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The paper published Monday in the BMJ examined the prescriptions of nearly 860,000 women in the 15 months after contraception coverage began and compared them to what would have been expected without coverage.

Among prescriptions for women aged 15 to 49 between April 2023 and June 2024, 11,000 more women were prescribed IUDs, which are inserted into the uterus to prevent fertilization and considered 10 times more effective than pills or condoms.

Reached in Vancouver, lead author Laura Schummers said IUDs can cost up to $450 out-of-pocket compared to approximately $25 for a month of pills, according to a government estimate. Though IUDs last at least three years, they cost more upfront. 

"This tells us that costs alone are a huge barrier to the most effective methods of contraception across Canada,� said Schummers, an assistant professor of pharmaceutical sciences at the University of British Columbia.

Schummers says these results clearly demonstrate the need for national pharmacare coverage, as affordable access is unequal across the country. 

Many other provinces will only cover contraception for those who are below a certain age or income. The federal government said just a fraction of Canadians are eligible for that low or no cost option.

The British Columbia government started covering 100 per cent of the cost of all IUDs, such as copper and hormonal, contraceptive implants and injections, vaginal rings, most birth control pills and emergency oral contraceptives on April 1, 2023. 

The federal government announced in October 2024 that it intended to cover the cost of contraception and diabetes medications. That required the government to negotiate and sign deals with each province and territory.

But the Liberal leadership changed ahead of the spring election.

Last week, federal Health Minister Marjorie Michel said the Mark Carney government would not commit to signing pharmacare funding deals beyond the three provinces and one territory that did so under Justin Trudeau. Those include P.E.I., B.C., Manitoba and Yukon.

A spokesperson for the minister says the government will protect the four deals that have been signed.

Schummers says those who cannot afford IUDs may either choose cheaper but less effective methods, or forgo contraceptives altogether.

“This is not a small fraction of people who are falling through the cracks," she says.

The study says that 15 months after the policy was implemented, there were 1,981 more monthly prescriptions filled when compared to what they were expecting based on pre-policy trends.

Schummers says the increase in IUD use was seen across all age groups, but most pronounced for people aged 20 to 29, many who had previously not been using any prescription contraception.

Halifax pharmacist Kari Ellen Graham says she's seen customers prescribed birth control leave empty-handed because of the cost. 

She said one woman was in an abusive relationship but could not afford to pay out-of-pocket for birth control. The next summer, she saw the woman with a newborn in tow. 

“We see this all the time in gender-based violence and it's a really sad thing when people don't have reproductive autonomy,� Graham said.

There are deductibles and copayment options for contraception in Nova Scotia, but both require the patient to pay at the counter. 

“It's been decades that we've been having these conversations around birth control here in Nova Scotia and we are exactly where we were decades ago,� she said. 

Dr. Amanda Black, past president of the Society of Obstetricians and Gynecologists of Canada, said there's a financial incentive for the federal government to cover the cost of contraception. 

A paper she authored in 2015 estimated the direct health-care cost of unintended pregnancies in Canada was at least $320 million per year, which she said is very likely higher in 2025. That figure accounted for the cost of abortions, ectopic pregnancies and births. 

She said UBC researchers in 2018 estimated that the provincial government breaks even within two years of funding birth control. 

“After that the government is actually saving money,� said Black, a professor of obstetrics and gynecology at the University of Ottawa. 

Black said it would be a step backwards for women’s health in Canada if the federal government stops signing pharmacare agreements with the provinces, particularly as reproductive rights are being rolled back in other parts of the world.

“We want to be moving forward and continue to move forward and this is one of the biggest things that has happened for women’s gender equity in decades.� 

- with file from Sarah Ritchie

This report by °µÍø½ûÇø was first published July 28, 2025. 

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