Imagine walking into a pharmacy and picking up birth control without a second thought about cost. For many people in Manitoba, this became a reality on Oct. 1, 2024, when the province launched the Manitoba Prescription Birth Control Program (MPBCP).

The program covers about 60 prescription contraceptive pills, intrauterine devices (IUDs), hormonal implants, and contraceptive injections for eligible Manitoba residents, and expanded to include Plan B contraception within the 2025 budget. The MPBCP reflects a growing movement in Canada toward universal contraception, with British Columbia’s free contraception program beginning in 2023 and policy proposals emerging in Alberta and Saskatchewan.

The federal Pharmacare Act was passed on Oct. 10, 2024, establishing national universal contraception coverage in addition to diabetes medications. In an announcement on Feb. 27 this year, Manitoba became the first province to sign a pharmacare agreement with the federal government.

By covering the costs of contraceptives, the MPCBP eliminates the financial barriers to accessing birth control for many Manitoba residents. The coverage provided by the program allows for a wider access to more effective, discrete, and long-lasting contraceptive options. This helps reduce the costs and stress of unplanned pregnancies at personal and institutional levels, while also pre-emptively mitigating the gendered inequities of unplanned pregnancies in relation to employment, education, and personal development.

MPBCP is important to advancing the accessibility of reproductive health care. At the same time, it represents a single, limited component of what should become a broader strategy towards achieving reproductive justice in Manitoba.

The MPBCP requires individuals to obtain a prescription for contraception from a prescriber and have a valid provincial health insurance number. This approach works well for a majority of people, but also replicates some of the existing inequalities in our health system. People who are ineligible for Manitoba Health (such as international students and others) and people who have difficulties obtaining their health card may continue to face access barriers.

This undermines the universality of the program and leaves some of the most marginalized individuals without access to essential reproductive health care. Expanding the MPBCP to fund community-based birth control programs would help mitigate these challenges and allow for community health agencies to tailor their programs to the needs of the vulnerable community members they already work with.

Further, access to contraception does not guarantee informed choice. Free birth control is only as effective as the health-care infrastructure and pro-choice sexual education supporting it. Many people, particularly those in rural and remote areas, still struggle to access primary care providers willing to prescribe contraception or insert IUDs. Without investment in these services, people may not receive the information or the support they need to make informed choices about their reproductive health.

Additionally, by continuing to not cover condoms, or other non-prescription forms of birth control, the MPBCP misses out on broader contributions to reproductive and sexual health. Excluding these forms of contraception not only leaves out key resources that could benefit people who cannot or do not want to use hormonal birth control, but also the protection against sexually transmitted and blood-borne infections that condoms provide.

The MPBCP largely directs its focus toward pregnancy prevention without fully addressing how common contraception methods, though highly effective, do not guarantee the prevention of pregnancy and may not work well for everyone. The addition of Plan B contraception mitigates some of this, but abortion services will continue to be a key component of comprehensive reproductive healthcare, regardless of the accessibility of birth control. In this way, sustained investment in abortion services remains crucial.

The province’s primary abortion provider, Women’s Health Clinic, had to suspend services for a full week in February due to failing infrastructure. The recently announced $10-million investment by the federal government to address long-standing infrastructure concerns at the Women’s Health Clinic is an encouraging step forward. However, additional provincial investment in this estimated $23-million upgrade is necessary to ensure timely and reliable access to these essential services.

The language surrounding the MPBCP relies heavily on framing contraception as a matter of individual “planning,” “control,” and “choice” for economic benefit, sidelining systemic barriers. This narrative places the responsibility for preventing unintended pregnancies solely on individuals, reinforcing the perception that unintended pregnancies are personal failures rather than the result of systemic gaps in healthcare, education, and access to services. An approach to bodily autonomy grounded in reproductive justice is, yes, about choice, but also about what choices are genuinely available within one’s community.

The MPBCP is an important step towards achieving gender equality and reproductive justice, but it cannot be the final one.

Investing in a full range of reproductive health services and funding barrier-free community-based models of providing contraception and other reproductive health services in Manitoba would demonstrate a real commitment to reproductive justice — one that is attuned to the wide range of barriers experienced by the most marginalized community members and recognizes access to contraception as a human right that enables bodily autonomy for all.

Lindsay Larios is an assistant professor in thefaculty of social work at the University of Manitoba, a board member of the Women’s Health Clinic, and a research associate with the Canadian Centre for Policy Alternatives – Manitoba. Emma Cowman is a master of social work student and research assistant at the University of Manitoba.

Previously published in the Winnipeg Free Press April 3, 2025