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Canada

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OVERVIEW

In Canada, you will find a wide range of health care options. Contraceptive methods, including condoms, pills, patches, shots, etc, are widely available. While contraceptives are not subsidized by the Canadian health care system for all people, you can find lower-cost pills and IUDs (including insertion) at public sexual health clinics. You can purchase emergency contraception ("the morning after pill") at pharmacies or obtain it at sexual health clinics. There are no formal age restrictions but pharmacists can refuse to dispense EC to people who do not seem "mature." There are many public sexual health clinics that offer STI tests. While some only cover HIV, other clinics can test for a range of STIs, especially if you make an appointment rather than dropping in. There is an HPV vaccination program in place. You can access Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). Regarding abortions, they are legal and there are no formal restrictions. If you're not a Canadian citizen or permanent resident, you can expect to pay $300-$900 for the procedure, but there are some financial assistance resources available.

Contraception (Birth Control)[edit]

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas[edit]

In Canada, you can find condoms sold in many stores. For other birth control options, like the pill, IUD, shot or implant, you will need a prescription from a physician or nurse.

Generally, Canada has a high rate of contraceptive use. It's estimated that over 70% of Canadian women (of reproductive age) use modern contraceptive methods, and about 22% of Canadian men have underwent male sterilization.[1] Yet some women still face difficulty when trying to access birth control. The Society of Society of Obstetricians and Gynaecologists of Canada found that Canadian women have less birth-control options than women in other developed countries.[2] Furthermore, the Canadian Contraception Consensus report found that 15% of sexually-active Canadian women aren't using any form of birth control, and 20% are using birth control inconsistently. The largest barrier is probably cost. Contraceptives aren't free under Canada's universal health care plan, and affordable birth control options are typically found through the public sexual health clinics (which can have limited drug choices, limited opening hours and long wait times). It should be stressed, however, that these clinics do provide affordable options and are an invaluable resource in Canada.[3]

What to Get & Where to Get It[edit]

You can buy condoms online at Top Condoms Canada, IdealCondoms.ca and Undercover Condoms.

For information on birth control in Canada, please visit the city pages, like the Toronto page, as recommendations will vary by city.

Costs[edit]

While Canada has a universal health care system, it does not offer free contraceptives. You can get lower-cost birth control at the public sexual health clinics (for example: birth control pills ranging from free to $10/per month supply, and IUDs for $60). If you get IUDs at a private clinic, you can expect to pay around $55 (for Mona Lisa), $290-$300 (for Jaydess) or $360-380 (for Mirena).

Emergency Contraception (Morning After Pill)[edit]

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC.

WhatsNextForMe.ca is a Canadian website developed by a group of physicians and researchers based at Women’s College Hospital in Toronto. It provides information about what emergency contraception options are available in Canada, how they work and how to get them. General information on emergency contraceptives can also be found here and here.

Laws & Social Stigmas[edit]

In Canada, the emergency contraceptive pill (the morning after pill) is available at a variety of places, including women's clinics, sexual health centres, hospitals, and pharmacies. However, the laws around its availability vary by province. In Ontario and most provinces, emergency contraceptive pills are available over-the-counter, except for Ulipristal-based pills, such as ellaOne, which requires a prescription.[4] In Quebec, emergency contraceptive requires a prescription, and in in Saskatchewan, it is available behind the counter at pharmacies.[5]

Generally speaking, age restrictions on emergency contraception vary by province. In many provinces, there are no age restrictions, so young people and teenagers are legally allowed to purchased emergency contraceptive pills without a prescription or parental consent. However, there are some age restrictions when purchasing EC. As reported by the International Consortium for Emergency Contraception, "In May 2008, the National Association of Pharmacy Regulatory Authorities (NAPRA) recommended full OTC access for the LNG regimen with no age restriction. This recommendation is being applied Under Common Law; however, pharmacists have the discretion to restrict sale of EC if a woman does not appear mature. All provinces follow Common Law with the exception of Quebec, which follows Civil Code, and Saskatchewan."[6]

What to Get & Where to Get It[edit]

  • You can obtain most emergency contraceptive pills (morning after pills) without a prescription from a pharmacy, doctor, women's clinic, sexual assault centres, sexual health clinics, or hospital emergency rooms.

In Canada, if you want dedicated progestin only EC, you can take NorLevo 0.75 mg (available over the counter) or Plan B (available over the counter). You should take 150mgs available in some places as 2 pills, or sometimes just 1 pill, within 120 hours after unprotected sex. If you can't access dedicated EC, you can use some oral contraceptives as replacement EC -- but, remember: in 28-day packs, only the first 21 pills can be used. Some of the contraceptives you can use are Ovral (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later), Minovral (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later) and Alesse (take 5 pills within 120 hours after unprotected sex and take 5 more pills 12 hours later).[7]

Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. It seems like ellaOne is available in Canada. However, a prescription may be require to purchase it. Check with your pharmacist or local sexual health clinic for details.

Costs[edit]

Prices vary, depending on where you bought the emergency contraception. If you go to a pharmacy, you can expect to pay around $23-$30 (as of 2013). If you go to a community health clinic, you can expect to pay around $13-$20 (as of 2013).

Sexually Transmitted Infections (STIs/STDs)[edit]

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas[edit]

In Canada, there are no travel restrictions attached to STI or HIV status. However, if you wish to stay in Canada for over 6 months, you'll need to get an HIV test. If you test positive, you probably won't be granted a residency permit. You will still be issued a residence permit if you fall into one of the following categories: you're an HIV-positive refugee, you're an HIV-positive sponsored spouse or common law partner of a Canadian citizen or permanent resident, or if you're an HIV-positive sponsored and dependent child of a Canadian citizen or permanent resident.

As reported by HIVTravel, "Accessing health care in Canada is expensive for non-Canadian residents or visitors and the cost varies from one province to another. Canada is a federation of provinces and territories and health care is the responsibility of each province or territory. Access to services can vary a bit from one province to another. In general, visitors to Canada need private health insurance from their home countries to pay for major medical costs here." For more details on HIV treatment for foreigners in Canada, click here.

What to Get & Where to Get It[edit]

Testing Facilities[edit]

For information on STI testing facilities in Canada, please visit the city pages, like the Toronto page, as recommendations will vary by city.

Support[edit]

  • Canadian Liver Foundation: Helps people with Hep B and Hep C. "The Canadian Liver Foundation is a national non-profit organization committed to promoting liver health and providing hope to people living with liver disease."
  • CATIE: "CATIE is Canada’s source for up-to-date, unbiased information about HIV and hepatitis C. We connect people living with HIV or hepatitis C, at-risk communities, healthcare providers and community organizations with the knowledge, resources and expertise to reduce transmission and improve quality of life."
  • AIDS Committee of Toronto: "ACT provides support services that empower men, women and young people living with HIV to achieve self-determination, informed decision-making, independence, and overall well-being."
  • BLACK CAP - Black Coalition for AIDS Prevention: "Since 1989, the Black Coalition for AIDS Prevention (Black CAP) has worked to respond to the threat of HIV and AIDS in Toronto’s African, Caribbean and Black communities." "Black CAP is Canada’s largest Black specific AIDS service organization."

Costs[edit]

Medications & Vaccines[edit]

Laws & Social Stigmas[edit]

PrEP was approved for usage in 2016.

What to Get & Where to Get It[edit]

  • There are two HPV vaccines available in Canada: Cervarix® (HPV2) and Gardasil®9 (HPV9). For some people, the vaccine is free and, for other groups. it is available but not free. For example, the HPV9 vaccine is provided for free to all girls and boys in Canada in Grade 6. Other people who can get free HPV vaccines are girls born in 1994 or before who were not immunized, HIV-positive people (9-26 years of age), transgender people (9-26 years of age), men who have sex with men (9-26 years of age), men who are questioning their sexuality (9-26 years of age), and men who participate in street activity (9-26 years of age), and some other groups. You can visit the Immunize BC website to learn more.
  • You can get the Hepatitis B vaccine at many sexual health clinics.
  • If you want Post-exposure prophylaxis (PEP), you should contact a hospital emergency department or their doctor for treatment. Generally, no appointment is required since patients should be counseled and treated ASAP.
  • If you want Pre-Exposure Prophylaxis (PrEP), it is available in Canada. In February 2016, Health Canada approved Truvada as prevention, and generic versions of TDF/FTC are approved for prevention. There are an estimated 900-1,100 people on PrEP in Canada, as of 2018.[8] According to ACT Toronto, "Any doctor can prescribe PrEP. If you have a family doctor that you feel comfortable with, that is a good place to start. There is ongoing testing and medical care required with PrEP, so accessing PrEP through a doctor that you already have a connection with is ideal."[9] CATIE has compiled extensive resources on PrEP for Canadians, which you can check out here. For updates on PrEP access in Canada, PrEPWatch is also a great resource.

Costs[edit]

Menstruation[edit]

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

You can easily finds pads and tampons in Canadian stores. If you want to buy a menstrual cup, you'll also find quite a few vendors. For DivaCup, check out Shoppers Drug Mart, PHARMAPLUS, Yonge Pharmacy, Nutrition House-Eaton Ctr Dund and Condom Shack. For MoonCup, you can deliver online. For Lunette, check out the Lunette North America website. For eco-friendly menstrual products, check out London Drugs, Loblaws, Save on Food, Whole Foods, Well.ca and Overwaitea.

Costs[edit]

Gynecological Exams[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

For information on gynecologists in Canada, please visit the city pages, like the Toronto page, as recommendations will vary by city.

Note: There is a Canadian website called Pap Test Info: "Every year, almost 400,000 Canadian women receive a call that their Pap test result is abnormal. In many cases, the call is made by a nurse or medical receptionist who cannot discuss the results or implications over the phone. Often women are not given any information about what that means and are left feeling nervous or unsure about what happens next. This website has been developed to provide women with information about Pap testing and what it means to have abnormal test results. All of the information contained in this website has been reviewed by physicians."

Costs[edit]

Pregnancy[edit]

Laws & Social Stigmas[edit]

In Ontario, Employment Insurance (EI) provides maternity and paternity benefits to people who are waiting for a child, have recently given birth, are adopting a child or are caring for a newborn. For details, click here.

What to Get & Where to Get It[edit]

Costs[edit]

Abortion[edit]

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas[edit]

In Canada, abortion is legal at all stages of pregnancy with no restrictions. It is governed by the Canada Health Act. However, it should be noted that some reports indicate that third trimester abortions are not generally available.[10]

Historically, there were significant challenges to abortion in the past. Until 1969, abortion was not generally legal. Following the Criminal Law Amendment Act, 1968-69, abortion became legal in cases where physicians decided the abortion was necessary for the physical or mental well-being of the woman. However, the Criminal Law Amendment Act also imposed restrictions on abortion access, as it was not generally accessible to all women. In 1988, the Supreme Court of Canada ruled that the existing abortion laws were illegal, and they were struck down. Since then, there have been no official laws on abortion in Canada, making it available to women without restrictions. Today, one-third of all hospitals in Canada perform abortions.

What to Get & Where to Get It[edit]

For information on abortion in Canada, please visit the city pages, like the Toronto page, as protocol and recommendations will vary by province.

Costs[edit]

  • Generally, abortions in Canada are funded by Medicare (for Canadian citizens and permanent residents). If you have a valid health card from Ontario, medical and surgical abortions at free-standing clinics and hospitals are fully covered.
  • If you're not a Canadian citizen or permanent resident, you'll need to pay between $300-$900 or an abortion at a free-standing clinic. The costs will vary, depending on how long you have been pregnant, the clinic and the type of procedure.
  • If you need help paying for your abortion in Toronto, call Planned Parenthood Toronto (416-961-0113) or the Bay Centre for Birth Control (416-351-3700) to learn about your options.

Advocacy & Counseling[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

  • The Kids Helpline: Call 1-800-668-6868. Toll-free, 24-hour, bilingual and anonymous phone counseling for teenagers and children.
  • Distress Line 416-408-HELP (4357): Provides telephone support for people facing crisis situations and suicide prevention.
  • Barbra Schlifer Commemorative Clinic: "The Barbra Schlifer Clinic offers legal representation, professional counselling and multilingual interpretation to women who have experienced abuse. Our diverse, skilled and compassionate staff accompany women through personal and practical transformation, helping to build lives free from violence. We are a centre by, for and about women"
  • Family Services of Toronto – David Kelly Services: Provides counseling and support for LGBTQ individuals. "We are committed to trauma-informed, anti-oppression practices to help empower LGBTQ+ individuals, couples and families, as well as people living with, affected by or concerned about HIV/AIDS, and to enhance participation in their communities and in the broader society. For more information about DKS, contact Service Access Unit at t. 416-595-9618 | sau@familyservicetoronto.org"

Costs[edit]

List of Additional Resources[edit]

  • Telehealth Ontario — a free 24/7 service which uses nurse practitioners to answer your health concerns: 1-866-797-0000. 1-866-797-0007 (TTY).
  • Sexual Health Information Line - Toll free: 1 (800) 668-2437; Local: (416) 392-2437. Hours of operation: Monday to Friday 10 am – 10:30 pm; Saturday and Sunday 11 am – 3pm
  • The Sex Information and Education Council of Canada (SIECCAN): "The Sex Information and Education Council of Canada (SIECCAN) is a national registered charitable organization founded in 1964 to foster professional education and public knowledge about sexuality and sexual health. SIECCAN works with health professionals, educators, and community organizations to ensure that all Canadians have access to high quality sexual health information, education and related health and social services."
  • The 519: "The 519 is committed to the health, happiness and full participation of the LGBTQ community. A City of Toronto agency with an innovative model of Service, Space and Leadership, we strive to make a real difference in people’s lives, while working to promote inclusion, understanding and respect."
  • Scarlett Teen: This website offers sex education to teenagers.
  • Teen Health Source: This website offers sex education to teenagers.

References[edit]

  1. [http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf Trends in Contraceptive Use Worldwide 2015]
  2. It's time to give Canadian women more options when it comes to birth control, experts say
  3. Canada lags behind other nations in birth control access, and it's costing us
  4. Emergency Contraception (EC)
  5. Plan B - Where to Get It (Canada)
  6. EC Status and Availability: Canada
  7. Princeton EC website
  8. PrEPWatch: Canada
  9. PrEP - How do I get it?
  10. Abortion in Canada