Birth Control Is Free in B.C. When Will There Be National Coverage?

We asked Dr. Wendy Norman, whose research helped bring about the policy, to explain where we’re at

Wendy Norman is a professor in the Department of Family Practice, and an associate member in both the School of Population and Public Health, and the Department of Obstetrics and Gynecology, of the Faculty of Medicine at the University of British Columbia (UBC).

She founded and leads Canada’s Contraception and Abortion Research Team (CART), whose impactful research, starting in 2017, laid the groundwork for free contraception in B.C. “We’ve been immensely honored as university-based researchers and with a consortium of healthcare providers to help the government understand what people need to be able to have children when they want, and to be able to best support their own desires for when they’d like to have children,” she says.

(Related: The Pill Is Good. Why Isn’t It Better?)

A big piece of CART’s research has been looking at when it’s hard for people to be able to prevent an unplanned pregnancy, says Norman, so that they don’t have to make choices around unplanned pregnancies that are difficult for them.

“We conducted a survey across B.C. to find out what people needed, and they said, We need contraception to be free. We also showed that [the government] can save more than $5 per person for every person in British Columbia each year, by the third or fourth year of a program that’s providing the prevention for unintended pregnancy, rather than paying to manage unintended pregnancies.”

How much do unintended pregnancies cost the government?

“The government—not only in BC, but all across Canada—is currently spending hundreds of millions of dollars every year to manage unintended pregnancies. The cost to provide people with whatever contraceptive method they want to help prevent that is always less than the cost to be able to manage unintended pregnancies, which is between 40 and 60 percent of pregnancies, depending on which province and territory you’re in.

As of April 1, 2023, all prescription contraception is free for all people who are residents of British Columbia. And we’ve received invitations from our Federal Minister of Health, the Ministry of Finance and the Prime Minister’s Office to present the evidence for a policy that would work across Canada.”

Certain groups face more hardships and barriers when accessing health care. What part does equity play in the journey to free contraception for all Canadians?

“Around the introduction of free contraception, the government said, Listen, we can’t bring this out until we understand how we’re best able to support the people who have the most difficulty [accessing health care]. And so a lot of work went in to understand how to reach the specific groups that have historically chronic, persistent barriers to be able to achieve their own equitable health. Canada has a long way to go to adequately support and equitably offer opportunities for Indigenous populations. But in this case, also very young people need support. Often recent immigrants need support, and those who’ve experienced racialized or adverse childhood events. People who were raised in families where substance use or mental health was a problem may be carrying forward barriers to accessing their ideal health. We can help address those barriers by making contraception free across Canada.”

How important is it to offer people their choice of free contraception?

“When we were modeling various costs and cost savings for contraception for the B.C. government, they were meticulous to understand how they could spend the least public money to get the best health outcomes. So we looked at, What if you only provide coverage for one group of contraceptives? Or what if you only let people have one contraceptive, or one contraceptive for a period of time? What if you only make it available for people under a certain age or over a certain age or in a certain subgroup of the population? And every single time we introduced a model with any restriction on those contraceptives, on the range of choices for people, the government costs to manage unintended pregnancy went way up.

The best and most effective policy is always to provide free choice among any contraceptive without restrictions on what you can get or how many. One of the really interesting things is that if you look at contraceptive methods that people can access when they don’t have money, or the ones that cost the least, we have almost 50 percent of people who currently are in a situation where they could become pregnant, but do not want to be pregnant. Almost one in seven of that group will say that they are not using a contraceptive because they can’t access one and almost always that access is cost.

Then you look at condoms. And you see that about 25 percent of people using condoms as their method of contraception when they don’t want to be pregnant, will become pregnant each year. You look at the birth control pill, patch, ring… about six to nine percent of people every year get pregnant. With IUDs, it’s one percent or less.

And the very best is the new method that came in as of September 2020—a contraceptive subdermal implant. That’s a little device about the size of a match in your arm, and with this method, you have a lower chance of getting pregnant than if we sterilized you. It sits there for three years. Whenever you want to become pregnant, it comes out, and the next month, you could be pregnant. It’s immediately reversible as soon as it’s out of your body. And it’s one of the methods the government is providing free now. Very few people know that because it came out during COVID.

The most effective methods—the implants, the IUDs—are the methods that are $300-400 up front, so they’re the hardest for people to access. And yet if you look at it from the health system perspective, because they’re the best at preventing pregnancies, the government is happy to provide all of these methods free because the more effective methods save more money in unintended pregnancies.”

Where are we at in the push for free birth control coverage in Canada?

“Right now, the federal government and all of the MPs are considering what will go in the next federal budget. And whatever party your MP is in, I urge people to write to your MP and contact your government representative to let them know that you believe that the federal government should provide contraception free for all people. Today, if you have a postal code in B.C., you have the best chance to avoid unintended pregnancy. And that devastating event in a person’s life shouldn’t depend on your postal code.

One of the most important things for family health is to support people to plan the times that they would like to have children, and to allow people to choose the contraceptive method that makes the most sense in their context. This means making contraception free for all, not just for some.”

Next: Will Pap Tests Soon Be a Thing of the Past?