Photo: Reproductive Health Supplies Coalition/Unsplash Credit: Reproductive Health Supplies Coalition/Unsplash
Everyone has sexual health over the course of their entire lives. This morning I was invited to speak to the Nova Scotia Standing Committee on Health about access to birth control and sexual health services, and I used this opportunity to remind the new PC government that the universal experience of sexual health should be reflected in how the health system is funded. Yet the recently released provincial budget had hardly any new funding to address these basic needs, and there are glaring gaps in access to services across the province.
I work in frontline sexual health service provision, in community advocacy, and in sexual health research and education. From my perspective, an achievable, efficient and effective approach to address persistent barriers to reproductive health equity in Nova Scotia would be to offer universal access to no-cost birth control options. Providing free contraception results in significant cost savings and improvements in population health. Governments save over $7 for every dollar invested in contraception.
As a nurse providing abortion care, I see how patients return again and again because while abortion services are rightly publicly funded, contraception is not, and abortion becomes the only recourse. The cost to Nova Scotia taxpayers of an abortion procedure is roughly $2,000. Compare this to $400 for a hormonal intrauterine device (IUD) that provides effective birth control for five years; or $30 for a monthly pack of birth control pills. Contraception is a wise investment.
When people can plan their pregnancies, evidence shows they are better able to care for their families, complete their education, and achieve employment. They’re also less likely to experience intimate partner violence and poverty. Yet, in Canada, half of all pregnancies are unintended, and one in every three people with a uterus will have an abortion in their lifetime. Unintended pregnancies are disproportionately experienced by people already marginalized by poverty, discrimination, and social exclusion. Access to free contraception can break this cycle. Recognizing the key role of contraception in healthy growth and development, the Canadian Pediatric Society recommends governments provide universal access to no-cost contraception to all youth under 25.
Currently, Nova Scotia has an inadequate approach to subsidizing private expenditure on contraception. People on income assistance — roughly 3% of the population — have prescriptions on the provincial formulary largely covered. The Family Pharmacare program, to which anyone can apply, has varying deductibles based on income, and is most useful for people experiencing chronic disease and high annual prescription expenditures — not young people needing help to prevent pregnancy. Youth rely on their parents’ private insurance, and end up facing violations of privacy, stigma, punishment, and unaffordable co-pays. Employment-linked private drug coverage is problematic because when you lose work, you lose the benefits, and COVID-19 caused massive losses to the labour force, particularly among women.
A straightforward solution is to cover the cost of contraception through MSI. We already have a model for how this could work: In 2017, Nova Scotia, like most provinces in Canada, started publicly funding medication abortion pills (Mifegymiso). The patient takes a prescription from a primary care provider to the pharmacy, shows their provincial health card, the pharmacist dispenses the medication, and the patient pays $0. Medication abortion ($360) costs a fraction of what a procedural abortion costs; this approach clearly saves the government funds overall. Universal funding of contraception will be even more cost-effective.
Contraception not only prevents pregnancy. Options such as IUDs can prevent menstruation — offering a form of gender-affirming care, reducing anemia (low iron), and reducing employee and student absenteeism associated with menstrual pain. There are several ways in which access to contraception empowers people to live full, empowered, healthy lives. Importantly, access to contraception is clearly a gender equity issue: continuing to burden half the population with this private cost is discriminatory.
Nova Scotia has the experience and nimbleness to lead nationally and internationally in this area. One of the most innovative and important recent changes to sexual health services in Nova Scotia and Canada overall was the 2018 introduction of self-referral for abortion services and public funding of a centralized hotline, 1-833-352-0719, through the Nova Scotia Women’s Choice Clinic at the QE2. This approach reduced wait times and costs, and improved outcomes. In recent years, the clinic has operated a compassionate IUD program, distributes dozens of donated IUDs every month to abortion patients, demonstrating the consequences of unmet need for affordable contraception and the demand for universal access.
Nova Scotia can continue to demonstrate public sector leadership in sexual health by committing to free contraception for all.
Martha Paynter is a registered nurse working in reproductive health care in Nova Scotia. She is a PhD Candidate at the Dalhousie University School of Nursing, and the chair of Wellness Within: An Organization for Health and Justice.
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Nova Scotia can demonstrate public sector leadership in sexual health by committing to free contraception for all
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Everyone has sexual health over the course of their entire lives. This morning I was invited to speak to the Nova Scotia Standing Committee on Health about access to birth control and sexual health services, and I used this opportunity to remind the new PC government that the universal experience of sexual health should be reflected in how the health system is funded. Yet the recently released provincial budget had hardly any new funding to address these basic needs, and there are glaring gaps in access to services across the province.
I work in frontline sexual health service provision, in community advocacy, and in sexual health research and education. From my perspective, an achievable, efficient and effective approach to address persistent barriers to reproductive health equity in Nova Scotia would be to offer universal access to no-cost birth control options. Providing free contraception results in significant cost savings and improvements in population health. Governments save over $7 for every dollar invested in contraception.
As a nurse providing abortion care, I see how patients return again and again because while abortion services are rightly publicly funded, contraception is not, and abortion becomes the only recourse. The cost to Nova Scotia taxpayers of an abortion procedure is roughly $2,000. Compare this to $400 for a hormonal intrauterine device (IUD) that provides effective birth control for five years; or $30 for a monthly pack of birth control pills. Contraception is a wise investment.
When people can plan their pregnancies, evidence shows they are better able to care for their families, complete their education, and achieve employment. They’re also less likely to experience intimate partner violence and poverty. Yet, in Canada, half of all pregnancies are unintended, and one in every three people with a uterus will have an abortion in their lifetime. Unintended pregnancies are disproportionately experienced by people already marginalized by poverty, discrimination, and social exclusion. Access to free contraception can break this cycle. Recognizing the key role of contraception in healthy growth and development, the Canadian Pediatric Society recommends governments provide universal access to no-cost contraception to all youth under 25.
Currently, Nova Scotia has an inadequate approach to subsidizing private expenditure on contraception. People on income assistance — roughly 3% of the population — have prescriptions on the provincial formulary largely covered. The Family Pharmacare program, to which anyone can apply, has varying deductibles based on income, and is most useful for people experiencing chronic disease and high annual prescription expenditures — not young people needing help to prevent pregnancy. Youth rely on their parents’ private insurance, and end up facing violations of privacy, stigma, punishment, and unaffordable co-pays. Employment-linked private drug coverage is problematic because when you lose work, you lose the benefits, and COVID-19 caused massive losses to the labour force, particularly among women.
A straightforward solution is to cover the cost of contraception through MSI. We already have a model for how this could work: In 2017, Nova Scotia, like most provinces in Canada, started publicly funding medication abortion pills (Mifegymiso). The patient takes a prescription from a primary care provider to the pharmacy, shows their provincial health card, the pharmacist dispenses the medication, and the patient pays $0. Medication abortion ($360) costs a fraction of what a procedural abortion costs; this approach clearly saves the government funds overall. Universal funding of contraception will be even more cost-effective.
Contraception not only prevents pregnancy. Options such as IUDs can prevent menstruation — offering a form of gender-affirming care, reducing anemia (low iron), and reducing employee and student absenteeism associated with menstrual pain. There are several ways in which access to contraception empowers people to live full, empowered, healthy lives. Importantly, access to contraception is clearly a gender equity issue: continuing to burden half the population with this private cost is discriminatory.
Nova Scotia has the experience and nimbleness to lead nationally and internationally in this area. One of the most innovative and important recent changes to sexual health services in Nova Scotia and Canada overall was the 2018 introduction of self-referral for abortion services and public funding of a centralized hotline, 1-833-352-0719, through the Nova Scotia Women’s Choice Clinic at the QE2. This approach reduced wait times and costs, and improved outcomes. In recent years, the clinic has operated a compassionate IUD program, distributes dozens of donated IUDs every month to abortion patients, demonstrating the consequences of unmet need for affordable contraception and the demand for universal access.
Nova Scotia can continue to demonstrate public sector leadership in sexual health by committing to free contraception for all.
Martha Paynter is a registered nurse working in reproductive health care in Nova Scotia. She is a PhD Candidate at the Dalhousie University School of Nursing, and the chair of Wellness Within: An Organization for Health and Justice.
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