Response - July 27, 2020
2020 Budget Estimates - Health
On Thursday, July 23, 2020, Norm Letnick, BC Liberal Health Critic and MLA for Kelowna-Lake Country asked the following questions of Adrian Dix, Minister of Health and BC NDP MLA for Vancouver-Kingsway.
We were pleased that Mr. Letnick asked about the governments plans regarding universal access to no-cost prescription contraception in BC, and wanted to respond to the answers given by Minister Dix.
Below you will find a video from Hansard featuring the questions addressing contraception, you can find the video of the full question and answer session here. This is followed by a copy of the letter we sent Minister Dix on the 27th of July.
AccessBC Response Letter to Minister Dix
Dear Minister Dix,
We write regarding your answers to questions posed to you during the Budget Estimates by Liberal Health Critic Norm Letnick on July 23, 2020 regarding the possibility of funding universal contraception coverage in BC in the upcoming budget.
We were heartened by your answer earlier in the morning, in which you emphasized that your priority in determining pharmaceutical funding is “to follow the evidence in every case.” However, that evidence-based policy approach appears to be contradicted by your answer to Mr. Letnick, in which you confirmed that your government does not intend to fund universal contraception coverage in the current year’s budget.
While you praised existing access to contraception in British Columbia, the facts are that current programs simply do not meet the needs of BC residents. Furthermore, the alternatives that you discussed in your response remain means tested programs, violating a core principle of Canadian healthcare - universality.
Choice of birth control method is crucial, as many patients have adverse reactions to higher levels of hormones, are unable to maintain a consistent schedule for pills, or cannot tolerate hormonal birth control at all. Nevertheless, there is no coverage under any of provincially funded insurance plans (including Fair Pharmacare, Licensed Residential Care, Income Assistance, Children at the Home, and First Nations Health programs) for the following contraceptive options:
Several forms of birth control pill, including Lolo (a low-dose hormonal pill), Seasonale, and Seasonique;
Nuva Ring, the only low-dose hormonal contraception option that does not require a daily pill and can be removed at any time by the patient;
Evra Patch, which is, along with the Nuva Ring, one of the only hormonal contraception options available for patients who cannot manage a daily pill or a hormonal IUD; and
Any copper IUDs, which are the only long-acting reversible contraception option for patients who cannot tolerate hormonal birth control. Copper IUDs are also the most effective, and only non-hormonal, method of emergency contraception, and the only method of emergency contraception that maintains the same level of effectiveness in people with a higher body mass index (source).
The result is that even those who qualify for provincial assistance under existing provincial programs may still not be able to access contraception that meets their needs. In the absence of coverage for those options, punting the responsibility for coverage to an imperfect clinic system (that, incidentally, is markedly less accessible for rural residents who already face more barriers to care) is not an acceptable alternative.
When it comes to universal contraception coverage, the evidence is clear:
Providing universal contraception coverage will save significantly more than the coverage would cost to implement (source; and see source; and source);
Universal contraception coverage has been proven to reduce unintended pregnancies, demand for abortion, and higher-risk pregnancies (source; and see source; and source);
Universal contraception coverage reduces barriers to accessing family planning care, which provides a natural segue into screening for concerns about intimate partner violence and educating patients on safer sex behaviours (source); and
Universal contraception coverage eliminates the most significant barrier to contraception, which is cost (source).
From an evidence-based policy perspective, the case for universal contraception coverage is strong. That case has only grown stronger in light of the economic effects of COVID-19.
Per a recent report issued by the Royal Bank of Canada, COVID-19 has pushed women’s workforce participation to its lowest level in three decades, and women’s job recovery has been markedly slower than that of men (source). The hardest-hit industries are those which disproportionately employ women: hospitality and food services, retail trade, educational services, health care, and social assistance. At the same time, women have shouldered a significantly higher proportion of unpaid caring labour in response to school closures, with concomitant impacts on their workforce participation.
These economic effects will have long-term and severe impacts on gender equality in our province if significant action is not taken to support women’s return to the workforce. One proven way to do that is to improve contraception access for everyone.
In a comprehensive study released in 2019, the Institute for Women’s Policy Research found that over the past several decades:
Young women’s access to contraception improved higher education rates;
Access to contraception allowed women to delay childbirth and increase their human capital investment in education and their careers;
Contraception access contributed to a substantial increase in the proportion of women in the workforce and the number of hours worked by women; and
Having access to contraception by age 20 reduced the probability that a woman lived in poverty (source).
While this study focused on US outcomes, its findings are echoed by Statistics Canada findings that access to contraception has had a marked and significant impact on women’s labour market participation over time (source).
AccessBC has been focused on access to contraception as an issue of basic equality and human rights, but as the long-term effects of COVID-19 become more clear, members of our campaign have become increasingly concerned about what the economic impacts that COVID-19 will mean for people who already struggled to access contraception prior to this health crisis. Our volunteers who work in health care have already observed first-hand that their patients are seeing increased barriers in accessing contraception as a direct result of COVID-19. We fear that these effects will be aggravated by an economic crisis that is disproportionately affecting women and other marginalized communities.
This proposed policy is one whose value has been recognized not only in last year’s budget recommendations, but among the policy endorsements at the BC NDP’s own convention in 2017. It has also been supported by the Canadian Medical Association, the Society of Obstetricians and Gynaecologists of Canada, and the Canadian Pediatric Society.
Despite the support for this policy in your party and among professionals in the field, it is disappointing that so little progress has been made to date in increasing contraception coverage in BC.
The longer the government waits to address inequalities in contraceptive care, the more likely it is that we will see worsening consequences as BC residents see their choices and opportunities limited by their reduced ability to access contraception that works for them.
In light of the clear supporting evidence and the increased urgent need resulting from COVID-19, we ask that you and your government reconsider including universal contraception coverage as a part of this year’s budget.
We would be happy to meet with you to explore the evidence supporting the benefits of programs that offer universal access to no-cost prescription contraception.
The Organizing Committee
AccessBC Campaign for free prescription contraception in BC