Hava Starkman was able to get an IUD during the pandemic for one reason, she says: she’s a medical resident at the University of Toronto. “In June of 2020 I wanted to get an IUD, but it was so challenging to get an appointment with anyone,” she says. “The only reason I was able to set it up is because I have privilege as a resident doctor.”
Thankfully, her health-care benefits covered the cost: copper IUDs run from $60 to $150 dollars, and hormonal IUDs from $395 to $500. Starkman says she can’t imagine having to access contraception right now without the resources she has: “If I had these challenges how are other people going to be accessing contraception?”
The pandemic has other medical professionals asking the same question — and proposing answers. On December 10, 2020, CoverContraceptiON, an advocacy group led by Ontario physicians, sent an open letter to Premier Doug Ford and Ontario's minister of health, Christine Elliott, demanding no-cost coverage of all contraceptives for Ontarians. Starkman was a cosignatory.
“Canada is an international leader in gender equity and reproductive freedoms yet the lack of universal contraception coverage encroaches on the rights of its very own peoples,” the letter reads. “The COVID-19 pandemic intensifies this pre-existing inequity and disproportionately affects the marginalized – those of low socioeconomic status, cultural minorities, Black and Indigenous peoples, and residents of rural communities. The Ontario government must act now to champion the reproductive rights, health, and autonomy of its peoples and implement universal, no-cost contraception coverage for all.”
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According to CoverContraceptiON, different methods of contraception get different levels of coverage in Ontario. OHIP+ covers most forms of contraception for those under 25. However, if the patient has access to private health insurance — for example, through a parent — they would be required to submit coverage through the private plan and would not be able to access contraception confidentially through OHIP+. If the patient is over 25, they receive coverage only if they have a private plan, are considered “low-income,” or are part of a specialty drug-coverage program. In all other situations, they pay out of pocket.
“A private plan might cover 100 percent of some pills, but 50 per cent or none for an IUD,” says Sarah Freeman, a resident in obstetrics and gynecology at U of T and a co-author of the letter. “This is another barrier to access for the type of contraception that you want — it’s very limiting.”
While limited contraception access has been a “critical public-health issue” for some time, it has been exacerbated by the pandemic, says Vivetha Thambinathan, a health-equity researcher and doctoral candidate in Health and Rehabilitation Sciences at Western University: “Especially during the pandemic, many have lost jobs and benefits to cover this medication, so this issue is emerging in a different light.”
The campaign has received support from doctors across the province. Ravinder Mistry-Dillon, a family physician in Barrie, says, that “access to contraception should be a universal right — those that are not as financially fortunate should have the choice to choose what happens to their body without the burden of cost.”
Freeman stresses that the issue goes beyond unplanned pregnancies. “We talk about our campaign in terms of contraception and not in terms of birth control, because contraceptives are not just used for birth control,” she says, adding that confidential access to contraceptives can be life-changing, including for patients who are not sexually active. “I have seen patients whose parents refuse to allow them to use contraceptives to manage polycystic ovarian syndrome, endometriosis, abnormal uterine bleeding,” she says. “Providing people with contraception is not going to increase sexual behaviour, and we have research to prove that. We’re treating medical conditions as well.”
Samra Zafar, a domestic-abuse survivor, author, and gender-equity advocate, says that contraception access should also be considered in relation to domestic violence, which research suggests has been on the rise during COVID-19: “Having children makes it infinitely more complicated to leave abuse, especially when a woman is dependent financially on an abuser.”
In British Columbia, Access BC, a campaign fighting for universal contraception coverage in that province, has seen some success. In October 2020, the government announced that free prescription contraception coverage would be included in the BC New Democratic Party’s 2020 election platform.
Following the recent election there, free prescription contraception coverage has also been included in Health Minister Adrian Dix's mandate letter and received the support of more than a dozen municipalities. “It’s kind of shocking that it hasn’t been a bigger part of the conversation around gender equality and reproductive justice in Canada until now,” says Devon Black, co-founder of Access BC.
In Ontario, CoverContraceptiON is asking the Ford government to implement universal, no-cost contraception for all Ontarians, regardless of immigration status. “If our plan were implemented, you would go to your doctor and get a prescription for whatever type of contraception you want and be able to go to a pharmacy anywhere in the province, give them your prescription, and get that contraception for free,” Freeman says.
A spokesperson for the Ministry of Health tells TVO.org via email that there are a number of sexual-health services available during the pandemic, "as well as funding for contraceptive products under the Ontario Public Drug Program."
While Freeman knows that the government is battling other pandemic-related issues, she says this is not something that can wait until the pandemic is over: “There are patients that may need blood transfusions because of uterine bleeding, patients who are in unsafe relationships — these are issues that we can’t ignore.”