The birth control wars: the Canadian context.

By: Chantaie Allick

The pill, the ring, an IUD, emergency contraception—say any of these in the United States right now and you’re likely to set off a firestorm of debate. Politics, religion, a woman’s right and personal choice all enter the conversation on this loaded issue—it’s a mere sideways glance away from the big A, better known at TheGaze as abortion.

In what some of the American media have called “The War on Women,” several invasive and pretty horrifying bills have been introduced in state legislatures. An example of these would be Virginia’s recent transvaginal ultrasound legislation, a bill that would require doctors to perform the invasive procedure before a woman receives an abortion. Transvaginal ultrasounds are used in the early stages of pregnancy, the first 12 weeks, so that women seeking abortions will have to listen to and view the fetal heartbeat and organs. In order to perform a transvaginal exam, a probe has to be inserted into a woman’s vagina while a doctor describes the fetal heartbeat and appearance. In this bill, the transvaginal ultrasound is mandatory. Therefore if you are seeking an abortion, whether or not you consent to the procedure, you must get the transvaginal ultrasound. The ultrasound is not a medically necessary procedure in the case of an abortion.

Though this initial bill did not pass, Mississippi and Pennsylvania are also introducing laws which would require similar measures of forcing women to view ultrasounds before their abortion. Alabama, Arizona, Florida, Kansas, Louisiana and Texas all require women to have an ultrasound prior to having an abortion. Click on the link below to read a doctors (anonymous) response to the transvaginal ultrasound bills and the need for doctors to speak up against what he/she calls “rape.” guest-post-a-doctor-on-transvaginal-ultrasounds

In Arizona, in response to the Obama Administration’s recent mandate that all employers have to cover birth control under their company health plans, state legislators have introduced a bill where employers could opt out. Furthermore, there is a provision in the bill (House Bill 2625) that would allow an employer to actively discriminate against a female employee for taking birth control, even if she were paying for the pill herself.

The above examples merely scratch the surface of recent legislation that actively and insidiously violates women’s sexual and overall health.

In Canada one rarely encounters the furor that contraception sets off among our Southern neighbours. It’s one of those issues polite Canadians and their leaders keep behind closed doors. But that doesn’t mean there aren’t any problems when it comes to accessing contraception in Canada; it just means we don’t talk about it. In fact women face a number of barriers in their attempts to access birth control across the provinces.

“Canada’s a big country and access to contraception varies in part due to geography,” said Jolanta Scott-Parker, executive director of the Canadian Federation for Sexual Health. “I think the situation that we’ve seen recently in the United States was very politically loaded,” she added explaining that that’s not quite the case in Canada.

Financial and educational barriers to access are also issues in Canada. Particularly when it comes to the pill. More women in Canada find themselves paying for it out of pocket because they don’t have a prescription drug plan that covers the pill (if a plan at all). There are places like walk-in clinics and community health centres that give them out for free, but that depends again on where in this vast country you live.

Currently Quebec is the only province where prescriptions are covered under a provincial plan. The government pays for 80 per cent of drug costs for those who don’t get it through work and that includes the pill. Scott-Parker says there’s a proposal before the British Columbia government to have it covered under a similar plan in that province. That leaves eight other provinces and three territories with no help for women without coverage. Advocates of the proposal sell it as a cost-saving measure for province.

There has been some progress in Canada, and to be fair, far more than there has been in the States. Emergency contraception, better known as the morning after pill or Plan B, is now available over the counter. But Scott-Parker warns that too plays out differently depending on where you are in the country. The pills are not always on the shelf. Despite being over the counter, pharmacists may keep them behind the counter and they, as a result, become an unofficial gatekeeper of the birth control method. They may also charge a consultation fee adding to the on average $40 cost of the pills (sidenote: in Toronto, Plan B can be accessed for $13.50 at Planned Parenthood at the Bay Centre for Birth Control).

Strangely enough, education is another common problem among the users of contraceptives (women and their partners).

“There’s still a lot of lack of information and lack of awareness of different methods,” said Scott-Parker. That’s in addition to lack of access to a health care provider in some parts of the country, or one who a woman feels comfortable discussing contraception with.

Somebody who is sexually active has to acknowledge her (or his) need for contraception, get enough information from a doctor to choose a method that works best and figure out how to get it. It sounds simple, but those steps may hold some women back. Teens are especially vulnerable in this area. The Society of Obstetricians and Gynecologists of Canada has a contraception awareness program in place to address this.

But once a woman knows how and where to access contraception, as a Canadian, her choices are limited. Over the past two decades oral contraceptive use has increased and it is now the method most used in Canada; the use of intrauterine devices has declined, while condom use has increased. Scott-Parker said women are often unaware of their options when choosing a method of contraception. While there are a number of other options including injections, the NuvaRing and other hormonal options the pill remains the most popular method of contraception. That is partly because it is the most readily available.

A comparison of availability of new products in Canada by William A. Fisher and Amanda Black in a CMAJ article on the issue, they found that Canadian women have access to only 17 per cent of the newer methods available, compared to Denmark, where 61 per cent of all newer products are approved and the United States, where 44 per cent are approved. Part of this is that the approval process for new drugs in Canada takes longer and the market is much smaller, making it less likely that a manufacturer will attempt to get access to Canadian women and their uteri.  In recent years, Canadians have lost access to products that are approved because suppliers have withdrawn them from the Canadian market write Black and Fisher. This includes the Gyne-T 380 IUD, Norplant, and the Lea Shield.

The World Health Organization recognizes reproductive and sexual health as a fundamental human right. According to them, the responsibility for ensuring these rights are up to governments, the health care system and health providers. I would add individual users to this list as well (at least it’s our responsibility to demand or appeal for those rights as Sandra Fluke did in the U.S.). They have to make safe and effective contraceptive methods available and accessible and provide adequate funding for delivery. I don’t know how that plays into the American debate, but given the facts, it leaves ample room for improvement and discussion in Canada.

“It’s clear that lots more can be done to improve access to contraception in Canada,” said Scott-Parker. Barriers continue to exist and she says we have a shared responsibility to fix that.

-With files from Britt Harvey.

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