Hats off to B.C.: Universal access to contraception is good social policy

Making reliable contraception available free of charge results in fewer unintended pregnancies. The research is clear on this point.

It’s sound, equity-promoting social policy, and makes good economic sense too.

One study estimated that for every $1 the state invests in providing no-cost contraception, it will get back $90.

Individuals benefit financially too: women can spend up to $10,000 on birth control during their reproductive years.

So, let’s applaud British Columbia vigorously for announcing universal contraception coverage in its recent budget.

But, at the same time, we have to wonder: what are the other provinces and territories waiting for?

Unintended pregnancy is not a trivial issue. One in five Canadian women will have at least one unwanted pregnancy, often due to a lack of readily available, affordable contraception.

In Canadian women and girls under the age of 24 alone, there are an estimated 60,000 unintended pregnancies annually, with more than half ending in abortion. (And those data are a decade old.)

Giving birth at a young age makes it more likely a young woman will not complete her education, and more likely she will end up on social assistance. Babies born of unintended pregnancies are also more likely to be premature and low-birth weight, which results in high medical costs.

The B.C. plan, announced last week by Finance Minister Katrine Conroy, is a pretty sound one. In the grand scheme of things, the cost is minimal, about $40-million annually for the province, and it will save at least $95-million a year in direct medical costs, never mind the social costs.

Beginning April 1, anyone with a Medical Services Plan (MSP) card will be able to access prescription birth control for free. That includes oral contraceptives, contraceptive injections, intrauterine devices, subdermal implants and emergency contraception (known commonly as Plan B).

Barrier methods like male and female condoms, and diaphragms, are not covered. (Yet?) Neither are vaginal rings or transdermal patches, as they are considered no more effective than “the Pill,” and more costly.

The abortion pill, Mifegymiso, is already covered in the province but, of course, that is not contraception.

More permanent methods of contraception such as tubal ligation and vasectomy are covered by medicare because they are surgical interventions.

The limiting factor in the new B.C. program is that a prescription is still required, and getting a doctor’s appointment is not always easy in a province where one in five people don’t have a family doctor and even those who do can have trouble booking an appointment.

But in May, pharmacists will be able to prescribe contraceptives directly, which should greatly improve access. Mind you, the most effective methods, IUDs and implants, still require a physician visit.

Dozens of countries around the world already offer free or low-cost contraception, but the rules vary widely. In many countries, oral contraceptives are over-the-counter medications, not prescription drugs. But that approach can actually increase the cost to individuals because OTC drugs are rarely covered by insurance plans.

One of the strengths of B.C.’s approach is that there is no age limit and no financial means test. It really is a universal program.

France, for example, long offered free contraception to girls and women under the age of 18, but recently expanded the age limit to 25. French pharmacies also offer condoms free of charge for anyone under 25, an approach driven by a big rise in sexually transmitted infections.

In most Canadian provinces and territories, contraceptives are offered at no-cost principally to those on social assistance. As with most prescription drugs, people tend to depend on employer-sponsored drug insurance, or pay out-of-pocket.

This is problematic. Teens don’t always want their parents to know they are using birth control because that could imply they are having s-e-x.

It should be noted though that many girls and women take oral contraceptives to treat chronic, painful gynecological conditions like endometriosis, dysmenorrhea (painful periods), menorrhagia (heavy menstrual bleeding), polycystic ovary syndrome and fibroids.

While B.C.’s plan will improve access, there are still challenges, especially in rural and remote areas where privacy can be an issue and where physicians and pharmacists sometimes refuse to prescribe contraceptives, and there are no alternatives.

Hopefully B.C.’s universal, no-cost contraception plan will spur other provinces and territories to act.

It should also spark renewed discussion on other equity-related health issues, such as dealing with period poverty – lack of access to menstrual products.

Free (or at the very least affordable) access to tampons, pads and reusable products like Diva cups is certainly as important as access to contraceptives.