Young people who are offered confidential and free access to prescription contraception methods are significantly more likely to use them, according to a new McMaster University study.

The findings, published on Aug. 18 in JAMA Pediatrics, offer real-world evidence that providing confidential, free access to contraception increases use of prescription contraception, especially long-acting reversible contraception (like IUDs).

Access to contraception is an essential component of reproductive health care.

The results are especially timely as Canada considers the future of a national pharmacare plan that would include universal free contraception.

Researchers evaluated the impact of Ontario’s OHIP+ program, which provided free prescription medications to people under the age of 25 from January 2018 to March 2019, before the program was scaled back to exclude people with private insurance. The study examined both oral contraceptive pills (OCPs) and intrauterine devices (IUDs) and found:

• Over 1.17 million OCPs were dispensed to young people in Ontario, an increase of more than 250,000 (27 per cent) compared to the year before.

• IUD use jumped by nearly 80 per cent, before dropping again when the program was scaled back.

“Our findings show that removing barriers can dramatically improve access to effective contraception for youth,” says Amanda Downey, lead author of the study, who conducted the work as part of her PhD in Health Research Methodology at McMaster.

“Confidentiality also appears to be a critical factor for youth seeking contraception. When young people are forced to rely on their parents’ insurance, it can deter them from accessing the care they need.”

Researchers found that when OHIP+ was revised in April 2019 to exclude youth with private insurance, contraceptive use declined. These findings are especially relevant to the current debate about national pharmacare, with Ontario still lacking an agreement.

The study used a controlled time series analyzing using national pharmacy data to track over 44.9 million contraceptive prescriptions dispensed across Canada between 2016 and 2020.

“This study adds to a small but growing body of evidence concerning the impact of drug insurance on outpatient drug use, generally, and contraception in particular,” says senior author Emmanuel Guindon, associate professor in McMaster’s Department of Health Research Methods, Evidence and Impact, and Chair in Health Equity at McMaster’s Centre for Health Economics and Policy Analysis.

“Through this study we were able to see the clear, measurable positive impacts that this type of policy can have on the population.”

Last year, the federal government announced the implementation of a program to offer universal free contraception across Canada. The researchers say results from this study offer insight into expected trends that could be seen nationally through the federal government’s program.

The study was supported by a grant from the Canadian Institutes of Health Research.