As of April 1, 2023 all residents of British Columbia gained access to free prescription contraception. This includes the birth control pill, injections and implants, IUDs and emergency contraception known as Plan B or the “morning after” pill.
The bold move makes good on a campaign promise of the NDP government.
It’s the focus of sustained activism of groups like AccessBC and Action Canada for Sexual Health and Rights, and was ignited by the ongoing abortion politics south of the border, where a judge in Texas just issued a preliminary ruling invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone. That ruling was almost immediately followed by a contradictory decision by a judge in Washington state.
The B.C. policy could serve as a model for other provinces — Ontario’s Progressive Conservative government, for example, has already said it’s “looking closely at what British Columbia has proposed.”
Nonetheless, universal coverage of contraception beyond British Columbia is unlikely at the moment. It does not seem to be a serious proposal of any current provincial government.
While some provincial opposition parties have promised universal contraception, policy progress depends on whether they actually get elected. It will also depend on a number of factors that will shape their political agenda once in office.
List not fully complete
The new coverage in B.C. is extended to anyone with a provincial health card and requires a physician’s prescription until later this spring, when pharmacists will be able to prescribe contraceptives.
The list of contraceptives included in this plan is comprehensive but not exhaustive. Other forms of birth control and menstrual regulation, according to the B.C. government, might be considered in the future.
There seems to be no significant discussion of extending the coverage to B.C. residents who don’t have a provincial health card, such as undocumented residents and migrant workers for whom reproductive rights are already sometimes inaccessible.
And accessibility will be dependent upon pharmacists’ willingness to dispense medication, something that might be particularly contentious, not to mention time-sensitive with emergency contraception.
Pharmacists are allowed to refuse to stock or dispense medication as a matter of conscience, something that has been a barrier for medication abortion access in Canada, especially in rural areas. Yet despite these criticisms, the B.C. plan serves as an example of equitable primary sexual and reproductive health care delivered at the provincial level.
Opposition promises in other provinces
Opposition parties in Alberta, Manitoba and Saskatchewan have all promised to implement the same policy if elected. But at this point, such a commitment really just amounts to a progressive idea in the context of conservative provincial politics, with centre-right parties in power in eight of 10 provinces.
This means that the B.C. policy might reflect the uniqueness of the province’s political dynamics and also demonstrates what is possible, given the right political conditions, in the realm of reproductive rights.
It’s also reflective of the broader North American politics of abortion, as the timing of the policy — a campaign promise of the NDP government, elected in 2020 — seems to respond to the reversal of reproductive rights in the United States with the overturn of Roe v. Wade in June 2022.
The end of constitutional protection of the right to abortion in the U.S. created momentum for strengthening abortion policy and reproductive rights in Canada.
In response to the U.S. Supreme Court ruling, the federal Liberal government has increased and sustained commitments to ensuring access to abortion and other areas of sexual and reproductive health and rights.
Much of this work is carried out by organizations like Action Canada for Sexual Health and Rights and the National Abortion Federation Canada, with advocacy and information campaigns by the Abortion Rights Coalition.
All insist that contraception and abortion are both matters of individual autonomy and reproductive justice. At the provincial level, Québec reduced restrictions on the dispensing of mifegymiso, the drug used in medication abortion. Other provinces, including Nova Scotia, created abortion self-referral networks.
But the B.C. government’s universal contraception announcement is the most recent positive policy response to the reversal of reproductive rights in the U.S.
Of course not all of the impact of the Dobbs decision on Canada has been positive. In the immediate aftermath of the overturn of Roe, the Manitoba legislature defeated a bill that would have provided buffer zone protection for abortion clinics.
The same organizations that benefit from increased federal funding — and use it to support women and other pregnant people — indicate that Canadian women who used to travel to the U.S. for certain kinds of abortions are finding it more difficult to do so due to increased restrictions and bans on the American side of the border.
The recent duelling U.S. court decisions concerning restrictions on mifepristone will only increase this difficulty and limit reproductive rights.
Policies like B.C.’s universal coverage of contraception will help to expand reproductive rights. That’s why it’s such an important decision.
Defending reproductive rights
On a practical level, funding for contraception has the effect of making birth control available for everyone, with no privilege for those who have private insurance or can afford to pay and no disadvantage for those who have trouble affording it.
But beyond this, public support and payment for contraception serves to normalize birth control, Plan B and sexual health and reproductive rights as a public good and as a matter of public responsibility.
In an age of increased privatization in health care in general, and the increased stigmatization and criminalization surrounding abortion, the B.C. move is a positive step that fully embraces sexual and reproductive health and rights for everyone in post-Roe North America.
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