It’s time for all Canadians to have access to free contraceptive care: expert

Canada should join the ranks of other countries that have public healthcare systems and offer universal contraception coverage.This was one of the messages from Dr. Amanda Black, president of the Society of Obstetricians and Gynecologists of Canada (SOGC) who spoke at the society’s annual Ontario regional meeting. She is also a professor of medicine at the University of Ottawa.“What we’re advocating for is a single payer national, universal contraception coverage, so that the ability to attain contraception and avoid unintended pregnancy isn’t dependent on your postal code. All Canadians would have access to this,” she told the Medical Post in an interview.In fact, she pointed out, “Canada is the only country in the world that has universal healthcare but doesn’t have universal coverage for contraception.”Birth control was illegal until 1969 in Canada, and it’s time for Canada to take the next step forward and improve accessibility to it, she said.There are numerous compelling reasons for universal coverage. One is the fact that 40% of pregnancies are unintended, with various costs and issues associated with that. Among unintended pregnancies, 57% result in birth.There are numerous negative impacts of unintended pregnancies. While for some individuals it may be a happy surprise, for many others it’s not. There is the associated worry and anxiety, issues around the ability to continue education or a career path, and fear. For some it can be a traumatic experience. There are also significant costs to the healthcare system.Statistics from the province of B.C. show that 24,000 women have unintended pregnancies each year in that province alone, that is, prior to the recent introduction of universal coverage in that province. Extrapolating to the rest of Canada, this represents at least 160,000 women in Canada having unintended pregnancies along with 90,000 unplanned births.In a study Dr. Black coauthored in 2015 investigating the cost of unintended pregnancies and the potential impact of contraception, calculations found the 180,733 unintended pregnancies per year in Canada result in $320-million in direct healthcare costs.“That’s direct costs of the care of the pregnancy and the outcome of that pregnancy,” she said. Indeed, studies show that each one dollar invested in universal contraception can yield up to $9 savings in the public sector.At this point, birth control is not free for individuals, and cost is a barrier for youth, teens, low-income earners, and often newcomers to Canada. But even taking into account the costs of universal free prescription birth control if it were shifted to the government, overall, it would represent savings.“It will always be more expensive for the government to manage the consequences of an unintended pregnancy than it will be to provide contraception if you look at all the downstream effects,” she said.And while healthcare is generally under the purview of the provincial government, there are disparities in terms of cost and accessibility, adding to the need for a federal role. “It’s wonderful if we can get it going province by province,” she said. But it takes time, and some people may still be left behind. There is strong public support for a federal policy for free prescription birth control with a recent survey showing 83% support for it, and 69% saying it an urgent issue. It is also supported by various medical associations. In addition to the SOGC, stakeholder support also comes from the Canadian Medical Association, the Canadian Paediatric Society and the College of Family Physicians of Canada.“As we look at the federal government’s commitment to a national pharmacare program, we can say this is a first step (that birth control) be considered one of those essential medicines. That’s what we’re encouraging from the federal level,” she said.Universal contraception coverage helps improve women and their family’s ability to plan when to have children. It’s a gender equity issue, Dr. Black emphasized. To put it in terms of an individual, Dr. Black said, “When you think about it in terms of someone’s lifespan, if you plan to have one or two children it means you’re spending about five years of your life trying to get pregnant, being pregnant, and postpartum. And that’s without any infertility issues. That means you have another 30 years of your life where you’re trying to avoid a pregnancy.”Plus, universal coverage can increase a woman’s choice in the type of birth control she prefers and gives her more control over reproductive choices.“We know if women are able to avoid an unintended pregnancy, it helps improve their status, they can contribute to the workforce, it contributes to the overall economic stability of the home which is better for the other children they have,” said Dr. Black.There are other concerns, too. In parts of the U.S. and other parts of the world, access to reproductive care is being restricted. Having both the federal government and the provinces working together can help ensure, though policy, that birth control is both secure and equitable.Improving contraception availability can also reduce the number of abortions. Based on data from 2019, about one in five pregnancies ends in abortion, and overall, about one in three women in Canada have an abortion in their lifetime.“It’s not about sex, birth control is about having a reproductive life plan,” she said.

It’s time for all Canadians to have access to free contraceptive care: expert

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