We need to improve access to contraceptives in Canada

This column is an opinion of Vivian Tam, an Ottawa family emergency room physician. For more information on CBC’s Opinion Section, see the FAQ.

In a rural community, I was once taking care of a young woman who was having unprotected sex. Like many others, she came to the emergency room to seek birth control options. After an initial screening for non-consensual contact, we decided that the copper IUD would be the most appropriate option. A few hours later I got a call from one of the few pharmacies in town saying my patient had come in but they didn’t have the copper IUD in stock.

For the rest of the afternoon I called the few remaining pharmacies. None of them carried the device they were looking for. In the end, we had to settle for birth control pills, which are less effective three days after unprotected sex and in patients weighing more than 155 pounds. We could not be sure that an unwanted pregnancy would be avoided, but it was the only option my patient had.

Access to contraceptive care in Canada is patchwork: we are one of the only countries with universal health insurance that doesn’t also cover contraception. This means women who are insured through their jobs or who can otherwise afford contraception are more likely to have access to the options available than their peers who live in geographically isolated areas, have low incomes, or are unable to travel to access to receive contraceptives.

In young women aged 15 to 24 years lower household income This has been found to be associated with reduced use of oral and dual contraceptives and an increased risk of not using contraceptives at all.

The recent settlement of the Roe v. Wade in the United States has brought attention back to this group of young women who will be particularly at risk if they seek an abortion they are unwilling or unable to provide for.

In Canada, we must ensure that all women have access to the full range of contraceptive and abortion services, when and where they need it.

There are numerous strategies for this.

First, all contraceptive methods should be included in our universal health care system. IUDs are the recommended first-line birth control strategy, but a single IUD that lasts five years costs up to $390 per unit, a price unattainable for many.

A single IUD that lasts five years costs as much as $390 per unit, a price that is prohibitive for many. (Craig Chivers/CBC)

In addition to improving fair access, there is also an economic case to be made. A 2010 US Analysis Using data from the publicly-funded California Contraceptive Plan showed that every dollar spent providing intrauterine contraceptive systems resulted in $7 in cost savings from prevented pregnancies, potential sexually transmitted diseases, infertility costs and cervical cancer.

Second, the pandemic required the development of new ways of delivering reproductive medicine that should be made more widely available.

in one opinion poll of Canadian abortion care providers and administrators, by the end of 2020, nearly 90 percent of the 78 respondents had transitioned to offering some or all components of medical abortion care through telemedicine. This means that instead of having to wait in person at a clinic, patients can speak to a care provider online and have their medication delivered by mail or have it ready for collection.

A study of over 52,000 women in England in 2020 compared hybrid in-person and virtual-only abortion services to usual in-person care. The hybrid and virtual models have been shown to reduce referral-to-treatment wait times by an average of 4.2 days and increase the number of abortions performed at an earlier gestational age, resulting in a reduced risk of complications for the patient. All of the abortions made possible by the virtual models were successfully completed, and 96 percent of the patients reported being satisfied or very satisfied with the process.

Finally, we should expand the network of providers capable of prescribing and renewing contraceptive options.

Currently, pharmacists in Alberta, Saskatchewan, Nova Scotia and Quebec can and have counseled women on their reproductive planning options prescribe privileges as the primary contraceptive.

In a rehearsal of rural and urban pharmacies in BC, 80 percent of pharmacists reported a willingness to offer oral contraceptives.

In rural and remote Canada in particular, increasing the number of providers able and willing to offer contraceptive services will greatly increase access for women who may otherwise have few or no options.

Women deserve access to the full range of reproductive health services they need, regardless of their geographic location or ability to pay. More than ever, as a country, we must use available strategies to increase access to contraception and abortion treatment and uphold our commitment to reproductive rights.

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