Universal access to no-cost contraception youth in Canada

Question 1

Associations with adolescent parenting?

Answer 1

• lower lifetime educational achievement
• lower income
• increased reliance on social support programs

Question 2

Common categories of contraceptive types?

Answer 2

• Barrier methods (condoms and diaphragms)
• Hormonal short-acting reversible contraception (SARCs), used daily (oral), weekly (transdermal), monthly (vaginal) or quarterly (injections)
• Long-acting reversible contraceptives (LARCs) (IUS or IUD and subdermal implants - only IUS AND IUD available in Canada)

Question 3

Why are LARCs the recommended first-line contraceptive method?

Answer 3

Typical use failure rate of <1%

Question 4

Despite the proven effectiveness of LARCs, most adolescents use ______. What is the typical use failure rate of these methods?

Answer 4

• Short-acting hormonal contraceptives

- Typical use failure rate between 6% and 9%.

Question 5

What is the single most important barrier to access to contraception? What population is most disproportionately affected by this barrier?

Answer 5

• Cost

- Youth

Question 6

Additional barrrier for youth who are dependents of those with private insurance?

Answer 6

Confidentiality

Question 7

Recommendations?

Answer 7

1. All contraceptive (including condoms) should be covered under provincial/territorial or federal health plans at no cost, until age 25
2. Health ministries should also provide contraceptives at no cost to community-based health care services for youth, to support point-of-care dispensing and simplify access
3. Health ministries that adopt public-private models to cover contraceptives must ensure that privately insured youth have equal access to no-cost, confidential contraception. To that end, they must:
   a. Create a mechanism for pharmacists to identify a youth’s insurance provider, such that contraceptives can be dispensed without a parent’s knowledge
   b. Require private insurers to cover the entire cost of all contraceptives for youth at the point-of-sale, until age 25
   c. Require private insurers to protect confidentiality by not reporting the purchase of contraceptives to primary policy holder
4. If oral or other short-acting hormonal contraceptives become available over-the-counter, the law should ensure their continued provision at no cost, until age 25, under all government and private pharmaceutical plans