How universal contraception coverage is impacting people in B.C.

When Dr. Renee Hall and her colleagues at the Willow Clinic in Vancouver arrived at work on Monday, April 3, there were 350 messages on the clinic’s voicemail. That many people were hoping to get an appointment to get an intrauterine device (IUD) inserted. B.C. launched universal coverage of most forms of hormonal contraception on April 1. IUDs previously cost patients $80 and up for a basic, copper device and $400 or more for a hormonal one. Months later, demand continues to soar at Willow. “We can’t take any more people,” says Dr. Hall, as the clinic now has nearly 1,700 people on its wait list. As well, as of June 1, pharmacists in B.C. have been able to prescribe contraception direct to patients. Seven other provinces also give pharmacists this prescribing power. B.C. now offers more access to birth control than any other jurisdiction in North America. While it’s early days, the likes of Dr. Hall are seeing the impact of the change. “Overall, patients are loving that it’s free,” she says of contraception, noting that being able to get prescriptions direct from a pharmacist is good news for many, especially in underserved regions. “It’s going to increase access, helping people who may not be able to get to a doctor. It’s a good thing.” Chris Chiew, president of the BC Pharmacy Association, says the members of his organization have positive things to say so far. “There are 1,4000 pharmacies throughout B.C. and many of them are in small communities,” says Chiew. “They’re an access point where patients can get access to these types of products in a faster, more accessible way.” For example, when patients can get emergency contraception right away, the medication will be more effective, he noted. “I’m seeing a collaborative effort from healthcare practitioners. We’re feeding off each other to ensure accessibility. I’m excited to see how the number will bear out in a year’s time.” Already, the B.C. Ministry of Health is tracking robust contraceptive use. Between April 1 and July 31, 143,000 people were dispensed at least one contraceptive in the province. Meanwhile, the Ministry has year-over-year data for the monthly average of patients getting at least one dispense of birth control during this timeframe. It saw a noticeable bump in the number of people receiving birth control pills from 35,900 to 38,900, and an increase in those getting contraceptive implants from 300 to 500. Dr. Wendy Norman, founder and leader of the Contraception & Abortion Research Team (CART) at the University of British Columbia, says fewer barriers should help people upgrade to contraception that works best for them. “There are a small number of people in B.C. who are using no contraception at all,” she says. Such patients might start using a hormonal method now that it's cost free. As well, those using condoms or birth control pills might try something else. “What we see in countries that provide universal coverage is the change helps those who were only able to afford the least expensive kind of contraception move from lower efficacy products to higher.” Long-acting, reversible forms such as implants and IUDs come with the highest up-front costs, but have the lowest failure rates—under 1% for IUDs—and are considered the best and more reliable form of birth control. Dr. Norman says one in four users of condoms will become pregnant every year, while nine to 11% of users of birth control pills will get pregnant. “It should be 99%, but you have to take it every day at the same time.” When people switch to a more reliable method, or one that better suits them, they’ll be less likely to get pregnant and either have an abortion or experience an unwanted pregnancy—both translate to costs for the government. B.C. promised to spend $119 million over three years on contraception to save later. Dr. Norman co-led a 2018 study that showed universal coverage will lead to a savings of $27 million annually by the fourth year—the study was pivotal in urging the government to make this change. Back at the Willow Clinic, however, the flaws in the system are showing. Few practitioners in the province will insert IUD, as the procedure is tricky and the government reimburses them a mere $43.28 for the procedure, even if it’s a complex one. At Willow, the team will use a suite with an ultrasound and a technician to do insertions and conducts them with trauma-informed protocols. Physicians keep only half of the government fee for themselves, the rest goes back to the clinic to cover overhead. Willow can't afford to stay afloat if it offers unlimited insertions, so it has a backlog of around nine weeks. “An IUD in a box that’s free doesn’t reduce your chance of getting pregnant,” quips Dr. Hall. One recent week, she performed four medical abortions on patients who had their IUDs in hand but were waiting to get them inserted. Ironically, after an abortion, many physicians will insert an IUD—an ironic way to get to the front of the line. Meanwhile, Dr. Hall says universal coverage isn’t yet fully universal—the province only pays for some birth control pills, plus the birth control patch and the vaginal ring are not yet covered. Dr. Norman and other researchers in B.C. have plans for new studies to better understand barriers to access. For instance, one study will be looking at pharmacists and their experiences with prescribing contraception. The plan is to keep feeding this information to B.C. and other provincial governments to see, on the ground, if investing in contraception access makes a difference to health, and healthcare costs. Dr. Norman, for one, thinks supporting birth control and choice will pay off. “Ideally, you want to support people in the best way possible to work with their healthcare provinces and to do their own learning about the different choices and to decide what works for them.”

How universal contraception coverage is impacting people in B.C.

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