Thank you very much, Mr. Chair and members of the committee, for the opportunity to speak here today.
By way of introduction, I'm a family physician and a professor at the University of British Columbia, and I hold the Public Health Agency of Canada's chair in family planning research. I serve as the external chair for Statistics Canada's sexual and reproductive health advisory committee, and I lead the largest Health Canada sexual and reproductive health fund project to advance equitable access to family planning nationally. I also advise the World Health Organization on sexual and reproductive health and preconception health.
There are two issues I wish to highlight for you here today. First, universal single-payer, first-dollar contraception coverage has been demonstrated around the world and in Canada to be the most cost-effective government investment to lower health system costs and improve health equity and health outcomes. Second, universal access to free contraception to prevent unintended pregnancies will support positive, immediate, lifelong and intergenerational impacts on individuals, their families and society that improve health and equity.
To begin, evidence from health systems around the world has found that universal contraception coverage costs governments less than it costs to manage unintended pregnancies in universal health systems. The cost to provide universal free contraception is always less than the cost to manage pregnancies. In the U.S., after they implemented universal coverage through the Affordable Care Act, they found a savings of $7.09 for every dollar that they invested. Similarly, Public Health England saves nine pounds for every pound invested with universal first-dollar, single-payer coverage for all contraceptive methods. Our analyses in a CIHR-funded study working with the government of B.C. have modelled that within a few years, they will begin saving five dollars every year for every resident of B.C. in health costs because the cost of providing everybody with whatever contraceptive method they require is lower than the current cost to manage unintended pregnancies.
An important factor in contraception is the difference between universal first-dollar coverage and fill-the-gaps coverage. Contraception is a very stigmatized prescription, particularly among equity-deserving populations. Our studies have found that reproductive-age people, particularly women and pregnancy-capable people at the ages of highest fertility, are the least likely in our society to have prescription benefits. Among those few who do have coverage, the primary insurance holder is often a coercive partner or a parent. Many do not have confidential or private access to contraception coverage and would instead forego this opportunity.
Analyses under way by UBC's Dr. Laura Schummers, using the B.C. health administrative and pharmaceutical databases before and after B.C. introduced universal first-dollar, single-payer coverage for contraception last year, found that in addition to nearly 30,000 people who had unintended pregnancies before this policy—many of whom were unable to afford contraception at all—40% of those who obtained a contraceptive in B.C. paid 100% out-of-pocket for that method. Additionally, another 20% were paying copay for the cost.
After B.C. introduced their single-payer plan, we saw a massive shift with a big uptake in contraceptive methods overall, and a shift away from the less effective, less expensive methods towards those that are the most effective in preventing unintended pregnancy. Fewer than 10% of people paid any amount out-of-pocket for the very limited number of contraceptive methods that are not covered under the plan.
In Canada, 40% of pregnancies, or over 160,000 per year, are unintended, and the most common outcome is birth. These unplanned births can have devastating effects as they move forward. All outcomes for unintended pregnancy could have lifelong effects. These intergenerational consequences not only affect the pregnant person and the unplanned child, but also reduce the supports available for other children and extended relatives already in the home. More effective contraceptive methods offer families a better and safer start for planned and spaced children and allow family members to pursue advanced education and workforce opportunities. In contrast, people who are unable to afford contraception demonstrate lower education achievements, lower household income, higher exposure to intimate partner violence and suffer lower chances for their children to have food safety and adequate shelter during their development.
There are very few investments in health with the potential to offer health system savings, improved equity and a healthy quality of life for children and families across Canada. The investment the government is proposing to provide universal single-payer, first-dollar contraception has the potential for intergenerational and society-wide impacts on Canada and all Canadians.