Nexplanon Approved Hormonal Birth Control: Case for Universal Coverage

Like many of the women in her peer group, Cara (not her real name) began her contraceptive journey as a teenager. She was prescribed birth control pills like acne treatment, remained on them for the prevention of pregnancy long after the spots disappeared, and then maintained an intermittent relationship with the drug for more than a decade.

Familiarity eventually gave way to weariness with day-to-day maintenance and side effects, but with no family doctor to guide her, it was up to Cara to find a better alternative. “I went to walk-in clinics, meeting a different doctor each time,” says the 34-year-old freelance writer. “They don’t always take the time to fully explain things to you. When I first asked about an IUD, they just handed me a bunch of brochures.

After doing the research herself, she landed on Kyleena’s estrogen-free IUD. She paid part of it out of pocket – her husband’s insurance covered some of the costs – and endured an extremely painful 45-minute failed insertion process (some research shows this happens about 20% of the time). ) and a second appointment to do so. She is already considering the alternatives once her IUD expires in a few years.

Cara’s struggles with birth control are not uncommon; they are a symptom of Canada’s slow approach to accessing and advancing contraception. Although many international organizations, including the United Nations Population Fund, consider contraception a basic human right, the choice of Canadian women to prevent pregnancy is hampered by legislative, regional and socio-economic barriers that limit what types of contraception we have, when and where we can access it, and what we can afford.

In May, Health Canada finally approved the sale of Nexplanon, a long-acting, reversible form of contraception inserted into the upper arm.

Here’s an example: In May, Health Canada finally approved the sale of Nexplanon, a long-acting form of reversible contraception inserted into the upper arm – a procedure much less invasive than an IUD – and which lasts three years.

“We’re really excited to see the implant come out this fall,” says Dr. Julie Thorne, OB / GYN at Women’s College Hospital and Lecturer at the University of Toronto. But Nexplanon has been widely available in almost 100 countries for 20 years. Similarly, the non-invasive end-of-pregnancy drug Mifegymiso was not released in Canada until January 2017, almost 20 years later than in the United States.

Do these delays indicate a failure in prioritizing women’s sexual health options? Advocacy groups like Action Canada for Sexual Health and Rights have certainly made this case. Thorne blames bureaucratic red tape and business reasons – Canada’s small population and expensive customs clearance protocols can act as a deterrent to drug companies.

Nexplanon’s long-awaited endorsement has renewed criticism from reproductive activists of contraceptive blind spots in Canada, and they are asking the question: are we supposed to uphold birth control as human rights, how else can we deliver the most effective. affordable and abundant options in the hands of all Canadians?

Canada remains one of the few countries with universal health care that does not also provide universal access to contraception to its citizens.

Unlike the UK and Denmark, Canada remains one of the only countries to benefit from universal health care that also does not provide universal access to contraception to its citizens. “We know that (access to free contraception) has a very important impact for the individual in terms of autonomy over their own body and their ability to make decisions about the future,” says Natalya Mason, a social worker and education and outreach coordinator at Saskatoon Sexual Health.

Canada’s disparate contraceptive coverage poses a real public health problem. If you don’t have extended health insurance, in Ontario the pill can cost up to $ 470 per year. IUDs have a one-time cost of around $ 400 and last three to five years. The social ramifications of these costs are striking: Unintended pregnancies disproportionately affect young adults, recent immigrants, rural residents and those of lower socioeconomic status.

Beyond the individual experience, providing free contraception costs the system less than dealing with the consequences of an unwanted pregnancy, such as surgical abortion or children requiring social support. “The small investment in the initial costs of birth control would save so much money in the long run,” Mason says.

Another obstacle is confusion over where to look for reliable information. According to a 2017 article published in the Canadian Medical Association Journal, “There seems to be a storm of complete ignorance about contraceptive options, growing concern about side effects, and declining confidence in healthcare providers. as more and more women seek advice online ”. This contributed to a 23% drop in oral contraceptive use in Canada between 2006 and 2016.

Thorne, who has witnessed an increase in concern around the idea that hormonal birth control is unnatural, says more should be done to reduce patients’ internet addiction and share anecdotes. “I don’t think we give enough space to hear patients’ concerns, so that we can try to validate their experiences,” Thorne says.

Family physicians are expected to act as custodians of health information, especially on complex topics like contraception, but, like Cara, nearly 20% of Canadian women aged 18 to 34 I don’t have a regular doctor.

It’s a particularly pressing problem outside of urban centers, Mason says. “I’ll be in a city a lot to ask a high school class about their access to health care and they’ll tell me there’s a provider coming every two weeks,” she says. In socially conservative provinces like Saskatchewan, patients may face a misalignment of values ​​with these referring physicians. “It’s not a comfortable way to ask questions, to establish a rapport with the clinician, or to obtain (contraception),” Mason says.

“We need more (contraception) centers where patients can get same-day care, easy follow-ups, and the ability to talk to someone on the phone or in person,” Thorne says, citing the Bay Center for Toronto Birth Control as a model facility – she is a consultant gynecologist the.

Great emphasis should be placed on finding innovative ways to extend this service to hard-to-reach areas. As always, “it all comes down to money,” says Thorne, who, along with colleagues at the University of Toronto, is working on a campaign for universal contraceptive coverage in Ontario.

Mason insists that meaningful change starts from the bottom up. “Without the right pressure from our communities, we don’t see a change in access,” she says. If we want true contraceptive choice – the kind of contraceptive that is free from any conditions and stipulations – we have to start demanding it.

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