the full costs and may mean that they cannot access contraception as confidentially). In contrast, condoms are widely available and vasectomy costs are completely covered by OHIP, resulting in a difference in birth control access across genders.

Despite the upfront costs of contraception, universal contraception would save our health-care system money. In Canada, the associated direct cost of unintended pregnancies is about $320 million a year while the cost of a national program offering no-cost hormonal contraception would only be $157 million.

Sadly, we continue to see the disproportionate effects of the pandemic. Limited reproductive choice has broad socioeconomic implications, including reductions in education, employment, economic stability and family well-being. And there is so much more to contraception than giving people control over their reproduction. Patients with polycystic ovarian syndrome or endometriosis, for example, may rely on contraception to alleviate their symptoms.

Contraception must be easily accessible to all. No one should have to ask, “Should I buy my birth control this month, or should I buy my food next week?”

Yesterday, Sept. 26, marked World Contraception Day. Let’s commit to ensuring that, by the next World Contraception Day, Canadians have access to no-cost contraception. 

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Authors

Gali Katznelson

Contributor

Gali Katznelson is a fourth-year medical student at the Schulich School of Medicine & Dentistry, Western University, and a member of the communications team of CoverContraceptiON.

Katherine Zagrodney

Contributor

Katherine Zagrodney is a PhD Candidate in Health Economics at the Institute of Health Policy, Management and Evaluation, University of Toronto, and leads the research team at Cover ContraceptiON.

Mary Boulos

Contributor

Mary Boulos is a third-year medical student at the Michael G DeGroote School of Medicine, McMaster University, and leads the communications team at CoverContraceptiON.

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