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Devon Black Presentation to Select Standing Committee on Finance and Government Services 

June 20, 2020

Good morning. My name is Devon Black. I'm a co-founder of the AccessBC campaign for universal contraception coverage. We're a group of people from across the province who want to remove barriers to contraception coverage in British Columbia, and I'm here today to ask you to recommend funding for a program to provide universal no-cost coverage for contraception in our province.

Access to contraception is a basic human right. It's a key aspect of medical care that allows people to plan for the future, to manage their own health and to control their reproductive decisions. But unfortunately, as it now stands, too many B.C. residents can't access the contraception they need, and the biggest barrier to that is cost.

A 2017 study found that Canadian women are relying on less effective methods of contraception and using them less consistently than they did a decade ago. Nearly one in ten sexually active Canadian teens aren't using any contraception at all, which is nearly double the rate from ten years prior. Per the Society of Obstetricians and Gynaecologists of Canada, as many as 61 percent of Canadian women have had at least one unplanned pregnancy.

While there are some government-funded plans that are available to assist those who can't afford the up-front costs of contraception, there are still significant gaps in coverage. Those programs are largely income-dependent, involve cumbersome application processes and leave out a lot of people who are struggling to make ends meet but don't meet the income criteria for Fair PharmaCare.

Even when people do qualify for government-funded plans, the coverage they provide just doesn't meet patients' needs. Those plans provide no coverage for the Evra patch or the NuvaRing, which are frequently the best option for people who can't take a daily pill.

They also don't provide any coverage for copper IUDs, even though copper IUDs are the only form of long-acting, reversible contraception that doesn't use hormones. Because I can't take hormonal birth control, my copper IUD is the only birth control that works for me. If I couldn't afford to pay the upfront costs for my IUD, then even if I was able to qualify for provincial assistance, it wouldn't help me.

Many countries have already implemented universal contraception coverage, including the U.K., France, Spain, Sweden, Denmark, the Netherlands, Italy and Germany, in whole or in part. There are plenty of good reason for that, but one of the most significant is money. Programs that offer free contraception coverage have consistently proven to save significantly more money than they cost to implement.

Options for Sexual Health conducted a comprehensive study in 2010 evaluating the likely cost savings from implementing a program like this in B.C. They found that every dollar spent on contraception coverage can save as much as $90 in social supports. We've included a copy of that study in our written materials, but the key point is that they estimated that the B.C. government would save at least $95 million per year in direct health costs alone by implementing this kind of program, which is almost twice what the study estimated the program would cost to implement.

Similarly, a 2015 study in the Canadian Medical Association Journal found that implementing a nationwide universal coverage program for contraception would save more than twice as much as the program would cost in place. That reflects the kinds of numbers that have been borne out in evaluations of programs like this in other jurisdictions.

Covering contraception saves a lot of money. But most importantly, contraception is an issue of equality. People who can become pregnant almost inevitably take on disproportionate costs in the event of an unplanned pregnancy, whether that's in terms of lost earning opportunities, health consequences or the actual financial costs of raising a child. With planned pregnancies, people can make that choice with their eyes fully open and with plans in place to support themselves and their children, but with unplanned pregnancies, that's frequently not the case.

Reproductive options targeted towards men are easily accessible, low cost and even free. External condoms are available at every pharmacy and are often handed out for free at health and community centres. Vasectomy costs are covered by B.C.'s provincial health plan.

But contraception options targeting women are much more expensive and more complicated, putting people who can become pregnant in a double bind — either pay more to avoid pregnancy now or pay more to deal with an unplanned pregnancy later. This is an obvious gender inequality issue that we shouldn't still be dealing with in 2020.

I know you're going to be asked to consider a lot of excellent proposals that the province could fund to improve the lives of B.C. residents, but I'm asking you to make this proposal a priority. We know that the effects of COVID-19 have not been equally shared. They've disproportionately affected women, who are more likely to do high-contact, economically insecure and unprotected work, while increasing their care burdens at home and leaving them at greater risk for domestic violence.

Access to contraception isn't a silver-bullet solution to those problems, but it would be one way to help combat the gender inequalities that this pandemic has aggravated. It would put B.C. residents in the best possible position to plan their futures and protect their health. Thank you for your time.

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