No-cost birth control is fair, healthy, cost effective and not offered in Canada. Yet.
Health by Gregory Beatty
UPDATE 2023-03-01: The B.C. NDP government tabled its 2023–2024 budget on Feb. 28. Finance Minister Katrine Conroy says the government will allocate $119 million over three years to provide no-cost prescription contraception for all citizens and permanent residents covered under the province’s public health insurance plan. “This is a big policy,” Access B.C. chair Teale Phelps Bondaroff told CBC. “It’s going to transform reproductive health in the province, and my hope is that this makes British Columbia a beacon of hope for reproductive justice across Canada and further afield.”
While a huge swath of the U.S. seems hell-bent on time-travelling back to the 1950s with a reactionary crackdown on sex education and reproductive rights, British Columbia is poised to take a bold step forward — not so much into the future, really, just the present day.
At least, present-day Europe.
If premier David Eby’s NDP government lives up to a 2020 campaign promise in its upcoming budget, B.C. will become the first province to provide no-cost prescription contraception.
Birth control pills, copper and hormonal IUDs, patches, implants and injections would all be covered.
The policy is common in Europe, where countries as diverse as France, Denmark, Spain, Italy, Germany, Ireland and the Netherlands all provide free or subsidized contraception. In fact, pretty much every country that has some form of socialized medicine has a contraception program.
Not Canada, though. And we’re poorer for it, says Teale Phelps Bondaroff.
Phelps Bondaroff chairs Access B.C., a grassroots organization formed in 2017 to advocate for free contraception.
“If you make prescription contraception free, it improves health outcomes for infants and mothers because unplanned pregnancies have a higher risk of complications,” says Phelps Bondaroff. “If an abortion is sought, that has health risks too, along with higher costs.
“Even if you don’t buy the fairness argument — which you should, because the cost of contraception falls disproportionately on women and people who can get pregnant — there’s still the cost saving argument. It’s going to save governments millions of dollars,” he says.
“If people don’t like wasting tax dollars, it’s a program to invest in.”
Access B.C.’s roots date to Phelps Bondaroff’s doctorate studies at the University of Cambridge, he recalled in a recent Zoom interview.
“In England, all contraception is free,” says Phelps Bondaroff. “Then I came back to Canada and was shocked to find that wasn’t the case here. I talked to my friend Devon, who was on the board at Island Sexual Health Centre in Victoria, and we were like, ‘This is unacceptable that people in Canada would face cost as a barrier to accessing contraception’.”
That cost is significant, too.
Hormonal IUDs, which have a 99 per cent success rate, are $350 to $400. Implants and injections are in the same range, while copper IUDs are around $100. There can be additional costs too, especially for people in rural and remote communities, who may have to travel a long distance — first to get a prescription at an accredited clinic, then to get the actual implant/patch/injection, or IUD inserted.
From a humble start on Twitter, Access B.C. worked to build alliances with medical organizations, labour unions, advocacy groups and more. The Canadian Medical Association, Society of Obstetricians and Gynaecologists and Canadian Paediatric Society are three organizations that endorse the policy.
The next step was to propose a motion at the 2017 NDP convention that put no-cost contraception on the policy books.
Then in 2020, the party included it in their election platform.
“Since then, we’ve been tapping our watch with increasing impatience,” says Phelps Bondaroff. “We’ve been told by the premier that it will happen, so we’re hoping it will in the next budget which is due in late February.”
Money & Morality
Statistics show one in five pregnancies in Canada is unplanned. Their impact can be devastating, says Phelps Bondaroff.
“If you’re in school and you have to drop out because of an unplanned pregnancy, it can derail your life plan and limit your ability to get the type of job you want and have good earnings,” he says.
In the early 2010s, Colorado implemented a pilot program offering free IUDs to young people. Over an eight-year period, 43,713 IUDs were distributed at a cost of $28 million. The program reduced teen pregnancies by 54 per cent and teen abortion rates by 64 per cent. It also saved the state an estimated $70 million.
“The reason governments focus on young folks in particular is there are barriers for them beyond cost,” says Phelps Bondaroff.
“One question that’s often asked is, ‘Aren’t young people covered under their parents’ health plan?’ Some may be. But those who are sometimes face a difficult choice,” he says. “Their parents may be fine with them going on contraception, but others’ may not be. It could imperil their housing, mental health and safety.
“You shouldn’t have to give up your right to privacy to access contraception.”
In other cases, someone may already be raising a family and not be in a position to afford another child. Or even a first child, says Phelps Bondaroff.
“If you struggle to afford contraception, you’ll likely also struggle to be able to afford to raise a child. As a result, those costs will fall on the state,” he says.
Unplanned pregnancies can even derail relationships, leading to family break up and violence, putting further stress on already strained health, education, social services and criminal justice budgets.
Unplanned pregnancies aren’t the only ones that pose risks, says Phelps Bondaroff.
“A violent partner will sometimes use pregnancy to entrap their partner,” he says. “There are things like stealthing — removing the condom mid-act — or other types of sabotage, such as stealing or swapping out birth control pills,” he says.
“That’s why a person may want contraception — like an IUD or implant — that their partner isn’t aware of.”
But again, those options come at a cost. One that people may not be able to afford, or even know about. Free contraception can help there too, says Phelps Bondaroff.
“People aren’t going to go to a clinic and say, ‘Tell me more about the implant. It’s $350 and I can’t afford it but I’m fascinated to know what I’m missing out on.’ But if cost isn’t a barrier, it encourages people to go to their clinic and have open and frank conversations with medical professionals,” Phelps Bondaroff says.
“There’s a huge amount of misinformation on social media,” he adds. “Imagine if you’re a young person and you can’t afford an IUD, you go on the Internet and look for options. You might find some really bad ones that might not prevent you from becoming pregnant and may even hurt your health. We want people to have access to accurate, judgment-free information.”
Access B.C. has sister campaigns in Manitoba, Ontario and Nova Scotia, and invites anyone interested in setting up similar campaigns to contact them.
“People should have the right to make choices about whether, or when, they want to get pregnant and we should allow them to make that choice freely,” says Phelps Bondaroff. “It makes life more affordable for people and it’s going to save governments millions of dollars.
“It’s one of those policies where there isn’t a good reason to oppose it,” he concludes. ■
The Province That Time Forgot
While B.C. is poised to take a bold step in sexual and reproductive health, Saskatchewan, as so often seems the case these days, is mostly sitting on its do-nothing butt.
Caitlin Cottrell, executive director of Saskatoon Sexual Health, chalks inaction on this critical area of public health up to the province’s generally conservative mindset.
“Sexual and reproductive care is one part of healthcare that is much more prone to people’s personal and religious beliefs,” she says, pointing to abstinence-only sex education in at least some Catholic and Christian schools as an example.
“Not only are they not learning about proper consent and how to have conversations around sexuality, they’re learning nothing about what goes into becoming pregnant and having a baby,” she says. “I understand it can be uncomfortable for some people to talk about, but Saskatchewan has the highest teen pregnancy rate in Canada and there’s a reason for that.”
Teen pregnancy is just the tip of the iceberg when it comes to regressive attitudes towards sex and reproduction in Saskatchewan. Abortion is another obvious hot-button issue.
“People argue that there shouldn’t be complaints because abortion is legal. That’s true,” says Cottrell. “But there are only two places in the province, Saskatoon and Regina, where surgical abortion can be performed. That leaves the rest of the population having to travel.”
A patient needs a primary referral from a physician just to access abortion — and in many areas of the province, physicians won’t give that, says Cottrell.
“Folks have to come into the city just to get the ball rolling,” she says.
Even when physicians don’t have personal beliefs on abortion, they can face pressure from others in their community not to do referrals. And while abortion is covered under Medicare, related expenses like travel and accommodation are not.
Plenty of misconceptions exist around abortion in Saskatchewan, says Cottrell.
“People assume that because the word ‘surgical’ is used that it’s actual surgery done in an OR with an anaesthetic and your abdomen being opened. But it’s not surgery, it’s a dilation and curettage (D&C), so it’s basically a vacuum process where the contents of the uterus are removed vaginally,” she says.
“But we’ve encountered MLAs who still believe it involves surgery,” she says. “That’s one counter argument we get: ‘well, they don’t have ORs in Île-à-la-Crosse,’ or wherever. But that’s not what’s required.
“There just seems to be a general lack of education and knowledge around abortion. What the process is, and what the aftercare involves.”
It’s the same story with medical abortion, which is done with a medication known as Mifegymiso.
“Every general practitioner and nurse practitioner can prescribe Mifegymiso and help the patient through the process, but many refuse. Or they don’t even know it’s something they can prescribe,” says Cottrell.
The availability of Mifegymiso in pharmacies isn’t great either, Cottrell says.
“In a survey we did, about one in six had it in stock,” she says. “Others might be willing to order it in, but there is a truncated timeline. After about nine weeks Mifegymiso doesn’t have the efficacy that’s needed to terminate a pregnancy, so if you’re eight weeks, two days and you have to wait four or five days for your local pharmacy to order it in, you are past the point where it’s accessible to you.”
Even basic prescription birth control can be an uphill struggle to get in Saskatchewan — especially in rural and remote communities, says Cottrell.
“We do insertions for IUDs and implants, and there are a few other folks in Saskatchewan who do too,” she says. “But it’s certainly not common for all general practitioners.
“In fact, what we’re seeing is GPs outsourcing that care as it’s slightly more specialized and they’re simply not receiving the education they need. As well, pharmacies don’t necessarily carry those products.”
When Saskatoon Sexual Health closed for a few days over Christmas, staff returned to find over 500 voice messages, says Cottrell. “We do two drop-in clinics a week and they are always full. We try to meet everyone’s needs, but if people aren’t able to get an appointment right away they may fall through the cracks. That is something that is really troubling.
“Maintaining a pregnancy that is unplanned and unwanted… for a child to be brought into the world [in those circumstances], that’s not going to have a good outcome for anyone.” /Gregory Beatty