Most of the world doesn’t require a prescription for birth control. Why do Canadians still need one?

Leah Morris has been on birth control since she was a teenager. She remembers that first appointment being deceptively simple.

“It was just like, ‘You’re at a time that you should be on this,’” she said. 

She started taking Yasmine, a common estrogen-based oral contraceptive. At first, getting refills was as easy as visiting her local pharmacy.

But as Morris’s work in international development and venture capital took her around the world, getting a prescription became, at times, a major struggle.

“I have to keep going back to my doctor and proving I haven’t died on it,” she said. “It’s just a giant time suck.”

In Canada, oral contraceptives are by far the most common method of birth control among women, but they are only available by prescription — a situation very different for most other countries.

Outside of Western Europe, Canada, New Zealand, Australia and South Africa, birth control is frequently available prescription-free — even in conservative countries like Saudi Arabia, Turkey or Indonesia.

In the United States, where reproductive rights are often hotly contested, birth control has been available prescription-free since 2023.

So why does Canada still lag behind? The answer is more complicated than you might think.

Since 1960, the majority of oral birth control methods are so-called “combined pills” — combinations of the hormones estrogen and progestin, which prevent the ovaries from releasing eggs.

These pills, which include common consumer products like Yasmine, come with some side effects, such as bloating and headaches, and risks, such as cervical cancer or blood clots.

These risks start small, but increase among older women. That’s one reason, doctors say, why ongoing monitoring by medical professionals is often recommended.

Dr. Wendy Norman, a family physician and researcher in sexual health at the University of British Columbia, says that’s why only places with a higher tolerance for medical risk — usually developing countries — tend to allow prescription-free access to the combined pill.

“There’s no medical system in the world where malpractice would be [seriously] considered … that they will not regulate medications containing estrogen,” said Norman.