The Decibel - B.C.’s groundbreaking plan to fund birth control

Episode Date: March 9, 2023

British Columbia revealed its 2023 budget on Feb. 28. It introduced a host of new spending measures including a first in Canada: A plan to make contraception universally available in the province free of charge.Globe health reporter, Carly Weeks explains why reproductive health experts are celebrating the move and what this could mean for funding contraception in the rest of the country.Questions? Comments? Ideas? Email us at [e-mail]

Starting in April, British Columbia will cover the cost of contraception. It's the first plan of its kind in Canada. And it's a big deal because it means that if you're in BC, no matter how old you are or how little money you have, you don't have to worry about paying for most forms of birth control. Carly Weeks is a health reporter at The Globe, and she'll tell us about this universal contraception plan and if the rest of the country might follow suit. I'm Maina Karaman-Wellms, and this is The Decibel from The Globe and Mail. Carly, thanks so much for coming back on the show.

It's always a pleasure to be here. So let's just start with the very basics here. What is covered in this new BC plan? Yeah, that's actually a good question because not everything is covered. This is really a plan that's targeting prescription birth control options. So things like birth control pills, injectables and implants, intrauterine devices, as well as emergency contraception, which many people know by the brand name of Plan B. I think probably the most excitement among those who have been advocating for this change is about the IUDs.

Intrauterine devices or IUDs are small little devices that get inserted into the uterus. It can be a painful insertion, but basically once it's in, you don't have to think about it. And so it can be in there for months to years. And when you're ready and you feel that you maybe you want to have a planned pregnancy, you can have it taken out pretty easily. And the effects are, you know, very quickly reversible, whereas opposed to something like a hormonal birth control pill, it can take a little bit longer. It's also very cost heavy upfront. So it deters a lot of people from actually taking it. So the fact that this is going to be covered is generating a lot of excitement. Yeah, so it sounds like the IUDs is actually, you know, one of the key things that

people are really interested in hearing about here. You said it's a steep upfront cost. So how much would it usually cost someone? Yeah, depending on sort of, you know, whether you have insurance, if it covers it fully, you know, you can run anywhere in the range from, you know, $80 to up to somewhere around $500 for that upfront investment. And so if you are someone who is struggling, even something like, you know, an $80 upfront cost is going to be a little bit difficult. $500 will certainly be cost prohibitive. So that's why there's been, part of the reason why there's been this growing campaign to make sure there is universal access so that people really have the option to choose what works for them. And they're not going to have financial barriers standing in the way.

Okay, so yeah, for sure, this would be something that is quite exciting for a lot of people to see this now covered in BC. Okay, so those are the things that are part of this plan. What's not covered here, though, Carly? For sure, this would be something that is quite exciting for a lot of people to see this now covered in BC. Okay, so those are the things that are part of this plan. What's not covered here, though, Carly? Yeah, so this is prescription only, so things like condoms are not covered. There's also a couple of other perhaps less common contraception options that are not covered, such as vaginal rings and transdermal patches. The government has said that they may consider covering those in the future. But, you know, I think in all of the advocates and experts that I spoke to, none were particularly concerned about that. I'm sure there will be some individuals

who are upset that the coverage is not, you know, exactly universal. But I do think that based on the reaction so far from the community, there's a lot of excitement about the fact that this coverage will be including things like IUDs and other devices. And this sounds like a, you know, a pretty substantial plan. Do we know how much it's going to cost the provincial government? Yeah, they're saying that basically for about three years, they're expecting the cost to run around $119 million. Is that a lot? It's hard to know sometimes with budgets like this. I don't know. Is that a lot? It sounds like a lot. I mean, the provinces and territories just negotiated an additional $46 billion in spending, you know, across the whole country from the federal government. That's just an extra spending over the next decade. You know, healthcare is the biggest

line item in any provincial budget. You know, billions of dollars get spent annually. This is, you know, even though it's a lot of money, it ends up being a drop in the bucket in terms of overall spending. And I think that it's worth pointing out, you know, we're talking about a three-year investment in basically prevention, you know, making sure people have access to the health care that they need. And this will end up being a huge cost savings in the long run. Because, you know, we know that the rate of unintended pregnancies is quite high, about half of all pregnancies are not intentional. And many of those will end up going to be ended through termination, which can cost a lot of money. And of course, pregnancy and birth costs a lot of money as well. And so, you know, for people that want to be able to choose when and if they get pregnant, it makes sense from a financial, a social, psychological,

physical, every sort of way you look at it, this plan ticks every box in terms of providing care that people need and providing cost savings to the system. Let's just dive in a little bit to the financial stuff here, because obviously when a province makes this kind of decision, you said there's actually savings that are hopefully going to come out for the other side of it here. So do we have any numbers? Like what is the economic impact of a plan like this? So there's been a number of different studies that have looked at this from around the world. And some of the advocates in Canada have been talking about this as well. And so estimates can run anywhere from if you're going to be spending for every dollar on this kind of a universal contraception program, you will end up saving anywhere from

five to ten dollars in health care costs. That is what some of the rough estimates show. So it just gives you a sense of how expensive some of the effects of unintended pregnancies are. And those cost savings range because they start to go up when you're talking about investing in more effective means of contraception like the IUD. Okay. You also mentioned the social and the psychological effects of unplanned pregnancies. Can we get into those a little bit? What are you referring to there? Yeah, definitely. I mean, we know that the highest rates of unintended pregnancies do occur in young people, often vulnerable groups that don't have access to birth control. Maybe they don't have access to an insurance provider. And so they end up having an unintended pregnancy. This has, you know, it takes a huge physical toll, a huge psychological toll. And I think that sometimes we do forget that a lot of these burdens end up being carried by groups who are already so vulnerable. So basically, you know, toll, a huge psychological toll. And I think that sometimes we do forget that a lot of these burdens

end up being carried by groups who are already so vulnerable. So basically, you know, it ends up being this situation that for people of privilege, they are allowed a lot more choice than people who don't have the financial means to make the same choices. And that's not fair. So this is kind of a form of equity, essentially, trying to level the playing field a little bit and give everyone access that they should have this. Exactly. You know, birth control is a fundamental human right. The World Health Organization has affirmed this time and again. And so when you start to think about it from that lens, it is really essential that we provide this type of universal coverage. shouldn't be born on the backs of individuals to try and eke out coverage or find a prescription or all of these other things that stand in the way of just letting people get access to something

that gives them reproductive autonomy, really having a say over what happens to them. Carly, what if experts told you about this move? Yeah, it's funny. I write a lot of health stories, as you can imagine, and you're often going to get a lot of debate about things. It's very rare where a story comes along where everyone is in consensus and they're very united in their belief that this is the right move. And that's exactly what happened here. I talked to a number of different experts. I talked to the head of the Society of Obstetricians and Gynecologists of Canada. I talked to the woman who is an expert in pediatrics at McGill, who wrote the statement in 2019 calling for universal birth control coverage in Canada.

They're all saying this is something that we need to see across the country ASAP. And the fact that we don't have it already is kind of egregious. The evidence is clear, the social implications, the financial implications, the all the physical, everything's points in the direction of needing this plan in place across the country. And they're saying, how do we make that happen next? We'll be back after this message. So it sounds like there's there are a lot of things that we've talked about that are covered. Some things are not covered. Are there any other limitations, I guess, of BC's plan?

What are the experts saying about this? Yeah, I mean, one of the big questions will be how access sort of rolls out. The plan is for this universal coverage to start on April 1st. Of course, right now, a lot of that will depend on your ability to access a healthcare provider because we are talking about prescription options. However, BC has promised to extend prescribing privileges to pharmacists. So right now in provinces like Nova Scotia, you can actually get a birth control prescription from a pharmacist and have that prescription filled on site. And so when BC makes that move, it will suddenly become

much more equitable for everyone. There's a huge shortage of doctors, of nurses, and millions of people across the country simply lack that basic access to the front door of the healthcare system. It's difficult for people to get these prescriptions refilled in some cases, and we don't think about that. So I think that's going to be one of the main things that's being discussed in BC is how that access will roll out and when those changes are extended to pharmacists. That's going to be a really key part of making sure this actually ends up being universal. Yeah. Let's look at the big picture here a little bit, Carly. Why now? Why did BC decide to do this now? Yeah, that's a really important question. So there has

been a growing movement, I would say, in the last five, 10 years, where more and more people are kind of waking up to the fact that, wait a second, if contraception is a universal human right, why am I having to pay out of pocket if I don't have coverage? Why is this something that I can't afford the option that, you know, was really essential to me when I lived somewhere else? And so what happened in BC, there was actually an individual that was living in a different country, had access to a certain birth control option, and then found out once they moved back to Canada, it was going to cost a lot more money. And so there's been, I think, probably in BC, maybe the most advanced movement we've seen so far in Canada. But there has been this grassroots advocacy campaign to try and get provincial governments to listen.

The government there did promise for a couple of years that this change would be made. And now it's finally being realized. And why would a province cover it only for young people like that younger demographic? Yeah, so in places like Ontario, for instance, you know, there is a plan where people under 25 don't have to pay prescription costs, because there is that recognition that young people may not have coverage through their parents, they may not be working, they may not have, you know, their income may be too high, so they don't get covered under provincial plans that target low income earners. So there is that recognition there. But again, that's not universal. And so I think that there is basically across Canada, there has been quite a patchwork where there's been this recognition

that young people and you know, older people, people who are low income, people who are struggling shouldn't have to pay for prescriptions. But at the same time, our solutions often end up looking very patchwork. I want to ask you about this patchwork that you're talking about, Carly, across the country. How is birth control covered in the rest of Canada? As you say, the patchwork word is probably the most apt descriptor. So I'll unpack that in two different ways. So if you're not working or you are working and you're not earning not cover everything. Again, it may not cover the birth control of your choice. So you're forced to make a different choice. Something that may not be as effective, may not be convenient for you to take. Once you get past those insurance options, you know, other people who don't have insurance are just simply forced to pay out of

pocket. So they may do without. Other options include things like going to specialized sexual health clinics. Some offer coverage. If you're lucky enough to live near one, you have access, you can get to them. That's great. If you're a newcomer to Canada, you don't speak the language, you may be out of luck. It's going to be so much more difficult to access and navigate through that very complicated system. And then again, we talk about actually getting that prescription. So some provinces, you can go to a pharmacist. So again, if you're lucky enough to have insurance, you can pay for it. If you're struggling to, you know, get the insurance, get the payment, you know, having a pharmacist there

is not going to help you. So you can just see how these barriers start to build up and how, you know, it's easy for people to say that people should take responsibility for their choices and try and avoid pregnancy if they don't want a pregnancy. You can see how difficult that really is in practice for so many people and why we need more options available. Yeah, for sure. Now that BC's done this then, I mean, it sounds like other provinces might be maybe looking at this and seeing this as an example. Can we expect other provinces to maybe follow suit? Typically, when we see one province do, you know, sort of an important bold public health measure, that is sort of, you know, the catalyst for others to follow suit, you know, one starts and then the others follow. It will be interesting to see what happens here. You know, I reached out

to the province of Ontario last week to ask about this and did not even get a response. So that doesn't seem to indicate that that's really high on the priority list right now. We've seen this time and again. One province ends up being the pioneer and others will follow. I think it is clear that this is an issue that is on the mind of a lot of voters. And so I think that, you know, some savvy politicians will keep that in their back pocket when it comes time for big election promises. And we've talked a lot about Canada here, Carly. But now I'm wondering, like, how does Canada compare to other countries when it comes to birth control?

We love to think that our system is so great here and it's so universal. But in fact, so little is actually covered in terms of health care in Canada, just prescriptions being one glaring example. You know, we look to the United States and we think that things are going well because they're rolling back abortion rights. Reality check is that we're not doing well internationally and we are behind a lot of other countries. Some studies and surveys have looked at the UK as being a bit of a gold standard in terms of access to universal contraception, saying that the national health provider there makes sure that it's universal, that it is no cost that it's easy to go to a pharmacist spain is often talked about as well as some other european countries so again there may be some complaints about the coverage not extending to every brand every range

of contraceptive product but the fact is there are programs in place and they have been for a long time and they are clearly showing a lot of benefit. Studies have shown that in areas where people do have access to universal contraception, the rates of pregnancy are much lower, rates of abortion are much lower. When you give people reproductive autonomy, they will use it. Yeah. I want to talk a little bit more about the social aspect, Carly. We've touched on it a bit, but I really kind of want to address it head on, especially since you mentioned the U.S. and the regression, frankly, that we've seen on reproductive rights there. I think a lot of people might not think this is an important thing. Like, I guess, how can we explain or think about why having power over your reproductive rights is so important. I mean, where to begin? It's really fundamental for people to be able to make choices about what happens to their body, to, you know, in some cases, regulate their cycles for whatever reason. You know, they shouldn't have to explain themselves.

It's important for them to have access to the contraception that is right for them. And, you know, abortion is such a hot button issue in places like the US and in places like Canada, where we continue to have groups that are well funded, that are arguing against it, that want to see legislation in place restricting it. You know, a lot of misinformation being thrown about. The fact is, you know, abortion, contraception, they're all very important parts of healthcare. If you are able to make choices about when or if to become pregnant, suddenly, you know, your access to education can change your ability to take your life on a different path opens up. And so, you know, if we were just allowing people to make different choices, by giving them the freedom that by every health metric they are

owed and deserve, it just makes so much more sense on every different measure. Carly, thank you so much for taking the time to speak with me today. Well, thank you for having me. That's it for today. I'm Mainika Raman-Wellms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Adrienne Chung is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.