September 26, 2020

Healthcare workers demand universal, no-cost contraception coverage in Ontario


Hon. Christine Elliott, Deputy Premier of Ontario and Minister of Health
80 Grosvenor Street, 10th Floor, Hepburn Block, Ministry of Health and Long-Term Care, Toronto, ON, M7A 1E9
Fax   416-326-1571  

Hon. Doug Ford, M.L.A., Premier of the Province of Ontario.
Premier of Ontario, Legislative Building, Queen's Park, Toronto ON M7A 1A1
Phone 416-325-1941


Dear Minister Elliott and Premier Ford,
 

Access to timely, affordable contraception is a pillar of reproductive human rights. 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 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.
 
Cost is the single greatest barrier to contraceptive access in our nation (1,2). Each different contraception option - pill, patch, ring, intrauterine device - carries a cost of several hundred dollars per year. With a looming economic recession, widespread loss of employment and private coverage options, access has never been more compromised.
 
Now is the time to act. Universal coverage improves access to contraception, proves cost-effective, and confers significant savings in downstream medical costs (2,3). The consequences of continued government inaction are plain and far-reaching. We know that the bodily freedoms and safety of our patients are drastically curtailed amidst necessary lockdowns, as evidenced by the global rise in intimate partner violence (my 4). We anticipate a subsequent rise in unintended pregnancies leading to an increased burden on the health care system associated with the risks of safe and unsafe medical abortions (5). Impaired reproductive choice has far broader socioeconomic ramifications including reduced workforce participation, decreased economic stability and efficiency, and waning well-being of families (6,7). The consequences of inaction on this matter will be felt well into the future.
 
COVID-19 may have paralyzed our health care system and economy, but the reproductive health needs of our population are urgent and growing. Inaction further marginalizes our most vulnerable populations. In these unprecedented times, with many individual freedoms on hold for collective benefit, we must prioritize the reproductive autonomy and safety of all of Ontario’s peoples.
 
As healthcare providers committed to advocating for reproductive justice, we call on the Ontario government to take the following immediate action:
 
Implement universal, no-cost coverage for all contraceptive options.


Sincerely,


Emma Skolnik, MD
Emily Delpero, MD
Alix Murphy, MD
Allie Davidson, MD
Maria Leis, BA, Medical Student
Neelam Dhaliwal, BHSc, Pharmacy Student
Sarah Freeman, MD
Nour Bakhache, MD
Michael Chaikof, MD
Rachel Spitzer, MD, MPH, FRCS(C)
Julie Thorne, MD, MPH, FRCS(C)


Additional signatures can be viewed at the following link:
https://docs.google.com/document/d/15Vp-K-nBTQAdSPos5LZsvN_BDV-DRZLRvk_j30zcE4Q/edit?usp=sharing


Organizations in Support:
COVID-19 Women's Initiative
Action Canada for Sexual Health and Rights
Health Providers Against Poverty
The Association of Ontario Midwives
The Ontario Society of Obstetricians and Gynecologists
Canadian Federation of Medical Students
The Federation of Medical Women of Canada
The Obstetric Justice Project
Registered Nurses' Association of Ontario
The Society of Obstetricians and Gynaecologists of Canada
Primary Care Nurses Of Ontario
The BIPOC Women's Health Network

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References

(1) Hulme, Jennifer, et al. “Barriers and Facilitators to Family Planning Access in Canada.” Healthcare Policy | Politiques De Santé, vol. 10, no. 3, 2015, pp. 48–63., doi:10.12927/hcpol.2015.24169.

(2) Black, Amanda Y., 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.” Journal of Obstetrics and Gynaecology Canada, vol. 37, no. 12, 2015, pp. 1086–1097., doi:10.1016/s1701-2163(16)30074-3.

(3) Morgan, Steven G., et al. “Estimated Cost of Universal Public Coverage of Prescription Drugs in Canada.” Canadian Medical Association Journal, vol. 187, no. 7, 2015, pp. 491–497., doi:10.1503/cmaj.141564.

(4) Taub, Amanda. “A New Covid-19 Crisis: Domestic Abuse Rises Worldwide.” The New York Times, The New York Times, 6 Apr. 2020, www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html.

(5) “Consequences of Unintended Pregnancy.” The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families, by Sarah S. Brown and Leon Eisenberg, National Academy Press, 1995.

(6) Sonfield, Adam, et al. “The Social and Economic Benefits of Women's Ability To Determine Whether and When to Have Children.” Guttmacher Institute, 15 Mar. 2016, www.guttmacher.org/report/social-and-economic-benefits-womens-ability-determine-whether-and-when-have-children.

(7) Yazdkhasti, Mansureh et al. “Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article.” Iranian journal of Public Health vol. 44,1 (2015): 12-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449999/