Finance committee  Absolutely. The difficulty with contraception is that the less you can afford, the less likely you are to avoid an unintended pregnancy. You're more likely to get pregnant with condoms. When you go to prescription contraception, the baseline is birth control pills. Six to nine people per year using birth control pills, and twice that many if you're a teenager, will become pregnant with an unintended pregnancy.

Finance committee  It's a great question. By way of an overarching answer, I would look at the declaration by the American Public Health Association on the top 100 public health interventions over the past century, from when we came to the year 2000. This is basically from 1900 to 2000. The number one public health intervention across the country—and this was during the time we developed penicillin, vaccines and all of these things—was the introduction of family planning to support the success and engagement of pregnancy-capable people throughout our society.

Finance committee  It's women and their children. The ability to time and space pregnancies has a phenomenal impact on a woman's personal health. In situations where women have no control over their fertility, typically they are pregnant at least once a year, and sometimes more than once. This wears down their nutrition.

Finance committee  It's a great question, Don. The statement at UBC was based on about 10 years of research that we'd undertaken in partnership with the Government of B.C. and that was funded by the Canadian Institutes of Health Research. We did due diligence by collecting data from every sector of the province through sexual health surveys and putting them into a complex series of modelling that looked at all of the alternatives for how to support people to reduce the rates of unintended pregnancy.

Finance committee  As many of you may be aware—through history rather than your own knowledge—in the 1960s, when contraception became available and prevalent, there was a transformation in gender equity in our society. We were seeing a huge increase in the number of women, who now had control of their fertility, enrolling in colleges and universities, entering the job market and contributing to civil society and governments.

Finance committee  What you're asking me is a Canada Health Act question: Do we have universal principles with respect to how we deliver health care in Canada so that people in every province have an equitable chance to achieve their own goals for their health and for their health equity? Are people within Canada able to move between one province and another for their education or work and have coverage where they need it that is similar across the country?

Finance committee  The formulary that was proposed for the federal government, to my understanding, was designed to be the same as or very similar to what was implemented in B.C. In B.C., this formulary covers contraception in nearly every category. One category is excluded, where there are questions of health risk implications that are higher than others.

Finance committee  Well, the interesting thing to consider here, particularly in the case of contraception, is the health and societal implications from the costs of not providing prevention of unintended pregnancy. There are implications for families, society, education and our economics from the downstream effects of unintended pregnancies in our society versus prevention.

Finance committee  You don't have to go to a doctor for contraceptives. You can see a nurse practitioner. You can see a midwife. In many provinces, you can see a public health nurse. In seven provinces across Canada, you can walk into your pharmacy and have a private discussion with your pharmacist.

Finance committee  Yes. I referenced an analysis of the way the act was implemented in the first three years.

Finance committee  The act as it was first implemented—and not the way it is right now—to my understanding was providing single-payer coverage for the majority of the population.

Finance committee  I would have to go back and recheck that.

Finance committee  That started in April 2023.

Finance committee  My understanding is that the federal government would like a program that's implemented across all of Canada and would like all provinces to participate in providing this service. All provinces currently provide some component of their population with some coverage. At the moment, British Columbia has the most coverage, but the federal coverage, as I understand it, will be evening this across the country.

Finance committee  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.