Universal Access to Contraception in Canada
By: Michaela Rutherford-Blouin, Melissa Carvalho, and Semilore Ajayi
The federal government has initiated the preliminary stages of a national pharmacare program, with intentions to include a selection of contraceptives and diabetes medications. Discussions surrounding access to contraception have been prevalent among provinces and territories, setting the stage for their pivotal role in shaping the implementation process in the coming months.
Last year, British Columbia (B.C.) made headlines as the first province to implement a single-payer model to fund birth control and various contraceptive methods, serving as a blueprint for federal initiatives. B.C.’s policy, covering over 60 commonly used birth control methods, including pills, IUDs, injections, and emergency contraception, has influenced the federal product list.
Data from B.C. indicates a substantial uptake in free contraceptives following the policy’s implementation (over 188,000 recipients between April-November 2023), prompting the expansion of pharmacist-prescribed contraception to meet rising demand. This move proved significant in overcoming barriers to access, particularly in regions grappling with physician shortages.
Following B.C.’s announcement, the Manitoba NDP campaigned on covering contraception and following their election they have since reaffirmed their willingness to proceed. All eyes will be on provincial negotiations, as the federal Health Minister has stated the hope that some provinces will have pharmacare plans in place by the end of 2024.
Health and Life Sciences Insights
Our team shares their insights on the preliminary stages of a national pharmacare program.
Will other provinces follow suit?
Ontario, Alberta and Quebec on the other hand, are slower on the uptake. Ontario has been much less committal, with the Minister of Health stating that the province cannot state a position until they have more information, “I need a lot more details: which programs would be impacted, whether in some cases Ontario has already more than what the pharmacare proposal is.”[1] Ontario wants to avoid duplication or a replacement of their OHIP+ program.
On the other hand, Alberta and Quebec have publicly stated that they will be looking to opt out of a new pharmacare program. Alberta’s Health Minister, Adriana LaGrange has attributed intentions to opt out based on her government’s belief that the national pharmacare plan has limitations that overlook costs that provinces like Alberta would have to pay to implement. Although Minister LaGrange also referenced that most Albertans have access to contraceptives through employer or government health care insurance plans, poverty reduction advocates emphasize that these programs are either unavailable or inaccessible to lower income Albertans, youth, and newcomers.[2] Quebec has asked the federal government for an unconditional opt-out with full financial compensation from national pharmacare.
Lessons from B.C.’s rollout highlight critical considerations for other provinces, including infrastructure readiness and staffing capacity for contraceptive services. Addressing financial barriers associated with prescription contraception is imperative, given its pivotal role in promoting gender equality and improving health outcomes for individuals and families.
The Importance
The financial barriers associated with prescription contraception pose significant challenges, particularly for underserved populations. Contraception plays a pivotal role in addressing social inequities in our communities and can give women greater control over their own sexual and reproductive choices thus reducing gender inequality. This also fosters improved health outcomes for both parents and children and aligns with sound fiscal principles. An IUD can cost between $75 to $400, oral contraceptive pills can cost $20 per month (adding up to $240 a year), and hormone injections as much as $180 per year.[3] These price tags can present a considerable barrier to contraception accessibility for many people, with the burden falling disproportionately on women. The cost effectiveness analysis out of B.C. was clear, it was costing the government more to pay for the management of unintended pregnancies than it would cost to provide free contraception and was estimated to save the health system approximately $27 million per year.[4]
Why now?
The timeliness of progress on contraception reflects years of groundwork laid by researchers, civil society groups, and advocacy organizations. Groups such as AccessBC, Action Canada, the Society of Obstetricians and Gynaecologists of Canada, ProjectEmpowHER, and the Native Women’s Association of Canada have been instrumental in mobilizing public support, raising awareness, and contributing to policy shifts. These efforts have resulted in a significant advancement towards breaking down barriers and enhancing accessibility to contraception.
As provinces head to the negotiating table, they have much to consider between what coverage they are currently offering and how they want to proceed. There are still a lot of unknowns from the federal government’s plan, especially considering they want to see this rolled out in provinces before the year’s end.
[1] https://globalnews.ca/news/10334504/ontario-universal-pharmacare-end-of-year-questions/
[2] (1) Alberta intends to opt out of national pharmacare plan | Globalnews.ca
[4] https://www.med.ubc.ca/news/how-ubc-researchers-laid-the-groundwork-for-free-contraception-in-b-c/