British Columbia to Offer Free Prescription Contraception

The provincial government of British Columbia, Canada, will provide prescription contraception at no charge beginning on April 1. The policy is intended to ensure equitable access to contraception and to reduce the rate of unintended pregnancies, ultimately saving money for the province’s healthcare system.

The 3-year plan, funded to the tune of $119 million and announced in the province’s recent budget, will ensure full coverage of prescription contraception, including oral hormone pills, contraceptive injections, hormonal and copper intrauterine devices (IUDs), subdermal implants, and Plan B (often referred to as the morning-after pill).

Wendy V. Norman, MD, DTM&H, MHSc, associate member in the School of Population and Public Health and the Department of Obstetrics and Gynecology at the University of British Columbia (UBC) and the Family Planning Public Health Research Chair in Canada, led the research that informed British Columbia’s decision to make prescription contraception available without cost.

Before the pandemic began, Norman and colleagues conducted a sexual health survey, which revealed that 40% of pregnancies in the province were unintended. The most common outcome of these unintended pregnancies was birth.

In addition, the investigators found that births from unintended pregnancies constituted a greater cost to the healthcare system than births from intended pregnancies, because the babies from unintended pregnancies were more likely to require stays in the neonatal intensive care unit.

“It is cheaper for the health system to provide people with a way to prevent pregnancy than to manage the number of pregnancies that would be unintended,” Norman told Medscape Medical News.

Rising Costs

The rising cost of essentials such as shelter and groceries is making the cost of contraception, particularly more effective forms of contraception, such as IUDs, prohibitive, according to Norman.

“You can certainly see that for the most effective contraceptives, that might be an up-front cost of $300 or $400,” she said. “For an individual, if you are looking at whether you pay the rent or buy your groceries, you are going to take the chance of having unintended pregnancies. You would not be able to access the most highly effective methods [of contraception].”

The cost of hormonal pills is $25 per month, a cost that the British Columbia government noted would represent about $10,000 over a woman’s lifetime if she used this form of contraception throughout her reproductive life.

The sexual health survey also found that women whose pregnancies were unintended were more likely to be economically marginalized than women who had had intended pregnancies, said Norman. “You can see this policy would help to break intergenerational cycles of poverty.”

Pharmacists’ Role Expands

Although the cost of condoms will not be covered, because they are available over the counter, Norman encouraged their use in addition to prescription contraception to minimize the risk of sexually transmitted infections.

For the time being, women in British Columbia need a prescription from a family physician, which they would take to a pharmacist to receive contraception at no cost. Beginning May 1, however, women will be able to procure prescription contraception in British Columbia directly from a pharmacist, because the scope of practice of pharmacists will expand, and pharmacists will be permitted to prescribe contraception.

“That the implementation will mean pharmacists can prescribe contraceptives, we envision that’s going to be a huge boost for people facing barriers [to accessing contraception],” said Norman. He pointed out that women in British Columbia may be without a family physician.

A Model Policy?

Commenting on the contraceptive policy for Medscape, Doug Wilson, MD, president of the Society of Obstetricians and Gynecologists of Canada, said that other provinces should take notice of British Columbia’s decision to provide contraception at no cost.

“I think the provincial governments across Canada will look at this, because the economics are fairly clear, in terms of the cost savings to the healthcare system,” said Wilson. “I think this is going to be one of those ‘aha moments’ for governments both north and south of the [US-Canada] border.”

Wilson applauded the decision as a measure that ensures reproductive freedom for all women, regardless of their income. “It gives women reproductive autonomy, as [contraception] prevents pregnancies,” he said. “This will provide equitable access.”

Norman and Wilson have disclosed no relevant financial relationships.

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