Canada lags behind other nations in birth control access, and it's costing us
Canada is one of the only societies that pays for universal health care but doesn't provide a universal subsidy for contraception
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When her period comes each month, Anne Wilson* breathes a sigh of relief. “I’m like, oh thank God,” she says, laughing nervously.
The 31-year-old Toronto entrepreneur doesn’t want to play roulette with pregnancy, but she’s left with few options due to health issues that prevent her from using most forms of birth control.
At present, she and her partner use condoms, but, “I can tell you we’re not using them perfectly 100 per cent of the time,” she says.
Doctors have advised her that her only option is an IUD. Wilson’s painful menstrual cramps remove the copper IUD from her list of options — it’s known to exacerbate cramps in some women — leaving her with two remaining choices: hormonal IUDs Mirena and Jaydess.
But Wilson can’t afford either — both cost upwards of $300 and subsidized birth control clinics don’t offer them.
“I’m just starting a business so I’m always worried about when money is coming in, and these costs add up,” she says. “I wish there were more options.”
Wilson isn’t alone.
According to the Canadian Contraception Consensus report from the Society of Obstetricians and Gynaecologists of Canada, 15 per cent of sexually active Canadian women aren’t using any form of birth control and 20 per cent are using a form of birth control inconsistently. And according to the World Health Organization, 51 per cent of pregnancies in North America were unintended in 2012 (a stat that includes pregnancies that were not carried to term).
Low-income women are twice as likely to use no contraceptives compared to the highest earners. And one third of Canadian women will have an induced abortion at some point in their life. Simply put, Canadian women are facing enough barriers to birth control that a substantial number are risking unplanned pregnancy each month.
“When we look around the world, Canada is one of the only societies that pays for universal health care ... but doesn’t provide free contraception,” says Dr. Wendy Norman, chair of the Contraception Access Research Team (CART) at the University of British Columbia. “The number one barrier that we’ve identified for women accessing birth control is cost,” she adds.
The United States, 11 countries in Europe, the U.K., Australia and New Zealand all provide a universal subsidy for contraception.
In Canada, however, affordable birth control is provided to those in need through a patchwork of sexual health clinics funded by public health authorities. While these clinics do offer affordable options such as oral contraceptives ranging from free to $10 per month, or five-year copper IUDs for $60, many women find it difficult to access these services due to limited drug choices, clinic hours and long wait times.
Catherine Datta, the north/east manager of the Toronto Sexual Health Clinics, calls her clinics “oversubscribed,” noting in 2014, over 63,000 people visited them and sometimes experienced wait times of more than two hours.
“The hours (of subsidized birth control clinics) don’t support the people who may use them the most,” agrees Pam Krause, executive director of the Calgary Sexual Health Centre. According to Krause, the clinics in Calgary have hours similar to school and offices, making it difficult for teens or single working mothers to visit them.
That leaves many women using condoms or withdrawal for birth control, two methods with the highest rates of failure — 21 per cent failure for condoms over one year of typical use, and a 22 per cent failure for withdrawal over one year of typical use, according to research from Princeton University in 2011. In contrast, less than 1 per cent of women using an IUD will become pregnant over one year.
“Because the least effective contraceptive methods cause the most pregnancies, it costs the health system much more than it would to provide a more expensive option because so fewer pregnancies result when consumers use the most effective methods (which are the most expensive),” says Norman.
According to Dr. Norman, free, accessible birth control is one of the easiest ways to reduce costs on the health care system.
American research shows that the nation’s publicly-funded clinics — which provide access to free or subsidized birth control — saved the U.S. $13.6 billion in 2010, or about $7 for every public dollar spent.
And a study from St. Louis, Mo., conducted between 2007 and 2011 involving 10,000 young women given the option of various methods of free birth control resulted in a dramatic drop in unintended pregnancy.
The annual rate of pregnancy for participants in the study was 34 per 1,000 women, compared to a U.S. national average of 57 per 1,000.
About 75 per cent of the participants opted for long-acting IUDs, where in contrast, only about 2 per cent of the general female population in the U.S. use an IUD.
“We can see as soon as a subsidy is brought in, particularly for highly effective methods like IUDs, the population shifts towards using them,” says Norman.
“In Canada we don’t have much research to guide us. This (contraceptive access) hasn’t ever been a core principle within public health,” she adds.
In both the U.S. and U.K., extensive research has been done on contraceptive use and access in those countries. Norman is working to amass similar data through CART’s projects. Her group has been conducting surveys in B.C. to get a better idea of the rates of unintended pregnancy and prevalence of contraceptive use and some of this research will be published later this year.
They are also looking at alternative ways to offer contraceptives to make access easier for women. Currently, in B.C. and Quebec, nurses can prescribe oral contraceptives and Dr. Norman says her group has consulted with the College of Pharmacists in B.C. about offering contraceptives over the counter without a prescription.
Pharmacists would require additional training and be asked to administer blood pressure checks and health background questionnaires to women wanting to access contraception.
On Jan. 1, Oregon became the first state in the U.S. to allow pharmacists to prescribe oral contraceptives and the patch, and California is expected to follow suit in March.
“This would provide exceptional ability for people — especially in rural areas — to access contraception,” says Dr. Norman. “These drugs are very safe.”
*Name changed at source’s request.