“Doctor, can I have a Mirena IUD? I can’t afford to get pregnant again,” asked a postpartum patient who had multiple adverse conditions in pregnancy. “Of course, let’s chat about it,” I replied. “You don’t understand, my OB said she might be able to get me one for free.”
It quickly became apparent that the issue was not obtaining a prescription or finding a provider for insertion, it was cost. She told me that she was a single mother and could not afford the roughly $400 cost, that other contraceptives had proved intolerable, that her private insurance had denied her claim for a Mirena intrauterine device (IUD), and that her health care provider was trying to obtain a no-cost Mirena IUD when she became pregnant.
Unfortunately, scenarios like these are all too common. You name almost any permutation of unintended pregnancy and I have probably taken care of a patient with that outcome in my short career as a pharmacist and now an OB/GYN resident. Consequently, I have taken a leadership role in AccessBC, a grassroots campaign lobbying for universal no-cost contraception in BC.
I write in my own opinion today—an opinion informed by caring for people who found themselves in the working poor and in need of prescription contraception. Where their miniscule wage disqualifies them from income assistance and associated drug coverage, yet they are unable to afford the cost of contraception outright. My opinion is also informed by caring for teens. Currently, a teenager filling a prescription using their parents’ private insurance has the Drug Identification Number uploaded to the insurer’s platform. As you can imagine, this serves as a deterrent for many teens, as their parents could readily learn what medications they are taking. My opinion is also informed by taking care of people in abusive relationships, who may be in high-socioeconomic-status households but have no control of their finances. My opinion is informed by working on the front lines of the COVID-19 pandemic and seeing the impact on reproductive health care.
All these people, and more, would benefit from universal free prescription contraception, and the projected savings for this kind of program are well established. A 2010 study from Options for Sexual Health estimated that providing universal no-cost contraception coverage in BC would cost approximately $50 million but would save up to $95 million per year. Another study in Colorado provided long-acting reversible contraceptives (LARCs) to young people (n = 43 713) at a cost of US$28 million. The program demonstrated a reduction in teen pregnancy by 54% and teen abortion by 64% over 8 years, resulting in $70 million of estimated governmental savings. In 2015, a Canadian cost model found roughly 180 000 pregnancies were unintended annually nationwide, representing a direct cost of over $320 million. However, with increased uptake of LARCs, savings after 12 months was over $34 million.
When I think back to this patient and countless others I have cared for who are unable to access contraceptives due to cost, I think of the human cost of delaying this program’s implementation. I think of the cost to our health care system and the disproportionate impact that lack of access to contraception has on particular groups. I think of our calling as physicians to advocate for patients and our health care system, and to end the inequities we encounter in practice.
Universal access to contraception is a vital component of people being able to recognize their full reproductive rights; it is also fiscally responsible and equity based. Free prescription contraception was included in the three major political parties’ platforms in the last election. Every month that we wait, more folks experience unintended pregnancies. I hope you will join me in upholding reproductive rights and send a letter via www.accessbc.org/the-campaign urging the government to put no-cost prescription contraception into action.
—Ruth Habte, MD
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1. Options for Sexual Health. Universal access to publicly funded contraception in British Columbia. Updated 28 June 2010. Accessed 24 April 2022. https://c912be7b-91d8-4c9d-b312-79a2217f103e.filesusr.com/ugd/9fd619_5e84ed1e331649c199007a5081c206b3.pdf.
2. Colorado Department of Public Health and Environment. Taking the unintended out of pregnancy: Colorado’s success with long-acting reversible contraception. January 2017. Accessed 24 April 2022. https://cdphe.colorado.gov/fpp/about-us/colorados-success-long-acting-reversible-contraception-larc.
3. Black AY, Guilbert E, Hassan F, et al. The cost of unintended pregnancies in Canada: Estimating direct cost, role of imperfect adherence, and the potential impact of increased use of long-acting reversible contraceptives. J Obstet Gynaecol Can 2015;37:1086-1097.
Dr Habte is an obstetrics and gynecology resident physician at the University of British Columbia and a former registered pharmacist. She currently serves as campaign coordinator for AccessBC, the grassroots campaign to bring no-cost prescription contraception to BC.