Dr. Teale Phelps Bondaroff: Free Prescription Contraception

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2024/05/11

Dr. Teale Phelps Bondaroff became passionate about access to prescription contraception after he encountered universally available free prescription contraception while completing his graduate studies in the UK. After returning home and discovering that this was not the case in Canada, he helped launch the AccessBC Campaign.​

He has a PhD in politics and international studies from the University of Cambridge, and BAs in political science and international relations from the University of Calgary. In 2022 he was elected as Councillor in the District of Saanich. He is active as an independent academic researcher, and works as the Director of Research for OceansAsia, and the Research Coordinator for the BC Humanist Association.

Here we talk about the current work in practical terms of AccessBC.

Scott Douglas Jacobsen: What we were going to do, we will start with: You won the Jack Leyton Prize. What did you win it for?

Dr. Teale Phelps Bondaroff: Yes! The AccessBC campaign was awarded the Jack Leyton Progress Prize – a prize in Jack Leyton’s name was awarded in the last decade to recognize individuals and organizations that run a noteworthy political cause or campaign reflecting the ideals of Jack Leyton. 

The co-founder of AccessBC, Devon Black, and I were in Ottawa to receive this award last weekend. The fantastic thing about the prize is that it recognized the work we and the over 80 volunteers who fought for free contraceptives in BC did. 

A touching part of this award was receiving it with Devon – we have been doing politics together for over 20 years. Our first campaign was in 2005/2006, a federal election campaign when Jack Layton asked me to run in Calgary West for the NDP. 

I assembled a team of teenagers. I was 19. Devon was 17. She could not vote. She served as my Communications Director. We had this children’s campaign, basically [Laughing]. We ran a federal election campaign. After a long, grueling, 5-week election campaign, we have been doing politics together ever since. 

Getting the Jack Layton Award, meeting with Olivia Chow, and hanging out with progressives in Ottawa was really touching. It was great that the award recognized the work of AccessBC, which has been campaigning for free contraception since 2017 in BC. 

Jacobsen: From a progressive point of view, the most significant thing about this [policy] is that it is the right thing to do. It also saves a lot of money.

Phelps Bondaroff: When we do advocacy around this – and I have done like 360 TikTok videos advocating free prescription contraception – I say free contraception improves health outcomes for infants and mothers, makes life more equal, makes life more affordable, and saves governments money. 

There is excellent research on this. A 2010 Options for Sexual Health study estimated free prescription contraception would save the BC government as much as $95 million every year. There have been other studies. One published in 2015 in the Canadian Association Medical Journal would save Canada as a national program $320 million. 

There are even more examples. I have most of the numbers memorized. The other was a study in Colorado. It was over several years. They gave out 43,713 IUDs. It cost $28 million. It reduced teen pregnancies by 54% and teen abortions by 64% and saved the government an estimated $70 million over eight years [for sources see the AccessBC Campaign briefing paper]

I have said this time and time again. There are no good reasons to oppose free contraception. We have been doing advocacy for over 7 years. We have not come across a single argument against the policy that was not deeply bathed in misogyny. 

Jacobsen: Even if we are looking at the ends of looking across the political spectrum, people do advocate, whether explicitly or implicitly, for a reduction in teen pregnancies and a reduction in unwanted pregnancies. Even on that level of basic outcomes, these are the right things to do in practical terms.

Phelps Bondaroff: It is also noteworthy that people don’t only take contraceptives to prevent unwanted pregnancies. Rather, people use contraception for gender-affirming care, treating hormonal acne, chronic gynecological conditions, like endometriosis and PCOS, to prevent certain types of cancers, for menstrual regulation, and a whole host of other reasons. You have a whole bunch of reasons. They are all valid and important and improve people’s health and wellbeing. 

In BC, after the 2020 election, all of the political parties in the province supported the policy. Some of them had it on the platform. Some were forced to do it over Twitter due to scandals. But it was one of those things. All parties got behind because it made sense.

So an update about the issue across the country. BC made prescription contraception free in April 2023. Manitoba made it free just recently – they announced it in Web Kinew’s first official budget in Manitoba. 

Now, we are having a conversation on free prescription contraception at the national level because the NDP-Liberal government has proposed national pharmacare. It will start with free contraception and free diabetes medication. It is going across the country!

Now there are a few provinces that are holdouts. We have been getting some negative messaging from Alberta, where Danielle Smith and UCP have resisted the policy. This opposition raises an eyebrow, because there are arguments from every single part of the political spectrum to support this policy. 

From a progressive perspective, there are powerful equity arguments. From a health perspective, there are powerful maternal health arguments –  who doesn’t want to support maternal health? Please find me a government that doesn’t support maternal health; I will find you a government that shouldn’t be a government. 

You have affordability – we are talking about an affordability crisis. Contraception is expensive: An intrauterine device (IUD), hormonal variety, can cost $500. Copper IUDs are $75. Implants are $350. Injections may cost $180 over a year [learn more on the issue on AccessBC website]. A pill can be $20 or $30 per month, which adds up. Those costs fall disproportionately on women and people who can get pregnant. It makes both an equity and an affordability issue.

On top of that, this policy saves governments money. When explaining this to people, we often say things like: “Unplanned pregnancies are expensive, whether they end in abortions (which are more expensive than contraceptives) or a child carried to term, they are expensive. Unplanned pregnancies can be at a higher risk of complications to the child and mother, which can put additional costs on our healthcare system. And likewise, the slogan “if someone cannot afford contraception, then they may struggle to afford to raise a child” also summarizes why the policy is revenue positive.

We know this from stats. The same Options for Sexual Health study from 2010 estimated that every dollar spent on contraceptive support saves $90 in expenditures for social support. We know these policies save money. So there is a strong fiscally conservative argument in favour of contraception. 

Also, there is a socially conservative argument. Free prescription contraception reduces unplanned pregnancies and, therefore, reduces the need for abortions. The fact that we have publicly funded abortions in Canada is fantastic, and we have to work to expand that. At the same time, if people have access to contraception, there is a lowering of the rate of unplanned pregnancies as a result, and that is also a good thing. 

Free prescription contraception is one of those policies that everyone can get behind. Seeing the odd political party get it wrong is always disappointing. There tend to be electoral consequences as a result. 

Jacobsen: You mentioned most or all the arguments that are counter, against, these advancements in what you and I would consider basic human rights arguments or the implementations of human rights arguments tend to be or are steeped in misogyny. What are some key examples of that? 

Phelps Bondaroff: I don’t like to give strawman/bad arguments. I often use social media to argue with trolls and hold space for the campaign. A lot of times, there are people saying things as silly as “I don’t want to pay for other people to have sex.” Which is silly, as we have publicly funded healthcare. They are already paying for others to have sex. Also, it is ridiculous because that is not how it works. We are talking about necessary medicine used for a lot of reasons. People have a knee-jerk reaction when they see reproductive and sexual health conversations taking place. This is also a barrier to accessing contraception. 

When we are talking about prescription contraception and barriers, there are direct costs, but there are also indirect costs, stigmas, taboos, and barriers in society. Imagine someone living in a remote community. They may have to pay for transportation to a clinic, maybe multiple times to get a prescription, pick up their prescription from a pharmacy, get an IUD inserted. And similarly pay for childcare, and/or pay for time off work or miss school. These are all indirect costs that compound, and again, fall disproportionately on women and people who can get pregnant.

There is a stigma in our society around sex and reproductive health that makes those conversations even more difficult. So, I think many people have knee-jerk reactions. 

You see a lot of arguments around control. Those who want to control other people’s reproductive health. It is about the patriarchal control of other people’s reproductive autonomy. I find that abhorrent. 

You get weird arguments. This comes up a lot, and it is a terrible argument in the pro-forced birth community. They want people to experience unplanned pregnancy as a consequence or punishment for behaviour they don’t like. That is reproductive coercion. The list of terrible arguments goes on. They are about control, misogyny, and the patriarchy; they are all garbage.

Jacobsen: How many are grounded in religious community, ethics, and texts? They are explicitly mentioned. I want to make a slightly nuanced distinction or parse between a religious community that has its ethics around things that may not come from the text explicitly and those who actively cite religious texts to support those misogynistic views.

Phelps Bondaroff: It doesn’t come up as much as one would expect. In BC, even though we ran the campaign for seven years, had multiple waves of letter-print campaigns, earned hundreds of news stories, and were quite prominent, we didn’t get as many strange attacking blogs from the far-right religious community as we expected. At least not until a little bit later when the policy became closer to being implemented. 

The policy is about individual, personal reproductive autonomy. I have always found it strange that someone would want to impose their religious views on another person and do so via legislation. Some want to do this more than others. We have not seen a concerted effort in BC to oppose the policy. It doesn’t mean opposition doesn’t exist, I just don’t run in those circles. I don’t get the Campaign for Life daily email blast. For all I know, they are having a lengthy conversation about us as we speak.

A lot of the profoundly conservative arguments talking about patriarchy and misogyny and controlling people’s reproductive autonomy are sometimes grounded in faith traditions. Still, you can see people from a range of faith traditions standing up for people’s reproductive autonomy in other contexts. It is probably a deeper conversation about certain religious values in society and how these influence policy. 

I would say a lot of the taboos, and the reticence people have about discussing sex and reproductive health, probably stem from the lingering impact of religious faith traditions in our society, but that is probably a question for sociologists to dive into. 

Jacobsen: Certainly, we can make these armchair historical contingency arguments. The country was long a majoritarian Catholic and Christian country. We’re only recently coming out of that legacy. A lot of those unspoken mores are stuck in my mind.

Phelps Bondaroff: It is worth repeating. People have their religious views for whatever reason: They like wearing hats, dressing a certain way, and doing certain behaviours. They do or do not like contraception. That is on them. This is about making contraception publicly available to those who want it and need it. It is about people’s reproductive autonomy. 

I always found imposing on other people’s reproductive autonomy abhorrent. It usually comes up in comments on social media with people who haven’t thought through the consequences of what they are saying. Any time anyone brings up the issue of population growth in this conversation, for example, that is a massive red flag. We are talking about individual reproductive autonomy; whether you have concerns that the birth rate is going up or down. It is completely irrelevant to the issue. 

The worrying alternative is when these two things are put together: If someone does have concerns about population and are talking about contraception, they are probably talking about limiting people’s access to contraception to force people to have babies. It is abhorrent. It is reproductive coercion and forced birth. 

Jacobsen: At a State level.

Phelps Bondaroff: Exactly. I point out and try to ask people to think through the consequences of their arguments or beliefs. I’ll say something like: “You have to walk through the consequences of what you just said.” It is messed up to try to have the state involved in whether someone has or does not have kids. It is individual reproductive autonomy. It is a fundamental thing. The state should make this as easy for you as possible, in a judgment-free environment, with as much up-to-date and accurate information as possible, to make your own choices.

Jacobsen: Are we at the cusp of a Tommy Douglas moment with Canadian healthcare expanding from the provincial to something like universal pharmacare across the country? Are we seeing the beginnings of this in the future, at least on the reproductive front?

Phelps Bondaroff: Yes, I hope that the national pharmacare is expanded. The fact is that it started with just two medications is a start, but more needs to be done. Look, I wasn’t part of the conversations. I would cover all medications. 

I have been advocating for publicly funded pharmacare and healthcare since I was a teenager doing politics in Calgary. This has always been the dream of Tommy Douglas, the NDP, and progressives everywhere. You should have access to healthcare fully, without regard to income, socioeconomic standing, race, religion, whatever. It all should be a fundamental human right. 

It is not just about going to a doctor. It is about getting the medication you need. Getting glasses you need. Getting dental and mental healthcare you need. It is a comprehensive package. “You are a human being with dignity and deserve to be happy, healthy, and alive. We should provide you with that basic necessity.” If we can’t furnish that, we should fix our society. 

The national pharmacare program – the way it is starting, we have two medications that will dramatically change and improve people’s lives. The fact is that insulin is so expensive in this country – I can’t speak to statistics around diabetes expenses because I haven’t explored them – But it is expensive. The fact it is so expensive is abhorrent. 

The fact that some people have to spend $500 to get an IUD to avoid a pregnancy they don’t want, also is abhorrent.

I hope that when these policies filter throughout the country and the healthcare system… When we say the free prescription contraception policy will save $95 million in BC per year, those are the costs associated with unplanned pregnancies and complications around pregnancies, and those costs, when saved, stay in the healthcare system and can be used to fund other services. 

I am not the Minister of Health, so I couldn’t tell you exactly where to put that money, but it will certainly help. One challenge with these savings is that savings are always realized somewhere else in the system. We saved money here, and the policy was implemented there. But these a minor complications, who wouldn’t want to save $95 million? We could do literally anything else with that money.

Jacobsen: Building houses is a big issue for a lot of Canadians.

Phelps Bondaroff: Just by keeping the money in the healthcare system, you could spend the money on anything else. Once we get a couple of years of the national pharmacare plan, it is easy to expand and grow. 

When contraception was made free in BC, we were really happy and. One of the members of my team called me up. “I am so pissed.” I said, “Why?” She said, “Because the one contraception I use isn’t on the list.” The policy covered a wide range of pills, hormonal and copper IUDs, injections, and rings were later added, and it covered Plan B/emergency contraception. But it didn’t cover the patch. She was like, “Come on!” 

So, we have been advocating for the expansion of the policy. It is easier for the government to change the formularies and make some changes. The ring was missing from the original list (I do not recall seeing it on the initial list). Now, it is on the list. They added it. It takes a stroke of a pen, and thousands of people who use the ring in the province can access a form of contraception for free that they couldn’t before. 

With the national pharmacare system, you get contraception and diabetes medication – and then ideally, we begin to add everything – because you should never have to worry about getting access to medicine that you need to stay alive. 

Just sticking around BC, I can give you the numbers insofar as the impact of the policy. The government came out with some numbers around the program’s first 8 months. In the first eight months, 188,000 British Columbians could access contraception without paying for it. 

The numbers in front of me are the first six months. It was 166,000 contraceptive prescriptions, not necessarily people, as sometimes folks will try a couple of types to find the type that works best for them. For example, there were 113,000 pill prescriptions. 30,000 Plan Bs and 20,400 hormonal IUDs, and the numbers reduce based on usage rates; that is a lot. 

So, we know those people are not paying. We also know when the policy was first rolled out, there was a long waiting time for IUD insertion in Vancouver. We thought. That is not good. It would help if you didn’t have to wait six weeks to have an IUD inserted. This was an additional  barrier. When the financial barrier was removed, people signed up to get contraception though, and this did indicate that cost was a barrier. 

Jacobsen: You are dealing with people on platforms where you can come across people who may be trolling and may be sincere. There may be a particular social or political leaning. They may have an ideological bias. Others may be trying to piss you off. 

Phelps Bondaroff: The example I would give is Danielle Smith and the UCP. They argued against the policy in the last election, saying, “People already have coverage.” We got responses from government officials when we wrote to them over the past seven years as well, noting that “There is coverage.” 

Yes, before free contraception in BC, there was an assortment of programs. People could get some coverage at a certain clinic because a clinic had a free program with samples. Some could do so if they were very low-income – there is a stepped program, and all your medications are covered if you make less than $12,500 annually. This is good, because you cannot survive on that per year, it is ridiculous. But if you make more money, only a certain percent of your contraceptives and medications are covered. 

Danielle Smith has argued that people are covered through work, and this is a terrible argument. For one, when you create these complicated processes, it is harder for people to access medication, and there is more red tape. Two, you may have heard the slogan. “It is expensive to be poor.” Right? 

Jacobsen: Yes.

Phelps Bondaroff: If someone is trying to access social programs, they have to take time to fill out the paperwork. They may have to pay upfront, and then wait for a cheque in the mail that may take weeks or months. This is particularly not good if people are in a situation where they are low-income. 

On top of that, you’ve got younger people. Maybe some people are on their parents’ plan that covers contraception. But they have to give up privacy if they want to access it. For some people, it may be fine and their parents may be okay with them being on contraceptives. For others, their health, safety, and housing could be at risk. 

It makes more sense to have a universal program rather than relying on this assortment of programs. 

Like some programs don’t cover some forms of contraceptives because they aren’t technically medications. A copper IUD is a medical device, not a pill or medicine. There are no “medical ingredients,” it’s just copper on an IUD, and as a result, they are often classified as a medical device, so some medical health plans don’t cover it. 

A universal program just makes more sense. If you have a means test, a bureaucrat must interpret and apply it. Someone will fail the means test and fall through the cracks, and they wouldn’t otherwise get access to contraception. 

Usually, conservatives argue that there are already healthcare plans. It is an argument favouring red tape, more barriers, health complications, people giving up their privacy, and is generally not better situation. If you make prescription contraction universally free, it solves all those problems. Don’t get me wrong; there are other barriers: indirect cost, stigma and taboo, travel time, and time off work—things like that. At least, we can tackle the direct cost and work at the other roots of the patriarchy. 

So currently, AccessBC is arguing for an expansion of the policy in BC, looking at additional forms of contraception. Currently, the program doesn’t cover Ella, the patch, Lolo, Slynd, or some brand-name pills. 

Jacobsen: What are those?

Phelps Bondaroff: Lolo and Slynd are low or no dose pills… for progesterone. I will direct people to their doctors and medical sites to learn more because I am not a medical doctor or expert. But my understanding is that these types of pills can be used by people who may experience side effects from other pills with higher doses. 

Ella is a morning-after pill or contraceptive. It works for more days and for people with higher BMIs. It is Plan B but more expansive in how it works. Copper IUDs can also be used as emergency contraception as well. 

The second thing we were looking for was more training for medical professionals for IUD insertions. After the policy was implemented, there was a 5-6 week waiting period for an IUD insertion. That is too long. We want more medical professionals trained in this. 

We also want to have a conversation about pain management. It is really important that… I haven’t had this experience…. But my understanding is that a UD insertion can be painful. The government can change how it funds doctors and provides funding to support pain management in that procedure. It is doable. We must ensure the funding is available for IUD procedure pain management and support medical professionals in doing proper pain management for IUD insertion. 

I had a TikTok a few days ago about this topic and the people sharing their stories in the comments were eye-opening. You shouldn’t have to go through that sort of pain to access IUDs.

Finally, we want to make some forms of contraceptives over the counter. You may have heard of Opill in the United States. They just made one form of pill over the counter. The need to get a prescription can be important if it is your first time getting contraception. If this is the case, go to a doctor, sit down, and find out what works for you. But if you have been using the same pill for two years, taking you and your doctor’s time to fill out a prescription to get a refilled again and again, is a waste of everyone’s time and money. Making some forms of contraception over the counter is another solution; other jurisdictions have done this. 

Those are our current four asks in BC. Across the country, we are working with our sister campaigns in other provinces: Alberta, Manitoba, Saskatchewan, Ontario, New Brunswick, and Nova Scotia! We are helping a campaign set up in Quebec. 

Great feminists are working on the issue out there. A lot of the work will need to be done through the national pharmacare plan, hopefully, but we need people to ensure the provinces are on board and make the policies as expansive as possible. We want to make sure the plans cover everybody with the widest range of contraceptives possible and are as simple to use as possible. It should be the BC model: You go to the pharmacy. You pick a prescription and pay nothing. 

There are people on the ground doing advocacy and this is critica with some provinces being reticent around the national pharmacare program.  Especially Alberta, where we are gearing up for a potential fight there. It’s hard to believe that we must convince the government to adopt a policy in everyone’s interest. The campaign in Alberta is called Project Empower. They are a fantastic group. They are gearing up for what hopefully won’t be a fight, but maybe.

Jacobsen: Would the conditions in Alberta and the fight go to the courts?

Phelps Bondaroff: I have no idea. It is outside of my expertise. It strikes me as so strange that any government would oppose a policy that improves health outcomes for infants and mothers, makes life more affordable and equal, and saves money. There is no reason for it. 

Suppose you look at who Danielle Smith has been appointed as her Minister of Health, and look at her record on this issue, especially over the last few months; it is worrying. We are gearing up for strong public pressure on the issue. I hope we won’t have to do it. I suspect we will. 

I want to be pushing forward forward on reproductive justice, but occasionally, we have to make holding and defence motions to protect the rights we already have won. 

I was sailing in the Gulf of Guinea when Roe v Wade was killed in the United States. It was shocking to so many people. It was the first time that we’d seen rights be rolled back in the United States. And a lot of people realized it could happen here. It could happen anywhere.

Jacobsen: It was a humanist disaster.

Phelps Bondaroff: Yes, we put together a national coalition. We wrote a reproductive justice manifest: reproductivejustice.ca. We got a whole bunch of groups together and put out our asks. What made that resonant was that people were looking for something they could do. They had justified rage at what was going on in the United States. They wanted to do something affirmative. We had momentum built around that. It is still growing. We started as a conversation at my kitchen table. Now, we are a national movement for free contraception. 

With all the rolling back of rights in the USA, what I’ve often said is we want to make Canada a beacon of hope for reproductive justice. You see, the rights are rolling back in the States and in other countries as well. We can step up and be the best. We can offer the most access to reproductive services. We can be better and make progress in Canada. It is something important for people to see. There is a lot of hopelessness and anger around it, justifiably. 

Jacobsen: Huge anger. I need to remember the name off the top. There was one writer in the US. She pointed out. Often, the anger women feel around these sensitive, personal, legal, moral, and physiological issues is the catalyst for many social changes going back at least a century and a half in the United States. The same is true for much of Canadian history. We have quiet cultural commentators and writers who greatly impact Margaret Atwood. But that is a different mode of activism. Yours is quite direct and intellectual and gathers people together. 

Phelps Bondaroff:  I just picked up this up last week at a conference. [Phelps Bondaroff holds a copy of Feminism’s Fight Challenging Politics and Policies in Canada since 1970.]

Jacobsen: There you go. It has been since 1970, probably before that, too, before there was a name for that.

Phelps Bondaroff: As you know, I wear a lot of hats. One of those is as the Research Coordinator for the BC Humanist Association. BC Humanists and Canadian Humanists, one of the founders was Morgentaler, who was instrumental in fighting for abortion rights in Canada. People need to realize just how recently that was. Right? When was the Morgentaler case? 

Jacobsen: Within the last 50 years.

Phelps Bondaroff: Our lifetime, my friend, ’88! 1988.

Jacobsen: [Laughing] Yeah. 

Phelps Bondaroff: I was exploring potty training at that time…

Jacobsen: It might have been a series of three cases, and that was the culmination case.

Phelps Bondaroff: Yes, I am looking at the Supreme Court case…. These things start early. If the decision was in ’88, the initial case would have been earlier. That is too recent, right? You see, in some countries, rights are just emerging now. So, there is more work to be done. It is critical to fight to protect our rights because they can be eroded.

Fortunately, in Canada, particularly in BC, there is a lot of widespread support for free contraception and reproductive rights. As I said, all three of the elected parties supported the policy in the last election, and with good reason. Like in Alberta, you can see other parties who might be reticent to explore the policy, struggle with it when it is introduced. 

I had a long conversation with Janice Irwin before the last election. Rachel Notley and the Alberta NDP presented free prescription contraception as part of their platform. When they did this, it gives the opposing party, in this case the UCP, the opportunity to do one of three things: 1) ignore it, 2) say, “We are going to do it,” – but this takes the policy off the table as far as an electoral issue – if both parties are doing it then it is no longer a wedge issue, 3) or they could say “we are not going to do it.” If they do the latter, all of a sudden, the policy becomes a powerful wedge issue. It does tip their hand to their core values. 

Final take: There is movement happening. We have a national movement for free contraception. It doesn’t stop there. The concept of reproductive justice is broad. It doesn’t just talk about free prescription contraception. It talks about access to childcare, access to IVF, time off work, and menstrual equity. Reproductive justice has a wide range of elements, and the fight continues.

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