Offer free birth control for youth, Canadian Paediatric Society says

Birth control pills, condoms and all other contraceptives should be available at no cost for youth in Canada age 25 and under, the Canadian Paediatric Society says.

In a position statement released on Thursday, the society called for confidential access to contraceptives to minimize the personal and financial costs of unintended pregnancies, such as derailing life plans for education and increasing the likelihood of needing social assistance.

More than 25 per cent of youth who do not wish to become pregnant don't use contraceptives consistently, studies suggest. About 59,000 unplanned pregnancies a year occur among those under age 24 in Canada, the society said.

Canadian contraceptive care providers have said cost is the largest barrier to access, and youth are disproportionately affected.

"We know that for an adolescent paying out of pocket, cost can be quite substantial so that even the $10 to $15 a month that the pill might cost or the $8 for a box of condoms, sometimes, even that's a challenge," said Dr. Giosi Di Meglio, one of the authors of the new paper and an adolescent medicine specialist at Montreal Children's Hospital.

 "Solving the cost problem helps."

That's why the group urges federal, provincial and territorial governments to move quickly to:

• Cover all contraceptives, including condoms, which also protect against sexually transmitted infections, under government health plans until age 25.
• Provide no-cost contraceptives to health-care service clinics for youth.
• Ensure that privately insured youth have equal access to confidential, no-cost contraception.
• Continue to make short-acting birth control pills, patches and injections available at no cost until age 25 should they become available over the counter.

A small study last year based in Quebec, which has a public prescription drug insurance plan, suggested about 10 per cent of youth didn't get the contraception they wanted or had to stop using it because of cost.

Those findings reflect what pediatricians across the country see in their practice, she said.

Coverage falls apart

"I think because we have universal health-care coverage … we often think that we've done the part that's really important, which is getting the prescription in hand.

"But the other piece of it is going from having a prescription to actually having the contraceptive, and that's where things fall apart in Canada."

Last year, the society recommended long-acting reversible contraceptives such as IUDs as the most effective form of contraception. The up-front costs can be $300.

Confidentiality is also key. Pediatrician Margo Lane in Winnipeg, a member of the society's adolescent health committee, gave the example of a girl whose father was sometimes violent. The family was covered under his private pharmaceutical insurance plan, and the girl was scared of having her father find out if she purchased contraception through the plan.

An individual like that could benefit from the proposed universal access to contraception, Lane said, although she also stressed that young people should have open discussions with parents and seek their guidance.