Last April, British Columbia became the first Canadian province to offer free prescription contraceptives, setting a standard for the rest of Canada. Months later, despite the obvious benefits that extend far beyond family planning purposes, no other Canadian jurisdiction has followed suit.
Costs remain the single greatest barrier to contraceptive access. Advocacy groups remain steadfast as they renew calls for universal contraception access while engaging political leaders in the discussion to end inequitable access to reproductive health care in Canada.
Prescription contraceptives offer a wide array of evidence-based treatments for significant health conditions, including abnormal uterine bleeding, endometriosis, precancer of the uterus, polycystic ovarian syndrome, and the prevention of ovarian and uterine cancer in certain patient populations. For the nearly 10 million patients eligible for reproductive health care in Canada, providing coverage would make not only a big difference in their wallets, but in their quality of life and overall health.
Managing menstrual conditions
Contraceptives have a well-known role in improving menstrual health. Hormonal contraceptives, including pills, patches, vaginal rings, injections, implants and intrauterine devices (IUDs) are effective treatments for irregular, painful, heavy and prolonged menstrual periods. For some patients, menstrual symptoms can be severe, leading to emergency department visits for blood transfusions, time away from work or school, and the necessity for surgical procedures.
While using hormonal contraception may not address the root cause of all menstrual health conditions, it is a reversible treatment that can provide symptom relief, prevent life-threatening blood loss, anemia, and reduce health-care costs associated with unnecessary interventions. About 30 per cent of menstruating patients experience heavy periods during their lifetime. Hormonal contraceptives can reduce heavy menstrual bleeding by up to 50 per cent, providing significant relief and reducing disruptions to patients’ daily lives. For patients with bleeding disorders such as Von Willebrand disease, contraceptives offer first-line treatment for heavy menstrual bleeding.
Beyond heavy periods, other chronic reproductive disorders rely on contraception for their management, including common and yet poorly understood conditions such as polycystic ovarian syndrome (PCOS) and endometriosis. PCOS is a hormonal condition that can cause irregular periods, acne, hair thinning/loss, facial hair growth, weight gain, infertility and increased risk of endometrial cancer. Endometriosis is a chronic pain condition and systemic inflammatory disease that often occurs with significant symptoms such as painful periods, chronic pelvic pain, gastrointestinal upset, bladder symptoms, fatigue, depression or anxiety as well as infertility. While there is currently no cure for either of these conditions, hormonal contraceptives are the first-line treatment recommended and can help alleviate symptoms, reduce the risk of uterine cancer with respect to PCOS, and prevent the progression of disease requiring surgical interventions that currently account for 51 per cent of the cost of endometriosis to the Canadian health-care system (annual cost of endometriosis is $1.8 billion total).
“it’s safe to say that family planning is only half the story.”
Looking beyond menstruation
For some, contraceptives are prescribed to manage acne by reducing circulating androgen levels, leading to oil reduction, and can result in decreased acne-related pain, improved confidence and healthier skin. These contraceptives offer a safer treatment alternative than other common acne prescriptions like accutane (isotretinoin) that require close follow-up due to potential side effects including joint and back pain, liver dysfunction, decreased bone density and life-threatening birth defects in pregnancy.
Contraceptives also play a key role in cancer management since the hormonal IUD is a first-line treatment for precancerous changes in the uterus, offering a non-surgical method to prevent progression to cancer. In fact, hormonal contraceptive use is associated with a reduced risk of ovarian, endometrial and colorectal cancers.
Taking into account the many health benefits and conditions treated by prescription contraceptives, it’s safe to say that family planning is only half the story. The World Health Organization (WHO) acknowledges reproductive health care as a fundamental human right. Menstrual conditions lead to painful and debilitating symptoms, further exasperating the inequity experienced by those who live on the margins and face gender inequity.
Considering how common these conditions are, contraceptives remain a key part of health care for half of Canada’s population. Economic analyses have shown that free contraception reduces the financial burden on the health-care system, improves workforce participation, increases education and much more. With financial cost being the main roadblock, it is crucial that the rest of Canada follow British Columbia’s lead and incorporate universal contraception coverage into our healthcare strategy.