I grew up in the U.K., with access to universal healthcare. When the time came to consider birth control options, price wasn’t a determining factor, as the cost of contraception is completely covered by the government. That means when a doctor prescribes the Pill, an IUD, a progesterone implant, injection, or diaphragm you won’t have to pay any out-of-pocket expenses whatsoever.
You can even get free condoms from a variety of sexual health information clinics. Back in the late 90s, my girlfriends and I were making typical teenage choices about which subjects to major in, whether we were going to get a part-time job at the mall, arguing with our parents about our curfew, and traversing that awkward path between childhood and becoming an adult. What we were not considering at all was the cost of contraception. I am sure that freed us to consider more important elements of this crucial developmental stage. Like whether or not we were ready emotionally and physically for sex. It also enabled us to select the best birth control options to meet our individual needs regardless of our budget.
The history of universal healthcare in the U.K.
Contraception has been offered free of charge from the U.K. National Health Service (NHS) since 1977, with the first birth control clinic opening before that, in 1921.
Doctors will prescribe free contraception to adolescents under the age of consent (16-years-old in the U.K.) as long as they feel they understand all the information and advice given to them. Although they encourage young people to talk to their parents and caregivers about their sexual health, they won’t speak to them without consent from the patient in question.
With this sort of nonjudgemental access to birth control, it’s easy to see why the U.K. has a lower incidence of unintentional pregnancies than the U.S. A report in the Studies in Family Planning Journal, available from the The National Center for Biotechnology Information (NCIB), found that unplanned pregnancies accounted for 38 percent of all pregnancies for women aged 15-44 years of age, compared to 51 percent in North America.
If we focus on teenage pregnancies alone, for every 1,000 girls in the U.S., 52 of them will fall pregnant between the ages of 15-19 in comparison to the U.K., which as 31 reported births per thousand.
Although this difference in teen pregnancy statistics seems impressive, the U.K. still tops the list in Europe and is only second to the U.S. worldwide, so we shouldn’t prematurely praise free contraception as the best way to avoid unintentional pregnancies.
Some of the lowest worldwide rates are reported in Japan and Sweden, both of which had a rate of fewer than seven births per 1,000 teenagers. Interestingly enough, neither country offers free contraception.
The secret to success in Japan and Sweden
The availability of the birth control pill in Japan is a relatively new development as of 1999, when it cost a reasonable ¥3000 Yen per month (about $25). This could explain why Japan had a history of women seeking abortions as their main form of contraception with abortion rates in the 1940s and 50s hitting 40-50 per 1,000 pregnancies. This rate has been declining over the last half a century and now sits at just 9.3 per 1,000 pregnancies compared to 19.4 in the U.S. and 18.2 in the U.K.
Japan’s low pregnancy rates continue into adulthood and seem to be based on a complicated set of circumstances. A shortage of quality daycare combined with punishing work schedules has caused many Japanese women to choose not to marry or have children at all. Spurned by the strict social and cultural shunning of children born outside of marriage, a rejection of marriage naturally leads to a lower birth rate.
Meanwhile, even though young Swedes have to pay for contraception, it is offered at a reduced rate until they reach the age of 25. Sweden has invested in compulsory sexual health education classes since 1956 and the country has an open and progressive attitude towards sexual activity.
Shocking price tags in North America
It would seem that education and societal attitudes have as much impact on lowering unintended pregnancy rates as subsidizing the cost of contraception. When I first moved to North America, it came as quite a shock to have to pay for the pill. Especially since I wrongly assumed that the cost of pregnancy and STI protection would be covered in Canada, which has a universal health care system.
For a young woman learning to navigate a new culture, find employment, and adjust to married life, $600 per year for contraception was an unwanted, additional expense. I also wondered if it was an unfair tax on women. After all, young men likely wish to avoid unintended pregnancies too, yet many of them aren’t held responsible for the cost.
Back when I was accessing sexual health resources for the very first time, I had so many considerations and emotions to contend with. I am so relieved that cost was never a factor in determining the sexual health protection I was able to select, while in those most formative of years. Although free contraception cannot be shown to have a direct link to fewer incidences of unintentional pregnancies, I still strongly champion the concept of birth control without cost as it gives young women more choices. Choice, surely, can never be a bad thing.