“Contraceptive information and services must be available in sufficient quantity, with sufficient variety, to accommodate everyone in need. This is a human rights necessity, just like access to clean drinking water, adequate sanitation and a minimum standard of health care.”

United Nations Population Fund, 2018

The development of effective and safe contraception has been a significant medical advancement of the 21st century. According to the United Nations Contraceptive Use by Method data booklet, 922 million women of childbearing age use some type of contraceptive (UN Population Division, 2019). 

September 26th, 2021 marks the 14 year anniversary of World Contraception Day, a global campaign dedicated to raising awareness for safe sex practices and information on effective and safe birth control options. The ability to determine when one gets pregnant is a huge benefit to individuals across the globe and can have a powerful impact on reducing gender inequity.

In fact, at the 1968 International Conference on Basic Human Rights, access to information and services regarding contraception was declared a human right (UNPFA, 2012). The outcome document, known as the Teheran Proclamation, stated “parents have a basic human right to determine freely and responsibly the number and spacing of their children” (United Nations, 2021).  

Despite the push from the United Nations for countries to provide access to contraception, there is a large unmet need across the globe (Center for Reproductive Rights & UNPFA, 2011).

Certain developed nations have started to tackle some of the financial barriers by providing most or all coverage under national drug plans – including Germany, Spain and in certain parts of the United Kingdom (Center for Reproductive Rights, 2012).

Canada however, a developed country that prides itself on its universal healthcare, does not routinely subsidize contraception. Surprisingly, the largest barrier for most individuals in Canada is cost (Hulme, 2015). 

The Problem 

Many of us know someone who has used contraception in their lifetime, whether for birth control or for the multitude of other benefits it provides. In Ontario for example, those under the age of 25 tend not to think about the cost thanks to provincial health insurance covering most of the available contraceptive options.

However, once that clock strikes midnight on someone’s 25th birthday, contraceptives become an out-of-pocket expense for anyone without a drug plan. The cutoff assumes that individuals over 25 years of age have secured employment with drug coverage, which for many may not be the case.

Once you do the math on some of the birth control options, you can see just how quickly things can add up (Figure 1).

This is not only a personal attack on bodily autonomy, but also creates a huge societal cost. Up to 40 percent of all pregnancies in Canada are unplanned, creating a huge economic burden to the healthcare system (Black, 2012). 

A study by Hulme and colleagues in 2015 showed that there are more than 180,700 unplanned pregnancies in Canada annually, most occurring in women aged 20-29 years old.

The associated direct cost was over $320 million (Hulme, 2015). Consistent use of contraceptives significantly decreases the risk of unplanned pregnancies and the potential to save millions in downstream costs.

Another study by Foster and colleagues estimated that for every $1 spent on contraception in the United States, $7 would be saved in associated costs of unplanned pregnancies (Foster, 2012). 

Even with all the options for birth control – the ring, the patch, the injection, the intrauterine device, the implant, combined and progesterone only oral pills – all come with associated out-of-pocket costs, up to hundreds of dollars per year. This particularly impacts individuals of lower socioeconomic status, which perpetuates income inequity from one generation to the next. 

This has been exacerbated by the COVID-19 pandemic, as women tended to be hit harder financially, with an increase in gender violence that restricts access to healthcare (Chen & Bougie, 2020). In addition to gender-associated inequity, racial disparities that have already existed will be exacerbated by the pandemic (Aly, 2020).

The fact of the matter is, financial access to contraception has always been a problem in Canada, but the pandemic has made this issue far worse.  

Although certain drug companies do offer compassion programs, they come with their own set of barriers. Most are income-dependent, require a lengthy application process and can require payment upfront before reimbursement is made later (Di Meglio G & Yorke E, 2019). Those interested in accessing reproductive healthcare should not have to jump through all of these hoops to obtain it. 

The Solution

The solution is simple: universal coverage to all contraceptive options for all Canadians. Drug coverage in Canada is provincially mandated, so it is up to individual provincial bodies to provide free contraception access.

Several medical associations across Canada have already expressed their support for this initiative, including the Canadian Medical Association (Morgan et al., 2015), the Society of Obstetricians and Gynaecologists of Canada (Black et al., 2015), and the Canadian Pediatric Society (Di Meglio G & Yorke E, 2019).

It is evident that physicians across the country see the value in contraception coverage, so why can’t our politicians? 

Access to contraception is a human right and a pillar of reproductive justice (UN, 2021). It is essential that anyone with a uterus has the ability to have control over their body, including when and if they become pregnant.  

What is being done? 

In regards to having contraception being covered for all citizens, certain provinces in Canada are starting to make headway. AccessBC was started in British Columbia, and CovercontraceptiON in Ontario. Both of these organizations are lobbying the provincial government to provide free coverage for prescription contraceptives.

In December 2020 CoverContraceptiON wrote an open letter addressed to the Hon. Christine Elliot, Deputy Premier of Ontario and Minister of Health, and the Hon. Doug Ford, Premier of Ontario, to call upon the provincial government to institute universal, 100% cost coverage for all contraceptive options.

Additional signatures can be added using the following link: https://docs.google.com/forms/d/e/1FAIpQLSeccjcTnXJVC7MtgZTpdl04MSP1CrVwoAFDBf99WKZiIRlJJQ/viewform

For more information on what these organizations are doing and how you can help, check them out here:

https://www.accessbc.org/

https://twitter.com/contracepti_on?lang=en