Barriers to Contraceptive Access in Canada

On Wednesday, November 7th, the Trump administration finalized major changes to the Affordable Care Act, to limit coverage for contraception. Passed in 2010, the Affordable Care Act mandated that all employer health benefit plans cover the cost of birth control as a preventative service. Now, the Trump administration is expanding exemptions for employers who oppose the use of birth control on the basis of religious beliefs or non-religious moral convictions. While the U.S. Department of Health and Human Services postulated that the changes would affect less than 200 employers, some policy experts worry that this is an underestimate.

Pharmaceutical birth control has played a pivotal role in promoting gender equality for decades. Multiple studies have shown that women who have unrestricted access to contraceptives earn higher lifetime wages, attain higher education, and have longer-lasting relationships. Birth control has also helped narrow the gender-pay gap and lower poverty rates among women.

While Americans’ reproductive rights are currently in flux, what does access to contraception look like for Canadians? Sadly, Canada’s situation is just as complicated.

Canada’s universal health care system is a point of pride for many Canadians. However, Canada is the only developed country in the world that offers universal medicare, without also offering coverage for prescription drugs. Under the Canada Health Act, the provinces are only required to cover pharmaceutical costs if the drugs are ‘medically necessary’ and administered in a hospital.  Since pharmacare is not explicitly required under the Canada Health Act, the provinces are left to determine if and how they will provide insurance for prescription medications, including birth control.

Because of these gaps in provincial and federal legislation, most Canadians rely on their employers to provide prescription medication insurance. While the Canada Labour Code ensures that an employee’s health benefits are protected during a leave of absence or job transition, there is no requirement for employers to provide benefits proactively. In order to stay competitive in the labour market, most employers offer some form of extended prescription coverage, but not all of them include coverage for contraceptives. Some insurance plans, such as the Alberta School Employee Benefit Plan for teachers, covers 100% of prescription contraceptives. Other plans, such as some offered through Sun Life Financial, do not provide coverage for any type of contraceptive, even if it is prescribed for a medical reason. In fact, up until April of this year, the Public Service Health Care Plan did not provide coverage for any type of contraceptive other than oral birth control pills (the same plan covered up to $500 per year for erectile dysfunction drugs).

In 2016, an NDP MP, Irene Mathyssen, sponsored a private member’s motion, M-65, encouraging the government to provide no-cost birth control to all Canadian women. While the motion ultimately failed, it shed light on the issues Canadians face when attempting to access their preferred method of contraception. In the 2018 Budget, the Trudeau government announced an Advisory Council on the Implementation of National Pharmacare, to develop a nation-wide plan to cover prescription medications for all Canadians. Hopefully, a national pharmacare plan would include prescription birth control.

Unfortunately, we can’t afford to wait for a solution from the federal government. Each province is capable of doing more to ensure that their female citizens have unrestricted access to all forms of birth control. Whether that’s mandating employers to include the cost of contraceptives in their benefit packages, or introducing provincial coverage, the provinces must contribute more. Ensuring unrestricted access to prescription birth control is key to ensuring gender equality in this country.