Teale Phelps Bondaroff and Devon Black go way back.
With a shared passion for local advocacy and social change, Phelps Bondaroff and Black first worked together on a political campaign in 2006. Phelps Bondaroff, then a teenager, was running in the federal election as an NDP candidate for Alberta’s Calgary West riding. Black, who went to the same high school as Phelps Bondaroff, signed up to be his communications director.
While Phelps Bondaroff wasn’t elected, he remembers his campaign fondly. In the years that followed, he said many of the young adults who worked on his campaign found other ways to advocate for issues they feel are important.
Phelps Bondaroff and Black, meanwhile, found an issue that resonates with them both. Together, they’re advocating for free prescription contraception in British Columbia.
Canada’s history of contraception
Contraception has been a major component of Canadian family planning activism since 1932, when Elizabeth Bagshaw, one of Canada’s first female doctors, established the first family planning clinic in Hamilton, Ont.
Family planning, the process of consciously timing or preventing pregnancies, often involves using contraception. However, an 1892 federal law made it illegal to sell or advertise birth control in Canada.
Despite this law, Bagshaw would prescribe contraception to women through her clinic, instruct them on their proper use, and schedule follow-up appointments. She was the target of intense criticism from medical and religious communities as a result.
The number of women who sought help from Bagshaw was well beyond the clinic’s predictions. According to the University of Toronto, Bagshaw’s alma mater, in the first year of opening her clinic, nearly 400 women used her services.
The birth control movement took off across Canada three years later, when Alvin Ratz Kaufman, an industrialist and philanthropist based in Kitchener, Ont., founded the Parents’ Information Bureau in 1935.
The types of birth control available were limited, and oral contraceptives weren’t widely available. Through the Bureau, couples could get referrals to doctors for diaphragms or medical sterilization. Kaufman also distributed birth control information and sent nurses directly to homes to provide families with other contraceptives, including condoms and spermicide.
More than three decades after Bagshaw established her family planning clinic, in 1969, the Criminal Code section making it illegal to advertise or sell birth control was finally removed.
Today, despite ongoing religious and medical debates surrounding contraception, the average Canadian seeking prescription contraception can access it fairly easily through their family doctor or health care provider.
The catch? They have to pay for it.
The origins of AccessBC
The idea to campaign for no-cost or free prescription contraception came to Phelps Bondaroff when he returned home to British Columbia from studying in the U.K.
Prescription contraception is free for most people in the U.K., with 15 methods to choose from, including contraceptive injections, diaphragms, and intrauterine devices (IUDs). This includes residents who are not citizens, so Phelps Bondaroff and his partner could still access contraception for free while overseas.
After returning to Canada, the couple realized they would have to pay for contraception. An intrauterine device (IUD) can cost between $60 and $500, whereas oral contraceptive pills cost $22 per month on average, even with insurance coverage.
“As a white man, I hadn’t really experienced barriers to contraception before in this way,” Phelps Bondaroff told The Pigeon in an interview. “It was like, ‘No, an IUD is going to cost you $380,’ [which was] not okay.”
He shared this information with Black soon after. Following what they called a “kitchen table conversation,” the two launched the AccessBC campaign in 2017, proposing a policy where no-cost contraception is made available to all British Columbia residents.
The cost of contraception in Canada
Black says cost is the biggest barrier for those who need it the most when it comes to accessing prescription contraception in Canada.
This includes but is not limited to those who are young, who have lower incomes, who may be racialized or marginalized, or who are newcomers or refugees in Canada.
According to AccessBC, 59,000 young Canadians under the age of 24 experienced unplanned pregnancies in 2014. Further, over 25 per cent of youth who don’t wish to be pregnant reported they don’t use contraception during every act of intercourse—and some never use it at all.
Related research has found that public health initiatives need to raise awareness and access surrounding contraceptives to increase their effectiveness.
The statistics for immigrants are just as worrying. According to research conducted in 2013, 24.8 per cent of immigrant women said they had problems getting birth control compared to only 15.3 per cent of Canadian-born women.
For Black, these statistics show “how ludicrous it is that this kind of basic health care […] is so expensive.”
Claire Dong is a co-founder of the BIPOC Women’s Health Network, a national advocacy group run by medical students. She told The Pigeon that immigrants and newcomers might face greater challenges in accessing sexual and reproductive health services due to language barriers, lack of access to private insurance and because they’re navigating a health care system different from the one in their home country.
“If you put yourself in the shoes of a newcomer woman, you’re not sure of where to go to get contraception, of how much it costs without insurance, and if the doctors will notify your families,” Dong said. “Will the doctor even speak your language? What’s the Canadian system of health care, and how [is it] different from yours?”
“This kind of uncertainty on how to navigate the system and where to go for resources is a huge barrier that we see in this newcomer, immigrant and refugee population.”
The varying costs of prescription contraception may also limit the kind of contraception women, and people with uteruses may choose to access. Black, for example, said she prefers a copper IUD because of the impact of hormonal contraception on her mood.
Under current pharmacare policies in British Columbia, however, an IUD’s cost isn’t covered because it’s considered a medical device rather than a form of medication.
While she can pay for the prescription contraception that works best for her, Black said people with low incomes might choose to forego expensive contraception methods like an IUD, even if that’s the kind of contraception that may work best for them.
“If you put people in a position where they’re not able to get the support they need to access that type of contraception, it puts them in a position where they might end up taking medication that doesn’t work for them,” she said.
Phelps Bondaroff agreed, adding that many factors play into the kinds of contraception people try to access, but removing contraception costs makes it easier for them.
“When you make contraception free, you allow people to actually explore and make choices and to choose the contraception that is right for them,” he said.
Contraception in the time of COVID-19
While AccessBC has been advocating for free prescription contraception in British Columbia since 2017, the need for no-cost contraception has increased due to COVID-19 for reasons including high unemployment and financial instability.
According to a new RBC report, almost half a million women who lost their jobs due to the pandemic hadn’t returned to work as of January 2021, and more than 200,000 of them were considered long-term unemployed.
Phelps Bondaroff said these high unemployment rates mean those who often bear the cost of prescription contraception will no longer be able to afford it.
“Affordability is a huge issue where people have lost their jobs,” he said. “They can’t afford the $20 a month [cost of oral contraception], which maybe was reasonable beforehand but is now a really insurmountable cost.”
Added to this is the challenge of what Phelps Bondaroff called “compounding barriers,” which include travel costs, the fear of going to meet a doctor in person, costs of taking time off work or school, or caring for a child at home.
Some contraceptive methods like IUDs and injections need to be administered by a health care professional and require in-person visits to do so. When COVID-19 hit, Phelps Bondaroff said many people were worried about going into clinics because they feared contracting the virus.
Phelps Bondaroff added that another cost of COVID-19 is the rise in family and gender-based violence, which has further impacted contraceptive access.
Referred to as a “shadow pandemic” by the United Nations, lockdowns across the country and the resulting increase in domestic abuse and gender-based violence make it difficult for people to access contraception.
Lockdowns have meant that many women, non-binary, and trans individuals are confined in a space with their abuser with no safe place to go. Since fewer of them are currently in the workforce, they’ve become reliant on their partners for financial support. The financial reliability and social isolation allow abusers to be nearby and exercise control.
“One of the things [COVID-19] emphasized for us was the importance of people being able to access contraception,” Black said. “But not just any type of contraception—it needs to be contraception that works for their situation.”
Canada’s politicization of contraception
AccessBC isn’t the first to fight for free prescription contraception in Canada. Similar campaigns have sprouted up across the country over the past few years. A 2019 statement by the Canadian Paediatric Society called on governments across the country to provide no-cost contraception to Canadians under 25.
Phelps Bondaroff says campaigns for free prescription contraception are “evidenced in strong support of policy.”
AccessBC became a part of conversations surrounding policymaking in 2017 when it helped pass its proposed policy at an NDP convention, which is the first step to getting it onto an election platform.
Phelps Bondaroff told The Pigeon one of the biggest incentives for governments to consider universal contraception access is the amount of money they could save.
According to AccessBC, programs that offer free prescription contraception to women are revenue positive because the cost of providing free prescription contraception to women is considerably lower than the costs associated with unintended pregnancies.
A 2015 study estimated the cost of delivering universal contraception in Canada at $157 million. Still, the savings, in the form of direct medical costs of unintended pregnancy, have been estimated at $320 million.
Contraception has benefits beyond birth control as well.
A 2011 study from the Guttmacher Institute shows that 58 percent of oral contraception users use the pill for at least one purpose other than pregnancy prevention, with 31 percent of the 58 percent using birth control methods for cramps or menstrual pain.
According to the National Coalition for Sexual Health, contraceptives can help regulate menstruation cycles, decrease acne and excessive hair growth, and help treat medical health issues like polycystic ovary syndrome.
Nonetheless, the policy has been difficult to pass.
Black said this is often because access to free prescription contraception is seen as a “special interest issue” or is challenged by policymakers and government officials.
“Almost everyone in British Columbia has either used contraception or has benefited from their partners using contraception, so the idea of this being a special interest issue is just wildly divorced from reality,” Black said.
“The other thread of opposition that we’ve heard […]is ultimately grounded in a desire to control women’s bodies.”
The future of free contraception in Canada
While there still isn’t any legislation making prescription contraception free, the number of organizations, communities, and people supporting the AccessBC campaign is rising.
The campaign has been directly endorsed by 18 municipalities across the province, including Victoria, Burnaby, and Vancouver. A growing number of groups, including the Vancouver District Labour Council and the Victoria Labour Council, the Abortion Rights Coalition of Canada, and the BC Government and Service Employees Union (BCGEU), support the campaign.
More notably, free prescription contraception was included in the BC NDP 2020 election platform. The province’s finance and government services committee has also endorsed this policy in its past two reports.
Brintha Sivajohan, another co-founder of the BIPOC Women’s Health Network, told The Pigeon making prescription contraception more affordable is necessary to make it accessible overall.
“Free prescription contraception is a step towards empowering BIPOC women,” she said. “But we need to take many more steps to ensure that this contraception is not only financially accessible but that there’s culturally-appropriate care being involved.”
Phelps Bondaroff said he hopes the increasing support from British Columbians and policymakers is an inspiration for Canadians and provincial governments across the country.
“We as a campaign aren’t stopping by the borders. We’re not stopping by the mountains. We’re trying to help our friends across the country get similar access to contraception as well.”
Meral Jamal was born and raised in a family of 20 in the United Arab Emirates. She is a journalism and history student at Carleton University, currently working as the newsletter editor and editorial assistant for LiisBeth.