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Poster Presentation  - International Federation of Gynecology and Obstetrics (FIGO), World Congress of Gynecology and Obstetrics, Paris, October 9-12, 2023.

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Advocacy Strategies in Reproductive Healthcare:

A Cross Sectional Analysis of Canadian Universal No-Cost Prescription Contraceptive Campaigns

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Authors: Habte R., Eftekhar, S., Wiesenthal, E., Black, D., Phelps Bondaroff T.
 

Objective
Analyze the landscape of contraceptive coverage and advocacy strategies utilized by no-cost contraceptive campaigns across Canada, clinician involvement, and effect(s) on public policy.


Method
The landscape of contraceptive coverage was extracted from government websites. Grassroots no-cost contraceptive campaigns across Canada were located through a Google News search utilizing region name and keywords in English and French equivalent, “free contraception campaign”, “free birth control campaign”, “contraception coverage”, and “birth control coverage.”


Results
Ten provinces/territories have income-based coverage. Five formalized no-cost contraception campaigns were found: AccessBC, Wellness Within, Universal Access to Contraception Saskatchewan, Birth Control Access for Manitoba, Cover ContraceptiON. Three were clinician-founded and all have clinician-trainee involvement. All conduct research, make statements, consult with government, and engage in public mobilization. Two have letter writing campaigns and six political parties have endorsed the policy. British Columbia was the first to implement universal no-cost contraception on April 1, 2023.


Conclusion
In Canada, the primary approach by advocates is letter writing, statement generation, and
lobbying government. Campaigns variably have clinician-in-practice involvement and have
driven system level change.

 

Poster FIGO2023.JPG

Findings

 

NATIONAL

  • Prior Landscape: no federal mandate, status Indigenous or Inuit patients have most options covered under National Insured Health Benefits (NIHB)

  • Campaign details: Canadian Federation for Medical Students (CFMS); Action Canada for Sexual Health & Rights; Dr. Rupinder Toor

  • Strategic approach: CFMS - direct advocacy by lobbying government officials and media campaigns; Dr. Toor - national petition to House of Commons

  • Policy commitments: none thus far

 

BRITISH COLUMBIA

  • Prior Landscape: means based coverage, limited coverage of contraceptives following therapeutic abortion

  • Campaign details: AccessBC is a grassroots campaign established in 2017

  • Strategic approach: letter writing campaign, conduct research, mobilize the public, meet with MLAs and ministerial staff, engage in awareness raising and outreach activities, and consult with government

  • Policy commitments: no-cost contraception in place as of April 1, pharmacists able to prescribe contraceptives

 

ALBERTA

  • Prior Landscape: means based coverage, limited coverage for <26yo if accessing specific Alberta Sexual & Reproductive Health clinic, pharmacist prescribing

  • Campaign details: no formal campaign, although group of obstetrics and gynecology residents doing grassroots advocacy

  • Strategic approach: consult with Members of the Legislative Assembly (MLAs)

  • Policy commitments: Official opposition party has committed to including no-cost contraception if elected

 

SASKATCHEWAN

  • Prior Landscape: means based coverage, free emergency contraception and condoms, pharmacist prescribing

  • Campaign details: newly formed grassroots campaign Universal Access to Contraception Saskatchewan by medical students

  • Strategic approach: open letter writing

  • Policy commitments: none yet

 

MANITOBA

  • Prior Landscape: means based coverage, limited no-cost coverage following therapeutic abortion or through specific clinics

  • Campaign details: grassroots campaign Birth Control Access for Manitoba founded by OBGYNs, residents and medical student

  • Strategic approach: direct advocacy through consulting with government

  • Policy commitments: Official opposition party has committed to including no-cost contraception if elected

 

ONTARIO

  • Prior Landscape: meas based if >25yo, available at no-cost if <25yo if no private insurance

  • Campaign details: OBGYN residents started campaign Cover ContraceptiON

  • Strategic approach: letter writing campaign (both for public and specifically for healthcare workers), conduct research, make policy statements, meet with MPPs and ministerial staff, engage in awareness raising and outreach activities, and consult with government

  • Policy commitments: Official opposition party has committed to including no-cost contraception if elected

 

QUEBEC

  • Prior Landscape: means based coverage, some meds completely covered with claim slip, all 18-25yo covered, pharmacist prescribing

  • Campaign details: no formal campaign, one party, Quebec Solidaire, made a statement in response to Roe v Wade being overturned

  • Strategic approach: n/a

  • Policy commitments: Quebec Solidaire has committed to including no-cost contraception if elected

 

PRINCE EDWARD ISLAND

  • Prior Landscape: various plans possible, varying amount of co-pay

  • Campaign details: PEI Abortion Rights Network start on advocacy re: abortion access

  • Strategic approach: speaking to media, opinion pieces

  • Policy commitments: none yet

 

NOVA SCOTIA

  • Prior Landscape: Means based coverage, pharmacists can prescribe contraceptives, "Free Birth Control Act" first reading in NS legislature in March 2021

  • Campaign details: Grassroots advocacy by Dr. Paynter, Private members bill

  • Strategic approach: speaking to media, opinion pieces

  • Policy commitments: Bill 73 not yet adopted

 

NEW BRUNSWICK

  • Prior Landscape: means based coverage, limited pharmacist coverage, limited free coverage through horizon NB

  • Campaign details: Reproductive justice group, Save Clinic 554

  • Strategic approach: media campaigns

  • Policy commitments: none yet, current government very resistant

 

NEWFOUNDLAND & LABRADOR

  • Prior Landscape: means based coverage, Planned Parenthood has more affordable birth control

  • Campaign details: none found

  • Strategic approach: none found

  • Policy commitments: none yet

 

YUKON

  • Prior Landscape: limited pharmacare coverage of contraceptives (mirena only for failed tx of endo, nexplanon not listed), some clinics offering subsidized meds

  • Campaign details: no grassroots campaign found, political party made a campaign  announcement during the 2021 election

  • Strategic approach: n/a

  • Policy commitments: included in party platform in 2021 that later formed minority government 

 

NORTHWEST TERRITORIES 

  • Prior Landscape: means based coverage

  • Campaign details: no grassroots campaign found, government currently seeking feedback on no-cost contraception

  • Strategic approach: n/a

  • Policy commitments: none yet

 

NUNAVUT

  • Prior Landscape: condition based coverage for patients not covered under NIHB

  • Campaign details: no grassroots campaign found

  • Strategic approach: n/a

  • Policy commitments: none yet

 

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