Accessing the birth control pill, one of the most commonly used methods of contraception, isn’t always easy for some Canadian women.
Moving cities, going to multiple walk-in clinics, or feeling uncomfortable with a family doctor may impede consistent access to the pill, said Emma Stern, co-founder of Felix Health based in Toronto.
The company is a prescription and delivery business that connects customers in five provinces with doctors and medication, including the birth control pill.
“I had a pediatrician until I was 19, and I really didn’t feel comfortable talking about birth control,” said Stern, who launched Felix alongside CEO Kyle Zien.
Felix’s doctors can also prescribe the birth control patch or ring, depending on what the patient needs. They can also recommend options like an intrauterine device (IUD).
Getting a prescription from the service will cost customers $40, as Canada doesn’t usually cover virtual medicine services.
Stern says she personally understands the difficulties women may face needing constant prescriptions or refills of the pill.
She recalls girls from her high school skipping class to visit a Toronto walk-in clinic to get birth control prescribed.
“It was only open certain hours of the day … and it was all very cloak and dagger and made you feel pretty bad about it,” she said.
After going to university abroad, Stern had more issues accessing birth control.
For young women, specifically, who rely on birth control, moving frequently can create a “slew of inconveniences,” she said.
“I’ve probably had to transfer my birth control prescription to a different pharmacy upwards of 10 times,” she said.
She adds that safety and constant, judgement-free communication between patients and doctors is a main facet of their business model.
Many women still can’t access contraception
The birth control pill is the second most popular form of contraception in Canada, behind condoms, according to the 2015 Canadian Contraception Survey. The survey found that 44 per cent of sexually active women not wanting to get pregnant were using the pill.
Yet, accessing a consistent prescription can be an issue.
While countries like Australia, Britain and 10 other nations in the European Union offer universal coverage for oral contraceptives, Canada does not. Most women in the world can take the pill without a prescription, according to a 2013 study by Ibis Reproductive Health.
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It becomes harder for women in rural communities, where there may be lack of access to doctors or the doctors know you personally. Contraceptives are underused in Canada, and one in three women choose to have an abortion, according to a 2015 study by Healthcare Policy.
Physician bias is also an issue that disproportionately impacts new immigrants, young women, Indigenous women and those in rural or remote communities.
Cost is the biggest barrier to birth control access, along with inconsistent sexual health education and limited access to doctors in rural communities, the study reported.
A shortage of primary care doctors in Canada means online health models may be a good way to fill the gap, especially for women outside of big cities, says Marilyn Ford-Gilboe, the research chair in rural health at Western University in London, Ont.
“It’s a way of ensuring that women are in control of their health care decisions and options,” she said. “There’s still many women who don’t have a connection to primary care services.”
While the number of doctors in Canada increased by 12.4 per cent between 2014 and 2018, 92 per cent of doctors live in urban centres, according to a Canadian Institute of Health information report from September.
To connect with patients, Felix has women fill out a survey created by health care practitioners who specialize in reproductive health and then connects them with a doctor who determines whether the pill is the right option for them.
Expanding to all of Canada is a priority and the company hopes to do so by early next year, said Stern.
Online medicine can fill gaps — at a cost
Although telemedicine — using private doctors online — creates health care at your fingertips, there are extra fees associated with it as it’s not covered by the government.
Felix charges $40 for its services if you’re given a prescription by one of its doctors, while Canada’s universal health care system wouldn’t have you paying for an appointment.
The company covers all shipping costs, even to remote areas, if you use their pharmacy partner Alliance Pharmacy. A $12 pharmacy fill fee is charged regardless of the pharmacy used.
If you don’t have health insurance, birth control typically costs between $10 and $15.
Maple, another Canadian telemedicine company, provides prescriptions for a $30 membership fee or a one-time $49 fee on weekdays.
“E-health” and telemedicine options have gotten more popular, with more offerings in the United States. Companies have been using a similar model to Felix’s to connect with patients who have depression and other chronic health issues for a while, said Ford-Gilboe.
Medication delivered to your door is appealing to women for many reasons, even if you have access to a family doctor, she added. Not worrying about how you’ll be treated by a doctor can be important.
“For young women… they may worry their provider will judge them for their sexual activity,” she said. “Especially if they happen to live in a community that has more conservative norms.”
Some health care professionals have criticized telemedicine, saying it’s contrary to the universality principle as you have to pay to access it, and the standard of care may not be the same, as the doctor is at arm’s length, as reported by the CBC.
Having telemedicine be covered by the universal health care system is something some doctors who work for those companies want, as reported by the Canadian Medical Association Journal.
It may not be a preferable option for all women, but the fact that it’s available at all is important when determining how to deliver health services in a country as large as Canada, said Ford-Gilboe.
After her family doctor retired, Rosemary Richings, 28, started using Felix because she was frustrated explaining to a new doctor why she needed birth control after using it for years.
Living in the U.K., contraception is as easily accessed as cough drops, she said.
“There was never any guarantee that the renewal would be processed on time,” she said in an email. “My life was changing and I was out of town a lot more than I used to be.”
Richings, a blogger and content strategist in Toronto, says that with delivery, at least she knew the birth control would arrive on time.
“It’s a huge relief, because the worst part of the pill is that if you don’t take it at the same day and time every day, it won’t work,” she said. “This system makes following those rules much easier.”
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