One of the most significant barriers to reproductive health equity in Nova Scotia is the cost of contraception, and universal access is needed.
That was one of the messages repeated during Tuesday’s meeting of the Nova Scotia Standing Committee on Health, which focused on access to birth control and sexual health services.
“Providing free contraception results in significant cost savings and improvements in population health. Governments save between $7 and $10 dollars for every dollar invested in contraception,” nurse and Wellness Within board chairperson and coordinator Martha Paynter told the committee.
“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.”
Paynter pointed out that while the cost to taxpayers for an abortion procedure is about $2,000, an intrauterine device (IUD) at around $400 provides effective birth control for five years, and birth control pills cost $30 a month.
“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, achieve employment, and less likely to experience intimate partner violence and poverty,” Paynter said.
“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.”
Paynter noted unintended pregnancies are disproportionately experienced by people already marginalized by poverty, discrimination, and social exclusion.
She said access to free contraception can break that cycle, and pointed to the Canadian Paediatric Society’s recommendation that governments provide universal access to no-cost contraception to all people under 25.
“Everybody has sexual health. All your life. It is absolutely basic, foundational to your well-being,” she told the committee. “The chronic underfunding … it causes so many population health sequelae that result in all kinds of harm to our economy.”
‘Daily discrimination against people with uteruses’
Paynter also stressed to the committee that excluding these products from coverage is a gender equity issue.
“Not funding it is very simply gender discrimination, very pure and simple,” Paynter said.
“So that’s our baseline here. We’re operating in a context of daily discrimination against the people with uteruses in this province.”
Describing the introduction of self-referral for abortion services in Nova Scotia and the public funding for a centralized hotline as one of the “most innovative and important changes” to sexual health services in the province over the past decade, Paynter noted the approach not only reduced wait times and costs — it also improved outcomes.
“Nova Scotia can continue to demonstrate public sector leadership in sexual health by committing to free contraception for all,” Paynter said.
‘Fall through the cracks’
Dr. Melissa Brooks with the department of obstetrics and gynecology at the IWK Health Centre agreed. She said at the Women’s Choice Clinic in Halifax, they receive donations for the purchase of IUDs to give to people who don’t have coverage.
Brooks said they give out those IUDs “like candy.”
“We go through hundreds and we could go through hundreds more,” Brooks said. “There are so many people at our clinic that need that service, and they just fall through the cracks of the system.”
Brooks reiterated Paynter’s comments, noting the one area where Nova Scotia could make “great advances” in reproductive services would be providing universal access to contraception. She said long-acting, reversible contraception like IUDs and subdermal contraceptive implants are particularly challenging for many to access.
One in three workers in Nova Scotia don’t have access to private prescription drug coverage, and family Pharmacare doesn’t adequately fill the gap. Brooks said she encounters this almost daily in her clinical practice.
“Research from around the globe has shown that providing barrier-free access to contraception is not only cost effective but provides cost savings in the long run,” Brooks told the committee.
“Nova Scotia could be a leader in Canada in advancing reproductive care with universal contraceptive access.”
Non-profit picking up the slack
The provincial coordinator for Sexual Health Nova Scotia also echoed that sentiment.
Leigh Hyde said their non-profit sexual health centres operate “compassionate care” or contingency funds for clients who need to access things like Plan B or birth control but can’t afford it.
“I want to make the point that our five rural centres operate on an annual operational budget of less than $50,000 a year,” Hyde said.
“And these little compassionate care funds is something they’ve taken on because the health care system hasn’t made it accessible for folks.”
At the end of Tuesday’s committee meeting, Paynter said in the 20 years she’s been doing abortion work, what the province achieved in 2018 was “extraordinary, world class.” She described the province’s access to abortion as the best in the world.
Paynter’s now hoping the province will also become a leader by providing universal access to contraception, something she believes is achievable.
Contraception is gender affirming care. You get an IUD, you’re not going to have a period for five years. That feels really good if that’s the kind of gender affirming care that you’re looking for. Universal access, it helps all the youth who don’t have to disclose to their parents and go through private insurance. They just get the care they need…
It addresses this issue about this month, dedicated to understanding and highlighting the issues with sexual assault and intimate partner violence. Contraception prevents that. It prevents poverty. It prevents low educational outcomes. It prevents unemployment.
It is the best win-win we could possibly imagine, and it’s definable and achievable. And so I want to leave again by really wishing us well on a path forward where we can get that done and again lead nationally and internationally in the way we care for the people of this province.