Could free birth control be on the horizon in Ontario? 

Posted on March 18, 2023 in Child & Family Debates

Source: — Authors: – Health/Ontario Hubs
Mar 15, 2023.   by Diane Peters

British Columbia will soon fully cover hormone-based contraception — and Ontario advocates are hoping this province will follow suit

Several times a month, a client at the SHORE Centre in Kitchener admits they can’t afford to pay for their birth control.

And SHORE’s executive director, TK Pritchard, suspects many more clients have a hard time paying for their birth control. “We know people who are choosing between buying food that week and getting their birth control,” Pritchard says. “Sometimes they tell us; sometimes they don’t.”

The centre — which offers a range of reproductive-related services, including a medical clinic counselling, education, and advocacy — has a fund that will offset the cost of things such as an intrauterine device or implant. SHORE also has a payment plan for contraception, which it sells at cost, and can sometimes offer free birth control pills. Fundraising and drug companies backstop these programs.

According to Pritchard, people will often choose a form of contraception based on price, not on what’s best for them. A pack of birth control pills runs around $20 a month (or $240 a year), an injection is about $180 annually, and IUDs cost between $75 and $380. Most people with a uterus must manage their fertility for 30-plus years. Some use hormonal birth control to manage other issues such as painful periods and endometriosis.

“The most reliable birth-control choices are the most expensive options, costing $380 upfront,” says obstetrics/gynecology resident Mary Boulos, spokesperson for Cover ContraceptiON, an Ontario-based group of physicians advocating for OHIP coverage of contraception. “We know that, in this climate, when people are living paycheque to paycheque, they don’t have $380.”

That’s about to change for people in British Columbia, which will fully cover hormone-based contraception as of April 1. Contraception is already free in the United KingdomNew Zealand, and Spain, among other places.

Ontario could be next. That’s the hope of St. Catharines NDP MPP Jennie Stevens, who tabled a motion on March 8 to cover hormonal contraception in the province, a move she says is just a first step. (During the 2022 election, the NDP promised to make birth control free if elected.)

“Our goal was to make sure the government was listening. We got a response from the minister, and we felt she was listening,” says Stevens, adding that she timed her motion so that contraception coverage could be included in the upcoming 2023 budget.

The money argument
In funding contraception, governments can spend money to save money, says Boulous: “We know that, for every dollar you spend, you get $90 in savings in indirect and direct costs.”

B.C. will spend $119 million over three years; one conservative estimate, which dates back to 2010, says that the province could save $95 million in direct costs per year. Per Boulos’s formula, it could save more than $3 billion annually.

Back-of-the-napkin math suggests that Ontario, which has nearly triple the population of B.C., would spend $119 annually to pay for birth control and could save at least $300 million or up to $10 billion.

Poor access to contraception can lead to unplanned pregnancies: 50 per cent of all pregnancies in Canada were not planned, according to the Society of Obstetricians and Gynaecologists of Canada.

There were 21,428 abortions performed in Ontario in 2020. Boulos says doctors bill about $200 per procedure; then there are costs related to support staff, nurses, anaesthesiologists, use of the operating room, and medications. Ontario does not have good data on the use of the so-called abortion pill Mifegymiso, which is covered by OHIP and costs between $300 and $450.

For pregnancies that continue, there are health-care visits and the actual delivery — unwanted pregnancies tend to receive less care, which can lead to premature birth and low birthweights, both of which cost the system more, says Boulos. Both parents and the government bear costs related to maternity leave, other missed work days, daycare, groceries, and education.

Unequal access
Groups such as the Canadian Paediatric Society and charitable organization Action Canada for Sexual Health and Rights have been calling for contraception coverage in Canada for years because of equity issues, not just money.

Women and people with uteruses usually bear the cost and responsibility of birth control. Further, the burden of birth-control costs is not shared equally across society.

2013 study of women seeking abortions at two clinics in Canada found that immigrants had more difficultly accessing contraception compared with those who were Canadian-born. A 2009 survey found lower contraceptive use in women with family incomes under $100,000.

Some have birth control paid for by employment-based insurance plans, and anyone under 24 in Ontario has coverage under OHIP+. However, Cover ConceptiON says 24 per cent of Canadians pay out of pocket because they either have no insurance or don’t wish to tell family members about their contraception use.

“We see clients for whom it’s risky to have people in their lives know they’ve accessed birth control,” says Pritchard. Some young people, for example, can’t access OHIP+ because their parents’ have private insurance — but they don’t want their parents to know they’re taking, say, the pill.

For those experiencing intimate-partner violence, using insurance which produces a claim their partner might see or paying with a shared credit card or bank account can be risky.

And many insurance polices won’t pay for birth control beyond the pill. Pritchard has talked to people who can’t get covered for copper IUDs, patches, or vaginal rings, and their insurance will cover some methods again only after a certain period has passed. Pritchard says that people who had their IUD taken out to have a baby often can’t get coverage to have it put back in and that this rule limits them from trying a new form of birth control if their current method is not working out. Many insurance plans cover Plan B but not the other emergency-contraception pills, such as Ella, which is recommended for people of a heavier weight, plus you can use an copper IUD as emergency contraception, says Pritchard, but it may not be covered.

Improving access
B.C. has also announced that its pharmacists will likely be able to prescribe birth control starting this spring — Alberta, Saskatchewan, Quebec, and Nova Scotia already do this.

Boulos says that would be a welcome change and would help people who don’t have family doctors or who live in rural or remote areas: “The first step is no cost — we know that’s the greatest barrier. But, in the future, hopefully, more allied health professionals can prescribe, which would lead to greater access. We’re taking a stepped approach.”

TVO Today requested comment from the Ministry of Health on paying for birth control or permitting pharmacists to prescribe hormonal contraception but did not receive a response by publication time. However, health minister Sylvia Jones responded to the motion in the legislature on March 8, “We obviously are looking closely at what British Columbia has proposed. Look, I’m a firm believer that when there are good ideas, when there are innovative ideas, I am always willing to talk and have those conversations to see if and when it is appropriate.”

Groups such as Birth Control Access ManitobaWellness Within Nova Scotia, and New Brunswick Abortion Care Network are working on similar projects in their respective provinces, and these groups and governments will be looking to B.C. for any early reports.
“B.C. has shown it can be done,” says Pritchard. Stevens agrees: “They broke the ice on something that was well overdue.”

Diane Peters – Diane Peters is a Toronto-based writer, editor, and teacher.

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