Sarah Munro receives grant to study equitable contraception access in British Columbia

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HSPoP faculty member Sarah Munro describes how two new policies in British Columbia are boosting contraception access for youth. 

In addition to her position on the faculty in the University of Washington’s Department of Health Systems and Population Health, Sarah Munro, PhD, is also co-director of the Contraception & Abortion Research Team, which she describes as “a network of researchers, decision-makers and advocates across Canada who work towards removing barriers to abortion and contraception care.”

She has long been interested in contraception access and equity, reflecting, “Before I got into research, I did community-based doula care and breastfeeding consulting. So I’ve always been interested in supporting clients to make informed reproductive choices.”

Recently, Munro received funding from the Ministry of Health Research Seed Grant program, in partnership with UBC Health, to study the impact of two new policies in British Columbia. The province took the leap of making all contraception methods available for free, including the pill and IUDs. Contraception is even available to those not yet enrolled in Canada’s single-payer health care system.

British Columbia also now allows pharmacists to prescribe contraception and provides them with training on different contraception methods. Depending on the contraception method, participants can either receive their contraception immediately or set up an appointment to access it.

Reaching youth in rural and remote communities

This new study builds on Munro’s prior research on contraception equity. For her study “Ask Us: Youth Voices to Improve Contraception Access,” also in partnership with the Ministry of Health, she interviewed 79 Canadian youth ages 15-25 in addition to 27 youth-serving health care providers. That study identified two major barriers for youth of all genders seeking contraception: cost and stigma. 

“Youth in rural and remote communities have limited access to contraception prescribers, and there can be a lot of stigma around accessing contraception in pharmacies, because it’s harder to stay anonymous in a small community. If [youth] have insurance to cover their contraception, it’s usually linked to their parents’ health insurance, so there’s a worry that if they access contraception, their parents may see. What we expect with these two new policies is those barriers can be overcome together–these ideas of cost, stigma and confidentiality–by having free contraception available from pharmacists.”

Sarah Munro, PhD

Munro’s co-investigator will analyze quantitative data to understand patterns in contraception access among youth, while Munro is taking a qualitative approach to make sense of that data. She’s seeking to understand two key barriers: pharmacy access and stigma. Munro plans to interview pharmacists and young people in British Columbia’s smaller, more remote communities.

She expects that in rural communities, a lack of car access or reliable bus service may prevent youth from accessing pharmacies. Meanwhile, in close-knit urban communities, youth may know their pharmacist personally and face stigma for being sexually active.

“We’re really interested to understand what other supports need to be put in place so youth can get the full benefits of these policies,” said Munro. “How do we support youth to continue to access these policies, but in a way that may be more appropriate for their heightened need for confidentiality?”

In addition to gleaning youths’ concerns, Munro is also stepping into pharmacists’ shoes. Building off her team’s work in developing patient decision aids to help patients and clinicians decide on the right form of contraception, she’s looking at pharmacist education as well.

Explains Munro, “We know pharmacists didn’t receive a lot of orientation and training before they were supported to begin prescribing contraception. So we’ll be learning, what else might they need? And what can we build into pharmacy education programs to ensure that pharmacists feel really confident and well-equipped to prescribe contraception?”

Research that bridges the Canada-U.S. border

Since transitioning from her position at the University of British Columbia to UW, Munro is excited to bring her expertise from the Canadian context to the United States health care system. She commends Seattle’s local government for “strongly support[ing] policies that improve gender equity.”

Reflects Munro, “In the U.S. right now, there are so many people who are mobilizing and enacting policies to improve equity around reproductive choices, which is really similar to the energy in Canada. I see an opportunity to take what we’re learning in a similar jurisdiction and share it in the U.S., because youth across North America need equitable access to contraception.”

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