loading
  • Photograph by Photo by Camila Cordeiro

My Light Bulb Moment: Contraception shouldn't be a luxury

The ability of women to participate equally in the economic and social life of the nation has been facilitated by their ability to control their reproductive lives.

As a medical student focused in women’s health, I've seen many women at different stages of the reproductive journey. These women may be actively seeking pregnancy, attempting to prevent pregnancy, or seeking termination. This is not the story of one specific patient, but a composite of the many patient stories I've witnessed, that share far too many of the same structural obstacles and challenges. "Anna" is a patient story I have seen again and again, typical of so many Canadian women who lack sufficient access to contraceptives.

Anna is in her early or mid-twenties. She’s pregnant for the third time in three years. She works part time at a precarious job and struggles daily to make ends meet.

Anna is stressed about her current pregnancy. She will likely get an abortion, since she doesn’t feel she’ll be financially or emotionally able to provide for this third child. You may wonder “why didn’t Anna just use birth control?”

Anna has used oral contraceptive pills on and off over the years for contraception, but cost has been a barrier to consistent use. She wishes she could afford an IUD for contraception, but the $400 upfront cost is unmanageable with a part time job. Anna is scared that even after her abortion she will get pregnant again because she cannot afford consistent contraception.

"We have to step away from simplifying the issue as one of behaviour, choice, or personal responsibility."

40-50% of Canadian pregnancies are unintended and up to ⅓ of Canadian women will have terminated at least one pregnancy by age 45. Currently, there are more than 180,700 unintended pregnancies in Canada each year. These facts matter for the health and well being of all Canadians.

Unintended pregnancy is a public health concern. There are substantial personal and health systems costs associated with unintended pregnancies. The total direct cost of unintended pregnancy to the Canadian health care system for women between 18 and 44 was $320 million, on top of the personal, financial, emotional, and reproductive health costs associated with unintended pregnancy.

One of the most effective birth control options is the Long Acting Reversible Contraceptive, aka the IUD or IUS. Studies show that when money is not a barrier, women are more likely to choose longer lasting contraceptives such as IUD’s.

The IUD also has the steepest upfront cost. The average price of the Mirena IUD across three pharmacies in Toronto was $412, making this option a non starter for a number of women. Gender inequity is one of the biggest challenges facing our global, national and community health. But "if you're going to lift women out of poverty... you've got to have access to contraceptives." Canada has the chance to become a global leader on this critical issue of health, human rights and social justice.

SNAG-0000.pngChart from womenspot.ca.

Anna’s journey to preventing unintended pregnancies is far from straight forward. We have to step away from simplifying the issue as one of behaviour, choice, or personal responsibility. For the health of our neighbours, as well as our economy and democracy, we should want everyone to have access to comprehensive contraception. But to make that a reality we need to take an intersectional approach that focuses on the underlying social determinants of health.

If we don’t, we won’t be able to address the fact that while overall, unintended pregnancy rates have fallen, women that live at or below the poverty line are five times as likely to have an unintended pregnancy as women at the highest income level. Some strategies may include:

"The ability of women to participate equally in the economic and social life of the nation has been facilitated by their ability to control their reproductive lives."

  1. Universal coverage of contraception for all Canadians. This includes access to IUD’s, OCP’s, patches, rings, and barrier methods.
  2. A basic income guarantee to ensure no one is living in poverty, sufficient enough not just to survive, but thrive. This will remove some of the barriers that low income individuals face when trying to access contraception.
  3. Health promotion around contraception that is sensitive of the unique barriers faced by marginalized populations for both adolescents and adults.
  4. Increasing and improving education on the social determinants of health among health professionals, to diagnose the underlying socioeconomic barriers to accessing contraception., instead of just personal behaviour.

On March 8th, 2017, the government of Canada committed $650 million over three years to improve sexual and reproductive health. The overall goal of this funding is to reduce unwanted pregnancies and unsafe abortions, as well as to promote the health and rights of girls and women. Studies from the US have showed health systems savings of $7 for every $1 invested in contraception and contraceptive counselling. Furthermore, longitudinal studies have shown that families with access to family planning were wealthier, healthier, and had a more valuable home.

It has long been argued that one of the key factors that keeps people in poverty is the inability to access contraception. It’s been acknowledged by the Supreme Court as far back as 1992, in Planned Parenthood of Southeastern Pennsylvania v. Casey:

"The ability of women to participate equally in the economic and social life of the nation has been facilitated by their ability to control their reproductive lives."

We must disrupt the status quo. The Canadian public deserves the right to access safe and affordable contraception, and to avoid unintended pregnancy. The only way to do that is to think upstream.

 


Are you a nurse, social worker, medical student, or health professional with your own Light Bulb Moment to share? Contact us, and we'll help you tell it!

Check out more Light Bulb Moments here.


Giuliana_Guarna.jpgGiuliana Guarna holds a B.Sc. in Biology with a minor in Music and Music Cognition from McMaster University. She is currently attending McMaster University as a medical student and has lived in Hamilton for the last six years. Her interests include writing for her personal blog, reading, practicing her calligraphy skills, and engaging in political advocacy.

Connect upstream.