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Access to contraceptives care unaffordable for rural, marginalized communities, doctor says

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The recent attention on abortion rights in the U.S. has put reproductive health in Canada in the spotlight, highlighting major gaps in the health care policy that should be addressed, says one doctor, including universal access to all contraceptive methods.

Canada is one of the only countries with universal healthcare but no universal access to contraception, making it limited and costly, especially for those in rural and marginalized communities.

At the same time, roughly 30 to 40 per cent of pregnancies in Canada are unintentional, according to Dr. Vivian Tam, a family emergency physician based in Ottawa.

"This disproportionately happens amongst women who are quite young, so those that are 15 to 24 years of age, those who live in rural and remote communities in Canada, who belong to Indigenous communities, or are newcomers to Canada," Tam told CTV's Your Morning on Thursday.

"This is the group that has the most difficulty in accessing contraception at large, but in particular, are long-acting reversible contraceptives, which are the most effective form of contraception."

Intrauterine devices, or IUDs, for example, is a highly recommended option that lasts for five years and can prevent pregnancy 99.9 per cent of the time, but can cost up to $400, pricing it beyond the reach for many. In addition, Tam noted that not all small communities have pharmacies that have all contraceptive options in stock year-round.

One U.S. study found that a publicly funded contraceptive plan resulted in major cost savings, with every dollar spent on IUDs resulting in seven dollars saved in other health-care costs. Tam noted that in countries like the U.K. and Australia where contraception is covered, there are clear downstream cost savings with respect to averted unwanted pregnancies, constituting STIs and infertility.

Detractors have argued that condom access is often available at low- or no-cost, but Tam says it is not enough, adding that condoms are also a predominantly male control form of contraception.

"What we really want to do is to protect and prioritize the reproductive freedom and health of people with a uterus," said Tam.

"Condoms are only effective 85 per cent of the time. And so when we have an option that is 99 per cent effective at preventing unwanted pregnancy, really using condoms alone and having access to them only is unacceptable."

Tam says Canada needs to expand the network of providers able to prescribe and renew

contraceptive care options.

"The first thing that we need to do as a country collectively is to reject the idea that just because you're poor or living in a rural part of the country or indigenous, that you need to accept a lower standard of health care and wellbeing," she said.

"So subsuming contraceptive care under universal health coverage is the first step. The second is that pharmacists in provinces, like Nova Scotia, Alberta, Quebec and Saskatchewan currently are able to counsel around and be primary prescribers of contraception. And this is a privilege that we need to extend to all pharmacists across Canada so that those who are living in geographically remote areas also have access to contraceptive care if and when they meet."

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