A new federal pharmacare legislation agreement, reportedly reached between the Liberal government and the NDP, is an important opportunity to give all Canadians access to effective contraception.
Federal NDP leader Jagmeet Singh advocated for providing free prescription contraception for all Canadians under the Canada Pharmacare Act. On Feb. 23, he announced that a pharmacare agreement had been reached that included coverage for several types of prescription contraception, including birth control pills, intrauterine devices (IUDs) and emergency contraception.
Singh was right on this point: it is vital that Canada’s national pharmacare program provides free prescription contraceptives for all Canadians.
Providing free contraception to all Canadians is a cost-effective way to reduce rates of unintended pregnancy and realize the right to reproductive health. By making it easier for women to plan their pregnancies, we can work toward gender equity and improving maternal and child health outcomes.
Access to prescription and emergency contraception
Access to contraception reduces the incidence of unplanned pregnancy. Yet a 2006 survey found that only 65 per cent of Canadian women at risk of unintended pregnancy always use contraception. National-level data from 2015 showed that 24 per cent of sexually active females not wanting to conceive did not use any form of contraception the last time they had sex with a male partner.
Moreover, 27 to 40 per cent of pregnancies in Canada are unintended, and one in three women have an induced abortion in their lifetime. It’s important to acknowledge that Canada needs to implement routine surveillance of reproductive health indicators, such as contraception use and rates of unintended pregnancy at the national level, to track changes in these statistics over time.
Avoiding unintended pregnancy is an important component of everyone’s right to reproductive health, which includes the ability to plan pregnancies. Furthermore, unintended pregnancy is associated with adverse maternal and infant outcomes, including depression during pregnancy, preterm birth and low infant birthweight.
The cost of contraception is an important reason for non-use in Canada. On April 1, 2023, British Columbia became the first province to offer several types of free prescription contraception to all residents. Manitoba is set to follow suit.
In other provinces and territories, individuals without adequate private insurance coverage, or who are ineligible for public drug insurance, must pay out-of-pocket or seek help from family planning organizations for prescription contraception.
The Canadian Medical Association and the Society of Obstetricians and Gynaecologists of Canada both recommend that provincial/territorial and federal health care plans cover all contraceptives for all Canadian women. The Canadian Paediatric Society also supports no-cost contraception for women of reproductive age and, in particular, suggest that no-cost contraception be provided under provincial/territorial and federal health plans until age 25.
New federal pharmacare legislation is an important opportunity to give all Canadian women access to effective contraception.
The importance of free prescription contraception
Highly effective contraception methods tend to be the most expensive. Prescription contraception options such as birth control pills and IUDs are more effective at preventing pregnancy than condoms alone. However, these forms of contraception are also among the most expensive and least used in Canada. For example, IUDs can cost up to $550 in upfront payment.
Certain populations are less likely to use effective contraception methods to prevent unintended pregnancy. These populations include youth, those with lower incomes and those who have recently immigrated to Canada. For example, a 2019 study reported that, among Canadians ages 15 to 24, lower income is associated with using condoms only, and with not using any contraception, compared to youth from higher-income households.
Being able to access prescription contraception through a universal public pharmacare plan not only removes cost-related barriers, but allows women to confidentially obtain contraception without having to claim it through a parent’s or partner’s insurance plan.
Recent research from the United States showed that providing women who have low incomes with vouchers to cover 100 per cent of the cost of their preferred form of contraception resulted in women choosing to use more effective contraceptive methods. The increase in effective contraception is estimated to reduce unplanned pregnancies by 32 per cent among this group of women, compared to those paying sliding scale prices. This study demonstrates the importance of removing cost-related barriers to contraception.
The benefits of providing free prescription contraception extend beyond preventing pregnancy and can include benefits for women who aren’t sexually active. Some forms of prescription contraception are also used to treat several painful and debilitating conditions common in women, such as endometriosis (a condition where tissue similar to the lining of the uterus grows outside the uterus) and polycystic ovary syndrome, or PCOS, which occurs when the ovaries produce an abnormal amount of male sex hormones.
Cover several types of highly effective contraception
It is essential that women be able to choose their preferred contraception method. Preferences may be influenced by several factors.
For example, women who recently immigrated to Canada may be more likely to have negative attitudes toward hormonal contraception. Providing the option for copper IUDs, for example, would provide a highly effective non-hormonal option to women wanting to prevent pregnancy without taking hormones. Additionally, some types of prescription contraception are contraindicated (should not be used) for women with certain health conditions.
It is important that several types of highly effective contraception be available cost-free so that all women can choose the safest and best option, based on contraindications, personal beliefs, culture, preferences and the ability to adhere to the chosen method without cost-related barriers influencing their decision. Health-care providers can then educate youth and adult Canadians on contraceptive methods and their effectiveness without concern about cost as a barrier to access or adherence.
Covering prescription contraception is cost-effective
A single-payer universal pharmacare program will provide Canada with better bargaining power to negotiate lower drug prices for certain contraception products than Canada’s current patchwork system of public and private insurance plans.
Additionally, a national pharmacare program that provides free prescription contraception means that health systems and, in turn, individuals or taxpayers spend less on managing unintended pregnancies. We can turn to British Columbia for an example. Researchers in B.C. found that the cost to provide a universal subsidy to all women in the province is less than the cost to manage unintended pregnancies that would be preventable with improved contraception access.
This logic contributed to the provincial government’s decision to provide free prescription contraception to all residents. The policy is expected to save the health system approximately $27 million a year from the fourth year onward.
While there are other barriers to accessing effective contraception beyond cost, making prescription contraception free for everyone in Canada is undoubtedly a step in the right direction. It’s both cost-effective and a movement towards gender equity and realizing the right to reproductive health for all Canadians.