Why B.C. should introduce universal contraception coverage in this year's budget

This column is an opinion by Morgan Haines and Janice Mok, who are third-year medical students at the University of British Columbia. They are members of the UBC Medicine Political Advocacy Committee, which is lobbying the provincial government for universal access to contraception. For more information about CBC's Opinion section, please see the FAQ.

As medical students, we have the unique privilege of hearing the stories behind the statistics.

Like the shy 15-year-old girl we met at the doctor's office in Prince Rupert, B.C., asking for contraception.

She told us she had recently started having intercourse with her boyfriend and was not using contraception. After we counselled her on the options, she wanted to know how much a hormonal intrauterine device (IUD) would cost. Physicians often recommend an IUD as the most effective option for youth as it avoids the need to take medication daily. 

Her face dropped when she learned that the IUD cost $385. She told us she could not afford it and she couldn't ask her parents to help pay for it. 

It is stories like this one that illustrate how B.C. is failing its citizens in not providing universal access to contraception and leaving young people vulnerable to unintended pregnancies. The provincial government has a chance to change this in the upcoming budget.

Currently in our province, about 40 per cent of pregnancies are unintended. Nationally, unplanned pregnancies cost our collective health-care systems $320 million annually based on medical costs associated with pregnancy, labour and delivery and abortion.

The data are clear: Investment in contraception is effective and most medical experts, from the World Health Organization to the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada and the Canadian Pediatric Society will agree.

Effects of unplanned pregnancies

Unplanned pregnancies are riskier for the mother and child. Women are more likely to die during an unplanned pregnancy, and are more likely to have postpartum depression. Children are more likely to be born prematurely, have low birth weight, and suffer developmental delays. And then, there is the societal cost: women with unplanned pregnancies are less likely to pursue further education, have lower rates of participation in the workforce and earn less. 

Contraception is effective in preventing unintended pregnancies but there are several obstacles to accessing it, such as differing levels of sexual health education and access in rural communities. 

The most widely cited barrier, however, is cost. 

Oral contraceptive pills cost around $13-20 per month or up to $240 per year, so while the cost may seem low, it adds up over time. IUDs last for three to 10 years but have high upfront cost of between $90 and $385.

Contraception is not covered for most British Columbians. Low-income and Indigenous people are covered through the province, but others must pay for contraception themselves or obtain coverage through private insurance.

In particular, youth who are dependent on their parents' private insurance often fall through the cracks as they are often unable to access contraception without their parents' knowledge. Although there are youth clinics that provide free or subsidized contraception, the limited hours, strict age criteria and limited locations make them inaccessible to many. 

Some might argue that young people should not be having sex at all or that abstinence is the best form of contraception. Yet the reality is that 41 per cent of 15- to 19-year-old women in B.C. have had sex in the past year. 

Still others will claim that such a universal contraceptive program would be expensive. Sure, Canadian studies have shown that national universal access to contraception would cost $157 million annually, but that's less than half the $320 million cost of unintended pregnancies.

Universal coverage exists elsewhere

We're already behind. Universal access to contraception exists in New Zealand, the United Kingdom and Australia. Closer to home, Ontario previously covered contraception for youth under 25, though recent changes have decreased coverage and left youth more vulnerable.

British Columbia's provision of contraception falls short. We cannot wait for a national pharmacare plan. And we're not alone in advocating for this. Earlier this year, Victoria became the first municipality to endorse a campaign for provincially funded contraception. 

Premier John Horgan has said he's open to the idea, so why the delay? Universal access to contraception benefits individuals and society, while leading to large economic savings for the government. The wait for universal access to contraception cannot continue. 

Note: While we acknowledge that we use gendered language in this article, we wish to include everyone across the gender spectrum in this conversation.

This article is the opinion of the authors and does not necessarily reflect that of the Faculty of Medicine of the University of British Columbia.

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