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We need to strengthen access to contraceptive care in Canada

Particularly in rural and remote Canada, increasing the number of providers able and willing to provide contraceptive services will significantly increase access for women who may otherwise have few, if any, options, writes Vivian Tam.

We are one of the only countries with universal health coverage that does not also cover contraception

This column is an opinion by Vivian Tam, a family-emergency physician in Ottawa. For more information about CBC's Opinion section, please see the FAQ.

In a rural community, I once cared for a young woman who had had unprotected sex. Like many others, she came to the emergency department seeking contraceptive options. After an initial screen for non-consensual contact, we decided that the most appropriate option would be the copper intrauterine device. A few hours later, I received a call from one of the few pharmacies in town: my patient had come in, but they didn't stock the copper IUD.

Over the rest of the afternoon, I called the handful of remaining pharmacies. Not one of them carried the device we were looking for. In the end, we had to settle for the contraceptive pill, which is less effective three days after unprotected intercourse, and in patients who weigh more than 155 pounds. We couldn't be sure that an unwanted pregnancy would be prevented, but it was the only option my patient had.

Access to contraception care in Canada is patchwork: we are one of the only countrieswith universal health coverage that does not also cover contraception. This means that women who have insurance through their work or are otherwise able to afford contraception are more likely to be able to access the range of options available, compared to their counterparts who live in geographically isolated areas, have low incomes or who are unable to travel to access contraceptive care.

Amongst young females aged 15 to 24, lower household income was found to be associated with decreased use of oral and dual-method contraceptives, and an increased risk of using no contraceptives at all.

The recent overturning of Roe v. Wade in the United States has refocused attention on this group of young women, who will be made particularly vulnerable if and when they seek abortive care for pregnancies they don't want or are unable to care for.

In Canada, we need to ensure that all women are able to access the full spectrum of contraceptive and abortive services, when and where they need it.

There are numerous strategies for doing so.

First, all contraceptive methods should be included in our system of universal health coverage. IUDs are the recommended first-line contraceptive strategy, yet a single IUD lasting five years costs up to $390 per unit, a price that is out of reach for many.

In addition to improving equitable access, there is an economic argument to be made. A 2010 U.S. analysis using data from California's publicly-funded contraceptive plan showed that every one dollar spent on providing intrauterine contraceptive systems led to a seven-dollar cost savings from averted pregnancies, potential STIs, infertility costs and cervical cancers.

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

In a survey of Canadian abortion care providers and administrators at the end of 2020, almost 90 per cent of the 78 respondents had shifted to offering some or all components of medical abortion care through telemedicine. This means that, instead of having to wait at a clinic in person, patients can speak with a care provider online and have their medications delivered by mail or available for pickup.

One study of over 52,000 women in England in 2020 compared hybrid in-person and virtual-only abortion services with the usual in-person care. The hybrid and virtual models were shown to reduce wait times from referral to treatment by an average of 4.2 days, and increase the number of abortions performed at an earlier gestational age, meaning less risk of complications for the patient. All abortions facilitated through the virtual models were completed successfully, and 96 per cent of patients indicated they were satisfied or very satisfied with the process.

Finally, we should expand the network of providers able to prescribe and renew contraceptive care options.

Currently, pharmacists in Alberta, Saskatchewan, Nova Scotia and Quebec are able to counsel women on their reproductive planning options and have prescribing privileges as primary providers of contraception.

In a sample of rural and urban pharmacies in BC, 80 per cent of pharmacists indicated their willingness to provide oral contraceptives.

Particularly in rural and remote Canada, increasing the number of providers able and willing to provide contraceptive services will significantly increase access for women who may otherwise have few, if any, options.

Women deserve access to the full spectrum of reproductive health services they need, regardless of geographic location or ability to pay. Now more than ever, we need to adopt available strategies as a country to strengthen access to contraception and abortion care to uphold our commitment to reproductive rights.

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Vivian Tam

Freelance contributor

Vivian Tam is a family-emergency physician in Ottawa and a graduate of the University of Toronto's MSc System Leadership and Innovation program. She has interests in public policy and social medicine.

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