HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

STANDING COMMITTEE

ON

HEALTH

 

 

Tuesday, June 10, 2025

 

 

LEGISLATIVE CHAMBER

 

 

Barrier-Free Access to Contraception and Sexual Health Services,

Including PrEP, for Nova Scotians

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

HEALTH COMMITTEE

 

John A. MacDonald (Chair)

Adegoke Fadare (Vice Chair)

Hon. Susan Corkum-Greek

Ryan Robicheau

Nick Hilton

Lisa Lachance

Rod Wilson

Hon. Iain Rankin

Hon. Derek Mombourquette

 

 

In Attendance:

 

Robin Dann

Legislative Committee Clerk

 

David Hastings

Assistant Clerk

 

 

 

 

WITNESSES

 

Access Now Nova Scotia

Kari Ellen Graham, Co-Chair

Jennifer Benoit, Member; and Provincial Coordinator, Nova Scotia Health Coalition

 

North End Community Health Centre

Marie-France LeBlanc, CEO

Dr. Leisha Hawker, Physician

 

Wellness Within

Natasha Hines, Board Chair

 

College of Pharmacy, Dalhousie University

Dr. Kyle Wilby, Professor

 

ROSE Clinic, Nova Scotia Health Authority

Cynthia Stockman, Clinical Operations Director

Dr. Lianne Yoshida, Medical Co-Director

Dr. Melissa Brooks, Medical Co-Director

 

Halifax Sexual Health Centre

Abbey Ferguson, Executive Director & Health Promotion

 

Department of Health and Wellness

Dr. Robert Strang, Chief Medical Officer of Health

Stacy Burgess, Executive Director of Clinical Care and Delivery and National Blood File

 

 

 

 

HALIFAX, TUESDAY, JUNE 10, 2025

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

John A. MacDonald

 

VICE CHAIR

Adegoke Fadare

 

 

THE CHAIR: Order. I call the meeting to order. This is the Standing Committee on Health. I'm John A. MacDonald, the MLA for Hants East and the Chair of the committee. Today, we will hear from witnesses regarding Barrier-Free Access to Contraception and Sexual Health Services, Including PrEP, for Nova Scotians.

 

As a reminder, please set your phones on quiet. The microphones for the people: don't touch them because they'll actually make noise and reverberate.

 

I'm first going to ask the committee members to introduce themselves for the record - just their names and their constituencies - starting with MLA Fadare.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, I'll also allow the counsel to introduce themselves.

 

[Assistant Clerk David Hastings and Legislative Committee Clerk Robin Dann introduced themselves.]

 

THE CHAIR: I'd like to welcome all the witnesses. What we'll do first is we'll go through and let you introduce your name and who you're with, then I'll come back for those who have opening statements. I will start on my far left with, I believe, Abbey Ferguson - how you want to be introduced, also.

 

I should say if the microphones are shooting straight up, point them down. Sorry.

 

[The witnesses introduced themselves.]

 

THE CHAIR: What I'll do is I have a list of five who are doing opening statements. If you're wanting to and you're not on the list, just let me know. The microphones will go on when I recognize your name, if you can wait for the microphone. Don't feel bad; we also talk before the microphone goes on, so it will happen.

 

I'll start with Dr. Brooks.

 

DR. MELISSA BROOKS: If there's one key message I hope that you take away from today's session, it's this: Enacting cost-free access to contraception is the most effective action that the government can take to significantly advance the reproductive health of Nova Scotians.

 

In Nova Scotia, lack of access to universal contraception creates a huge gap in access to contraception, especially long-acting, reversible contraception such as IUDs and subdermal contraceptive implants, which are the most reliable and cost-effective options but cost upwards of $400. Dr. Yoshida and I see the effects of this unmet need on a daily basis in our clinical practice. As abortion providers, so many of our patients find themselves with unintended pregnancy as a consequence of not being able to afford the contraceptive options that they want or any contraception at all on a consistent basis.

 

I have heard stories of patients who have had to choose between buying groceries and paying for birth control. That is not a choice that anyone should have to make.

 

One in three workers in Nova Scotia does not have private prescription drug coverage. There is a misconception that the Nova Scotia Family Pharmacare Program fills this gap, and I am here to tell you it absolutely does not. The deductibles and copays associated with this program are so high that for the average healthy person, the program is moot, and it does not improve access to contraception.

 

At the ROSE Clinic, we have established a compassionate access program for long-acting, reversible contraception for patients who would otherwise not be able to afford it, and we have given out almost 500 devices since 2023. Research has proven that these patients are significantly less likely to have another unintended pregnancy and abortion, and they are so grateful to have access to the contraception that they want and need.

 

I would be remiss to not mention as a gynecologist that drugs we call birth control to me are medicines that I prescribe on a daily basis to treat conditions that only affect patients with a uterus, such as heavy menstrual bleeding and endometriosis. I often see patients unable to access these medicines, and instead forgo treatment altogether or choose surgical treatments, which are much more costly to the health care system and pose more risks to them. The best part is that we can do this and save money. Research from around the globe has shown that providing barrier-free access to contraception is not only cost effective but provides long-term cost savings.

 

Again, we thank you for inviting us to participate in this session. We'd be more than happy to answer any questions or to work with members of the committee or the government to improve access to reproductive care for Nova Scotians.

 

THE CHAIR: Thank you. Abbey Ferguson.

 

ABBEY FERGUSON: The Halifax Sexual Health Centre is an independent, charitable health centre founded in 1971. The vision of HSHC is that: All members of our community have full, equal, non-judgmental and safe access to sexual, reproductive, and gender-affirming health care and education. I am here today to speak to the reality that we cannot have full and equal access to care when finances impact an individual's ability to access necessary medications.

 

HSHC has been providing low-cost and free contraceptive products to patients since the late 1980s. Our award-winning Compassionate Contraceptives Program currently provides $17,800 worth of free prescription birth control to patients every year. We sell an additional volume of $3,000 to $7,000 worth of birth control products for below pharmacy prices. We additionally offer $3,000 worth of free medications used to treat common infections. This program is currently being funded by a one-year project grant from the Community Foundation of Nova Scotia but is otherwise fully funded by the donations of private foundations and individual citizens.

 

People often have assumptions regarding the kinds of patients who access our services. There is a strong narrative that we are primarily offering free contraceptives to teenagers unwilling to tell their caregivers about their sexual activity. In reality, we are offering these products to people who come from all walks of life, including those working full-time without private insurance plans, patients on pharmacare who make just too much for a reasonable copay or deductible when they consider the other expenses in their lives, newcomers, trans folks looking to prevent menstruation, patients seeking treatment for a host of reproductive disorders, and more.

 

In addition to speaking on contraceptives, I am also able to discuss PrEP and the financial barriers to its use. PrEP management is also a service of HSHC, and we are no strangers to counselling patients who would like to be using it, except that they cannot afford the costs associated. PrEP is so expensive that it would be impossible for HSHC to step in and offer it for free to patients.

 

If traditional private insurance plans and provincial pharmacare were enough, our Compassionate Contraceptives Program would not need to exist. I implore you to listen to the diverse voices in this room and to implement no-cost, universal access to necessary sexual health medications.

 

THE CHAIR: Dr. Robert Strang.

 

DR. ROBERT STRANG: My colleague Stacy Burgess and I - Stacy's right behind me - will do our best to answer your questions within the scope of our areas of focus in the department. For me, I'm the lead on questions around PrEP and STI testing; Stacy is the lead on questions around termination, reproductive care, gender-affirming care, and contraception and pharmacare.

 

Contraception and sexual health services is a very broad topic that does span many branches within the Department of Health and Wellness. It is also a very important part of health care, and it impacts all Nova Scotians. I'll touch briefly upon several aspects of sexual health and the efforts we are making to support Nova Scotians.

 

Part of our work in public health is to raise awareness about and support access to contraception and sexual health services for all Nova Scotians. It is important because we know the broad and far-reaching impacts it has on Nova Scotians, our communities, and our health care system.

 

Addressing challenges and making improvements isn't something we achieve in isolation, however. It involves our partnership with our health authorities, other health partners, community organizations, and advocates. Much good work has been done, but more needs to be done.

 

Expanding access is one of those issues. We know that there is a desire for government to do more to provide universal access to contraception. As Minister Thompson has stated, she wants the best deal for Nova Scotians when it comes to barrier-free access to contraception.

 

As a result of the Nova Scotia STI Care Now program - an innovative program that was launched last year - people in Nova Scotia have significantly improved access to many sexual health services in person, virtually, in their home, or by self-referral. It's a first-of-its-kind program in Canada that offers people ages 15 and older access to free, confidential self-testing kits by mail and is supported by various forms of virtual care. It is an innovative program because not everyone is able to or comfortable to access traditional testing methods through the Nova Scotia Health Authority, primary care providers, or the province's network of sexual health centres.

 

Testing and access alone won't help people unless we can reach them where they are. That's where our community partners and organizations help bridge the gap between public health and people.

 

We certainly have heard from Nova Scotians about the need to enhance gender-affirming health care in the province. Steps have been taken because we believe in equitable access to health care for all Nova Scotians.

 

prideHealth through the Nova Scotia Health Authority is one example. They provide - among other health care services for the 2SLGBTQIA+ community - navigation support for people who want to access gender-affirming care services. prideHealth also supports people in accessing PrEP, trains health care providers to prescribe PrEP, and promotes education about this highly effective medication.

 

Reproductive care is another important area within the scope of sexual health. In situations of unplanned pregnancy, Nova Scotians want options. Part of our responsibility in the health care system is to provide them with information so that they can make informed decisions. That is why we have established a provincial self-referral line to receive information about accessing medical and procedural abortion care in the province. It's why doctors and nurse practitioners can prescribe Mifegymiso, a medication used for medical abortion, at no cost to the patient.

 

As I mentioned earlier in my remarks, there's a lot of good work happening to improve access to contraception and sexual health services in the province. Is there more that can be done? Absolutely. That's the answer always when it comes to health care. We must continue to work together to improve programs and services based on evidence. We must continue to engage and work with all our partners, like the ones who are here today, in health care.

 

We are committed to continued efforts to strengthen access to contraceptives and sexual health services for Nova Scotians.

 

Thank you. I look forward to answering your questions today.

 

THE CHAIR: Ms. Hines.

 

NATASHA HINES: Hi, everybody. As I said before, my name is Natasha and I'm a registered nurse working in abortion care, but I'm joining you today as board chair of Wellness Within.

 

Wellness Within is a volunteer-based non-profit organization working for reproductive justice, health equity, and prison abolition. As such, we have long advocated for free universal contraception coverage here in Nova Scotia. The cost of contraception is a major factor prohibiting its use. The Contraception and Abortion Research Team estimates that an individual lifetime cost for contraception may be well over $19,000. These costs disproportionately affect people with a uterus, making it a clear gender-equity and human rights issue when governing one's own body comes at such a high cost.

 

While some people's contraception may be covered by community pharmacare and private drug plans, so many people fall through the cracks of this patchwork system. High deductibles or copays may render coverage to be inadequate. People in low-paying, part-time, or contract jobs often do not have employer-based health plans. As many as 20 per cent of Nova Scotians have inadequate or no prescription drug coverage.

 

[1:15 p.m.]

 

Nova Scotians are currently facing intersecting crises of gender-based violence and unaffordable living. Universal contraception is a concrete, effective, and important tool that addresses both of these issues. Nova Scotia is tied for the highest poverty rate among Canadian provinces, and Nova Scotians really cannot afford to wait any longer for this coverage.

 

After clear success in B.C. and other provinces, including cost savings for our health care and social systems, implementing universal contraception does what the provincial government says it aims to do with the provincial budget by making life more affordable and building healthy populations. We believe that it is a common-sense solution.

 

THE CHAIR: Kari Ellen Graham.

 

KARI ELLEN GRAHAM: Thank you and good afternoon. I appreciate this opportunity to speak on behalf of Access Now Nova Scotia. Today, you have heard and will continue to hear compelling evidence on the wide-reaching benefits of no-cost contraception.

 

One, there is precedence: Three provinces and one territory have already implemented it. Two, it's cost effective: For every $1 invested, you can save up to $90 in social spending. B.C., for example, expects to save $27 million in annual savings this year. Three, it's medically sound: Removing cost barriers leads to better health outcomes. Four, It's sustainable: A universal policy is more efficient than our current patchwork system. Five, it reflects public opinion: 85 per cent of Atlantic Canadians support it. Six, it promotes equity: Contraception access is a gender equity issue and a protection against reproductive coercion. If you're unfamiliar with the evidence behind these findings, please ask. You're surrounded today by experts who can offer clear, validated data.

 

Beyond the numbers and policy points, I want to share a story. Years ago, a young mother regularly visited our pharmacy with her baby. Her partner was abusive and pressuring her to have another child. I spoke to her about contraception, but she shook her head. She simply couldn't afford it. Months later, she came in pregnant again, tearing up behind a forced smile. Her story isn't unique, but it's one I've never forgotten. I couldn't advocate for her then - but you can now.

 

Please use your voice to implement no-cost contraception: a compassionate, evidence-based policy that can change lives across Nova Scotia.

 

THE CHAIR: Okay, thank you. For people who don't know, it's 20 minutes for each caucus. At the end of 20 minutes - and the timer will be there - I'll say, “I'm sorry,” and interrupt because it'll go to the next caucus. When we finish off, we'll do a round of probably about eight to 10 minutes and then we'll do some ending comments.

 

We start with the Liberal Party - oh, sorry, the NDP. I do that every time and I don't know why. Okay, MLA Lachance. Oh, just before you do - don't start the timer - I'll let MLA Mombourquette introduce himself.

 

HON. DEREK MOMBOURQUETTE: Thank you, Chair, and I apologize for being a few minutes late. Derek Mombourquette, the MLA for Sydney-Membertou.

 

THE CHAIR: MLA Lachance.

 

LISA LACHANCE: Thank you, Chair. I will be pleased to start questioning on behalf of the Official Opposition. In the meantime, it did look to me like Dr. Wilby on the screen thought, perhaps, that they were delivering opening statements. I wonder if we could just give that some time.

 

THE CHAIR: I'll ask and, if so, I'll reset the clock for you. Dr. Wilby, did you have opening comments? I apologize.

 

KYLE WILBY: No problem. Thank you very much and thanks for accommodating me virtually here from Toronto. My name is Kyle. I am a professor and the director of the Dalhousie University College of Pharmacy, and I was the lead researcher for PrEP-Rx, which was a foundational study in Nova Scotia that resulted in pharmacists prescribing HIV PrEP as of July 1, 2024, which was the first in Canada.

 

I am an HIV PrEP user. When I relocated back to Canada in 2021 from New Zealand, I naively thought it would be the same simple process for me to access PrEP as it was in that country. There, I had a designated primary care prescriber. I was able to access all laboratory testing in the same place, and I paid a small copay of $5 for the prescription. Everyone paid that small copay of $5 for the prescription no matter what their income was.

 

Instead, my journey to access PrEP in Nova Scotia was very different. There are two major problems with accessing PrEP in Nova Scotia. First, it is well known that we are lacking primary care prescribers. I first obtained PrEP in Nova Scotia from a walk-in clinic physician, and while well intentioned, as a pharmacist, I had to educate the prescriber about the medication and the laboratory monitoring that was required. My research team has helped to solve this issue through pharmacist prescribing. Although pharmacists are now authorized to prescribe PrEP, we are waiting for reimbursement of this service to support widespread uptake.

 

The second and most major problem with PrEP access is the cost. Nova Scotia is far behind other provinces. A patient in B.C., Alberta, my home province of Saskatchewan, Manitoba, or Prince Edward Island can access PrEP at no cost. While PrEP is listed as a pharmacare benefit for specific populations in Nova Scotia, patients are required to meet large deductibles and copayments before receiving any funding. This makes the benefit largely futile for those who need this really important, highly effective treatment not only to protect themselves, but to protect our overall community, both in urban and rural areas.

 

During PrEP-Rx, we offered six months of PrEP free for patients. Well over 50 per cent of our patients could not afford PrEP outside of our study, meaning once the study ended, we were no longer able to support them in terms of being able to continue to take PrEP. Therefore, the current funding model is primarily benefiting people like me: wealthy people with good jobs and third-party insurance plans.

 

I'd like to thank the committee for making this a topic of discussion, and I look forward to any questions about my experience as a researcher or as a patient.

 

THE CHAIR: MLA Lachance, just to let you know, I did realize - Ms. LeBlanc let me know she wanted to do opening comments too. By the way, I do want to thank you for letting me know. Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: My colleague, Dr. Leisha Hawker, and I are pleased to be here. At the North End Community Health Centre, we understand that health is not just about what happens in a clinic; it's about access, dignity, and stability. That's why we approach care through a health and housing lens, because the conditions people live in directly impact their ability to stay healthy, make informed choices, and thrive.

 

Sexual and reproductive health is no exception. For the communities we serve - people facing poverty, homelessness, trauma, systemic racism - access to contraception and sexual health services is not just a matter of convenience; it's about survival, autonomy, and equity. At the North End Community Health Centre, we provide trauma-informed, culturally appropriate, barrier-free care. That means meeting people where they are without judgment or a cost barrier that too often puts care out of reach.

 

Offering free contraception and sexual health supports is a matter of public health, and it's smart policy. It prevents crisis pregnancies, reduces long-term health care costs, and gives people - especially women and gender-diverse individuals - real choice and control over their lives.

 

We know that when people are housed and supported, their health outcomes improve, and when they have access to reproductive care, their futures expand. Free access to these services isn't a luxury; it's essential and it works. We look forward to having this discussion.

 

THE CHAIR: I apologize. MLA Lachance.

 

LISA LACHANCE: As mentioned, British Columbia, Manitoba, Prince Edward Island, and Yukon have all signed agreements with the federal government to deliver universal, barrier-free access to birth control. We understand New Brunswick is moving in this direction with or without a deal. We have waited until we don't know what's happening with the federal pharmacare deal at this moment, but I hear all the compelling reasons in terms of why we need to move forward on this.

 

For Access Now Nova Scotia, perhaps you could start: Can you explain why it's vital that Nova Scotia follow the lead of other provinces and territories now to provide universal access to free birth control? You talked about how it's about more health issues than just unwanted pregnancy. I wonder if you wanted to talk a little bit about that as well.

 

THE CHAIR: Ms. Graham.

 

KARI ELLEN GRAHAM: It's very important that Nova Scotia get on the bandwagon now. We are lagging behind a little bit from the other provinces and territories for sure. Now is our chance. There's money on the table from the federal government. We've been advocating for this without federal money. Certainly B.C. did it on their own. We could as a Province, but we have this money on the table right now. We don't know how long it's going to be on the table, so it would be to our best advantage to use that federal funding as money right now.

 

That's why we should do it now, from an economic standpoint, for sure, but of course, as we've heard, there are multiple reasons why, particularly equity. As we know, it's a problem right here, right now in Nova Scotia, and this is one way to take a tangible step towards solving health gender-equity issues - as you said, not just for birth control. Some of our colleagues up here have mentioned other indications for heavy menstruation, endometriosis, transgender care, even hormone replacement therapy. There are all kinds of other indications and reasons why we should be approving contraception, not just for birth control.

 

LISA LACHANCE: I'm wondering, Ms. LeBlanc or perhaps Dr. Hawker - you were talking a bit about the reality of folks who come to see you at the North End Community Health Centre. If you could walk us through a bit more - how many of your clients would you say can't access birth control but would like to, for whatever health reason? If you could walk us through - you talked about some of the barriers, but just what that really looks like for folks on a day-to-day basis.

 

THE CHAIR: Dr. Hawker.

 

DR. LEISHA HAWKER: At the North End Community Health Centre, I provide gender-affirming care and well-woman care. I also treat a lot of patients with opioid-use disorder and other concurrent substance-use disorders. Many of our patients are insecurely housed. Many of my patients are fleeing intimate partner violence, which as you know is an epidemic in Nova Scotia. Just yesterday, I had a patient who was afraid to go to the pharmacy because her ex had assaulted her recently.

 

It's really important that we have this. Right now, I have patients who are on income-assistance pharmacare. That's probably the easiest route for my patients to get access, but there are many who are more working poor - they're working at Wendy's or the dollar store, for example - jobs that are sometimes cash and under the table. Many of my patients can't afford it outright when they pay out of pocket.

 

Then there's Family Pharmacare Program, which many of my patients - as Dr. Brooks, I think it was, mentioned - the copays and the deductibles are just outrageously high. One of my patients at the Newcomer Health Clinic today - I thought I was going to be late because I was on hold with pharmacare. He was confused. He said, “I thought I had pharmacare, but I'm still paying for my meds.” While this wasn't contraception, I figured out from talking to the pharmacare that his max copay is $270, and while he may have paid down his deductible, he still went $22 into that $270 copay. Most likely by the time he gets that paid off, he'll be starting all over again in April.

 

Every year in April, I have many patients relapse because their pharmacare doesn't get renewed because they're insecurely housed and the mailing for the renewal goes to the wrong address. It usually takes a couple of months to get them back on track. When my patients are in recovery for addictions, the last thing they need when they don't have a house and when they're trying to recover from substance-use disorder is to have an unwanted pregnancy.

 

LISA LACHANCE: I wanted to ask a bit about some of the places where we have seen the impact of barrier-free access. The folks from the ROSE Clinic spoke about the ability once you were able to provide IUDs in a barrier-free way - that the rates of insertions increased radically. Can you tell us a bit about what you see - what were the advantages you saw of that, and if you're still offering access to IUDs?

 

THE CHAIR: Dr. Yoshida.

 

DR. LIANNE YOSHIDA: To be clear, we are able to offer barrier-free, long-acting, reversible contraception like IUDs and contraceptive implants purely from donations from the public. We have had times when our donations run out and we're no longer able to provide the devices to patients who need them.

 

As Dr. Hawker said, a lot of our patients are working poor. Even the ones who are lucky enough to have third-party insurance - sometimes their copay is 50 per cent, and these devices are over $400. To have $200 to pay as their copay is sometimes very difficult with all of their other financial constraints - and those are the patients with insurance. We have many patients who just can't afford it. We are just able to do our screening and ask them what their choices are.

 

We often hear people who knew about IUDs and were interested and were waiting to save money or to get their insurance to kick in, and while they were waiting, they had an unplanned pregnancy. On a daily basis, we hear this. It's just so clear to us, the need for barrier-free access because the cost of performing an abortion at our clinic is much higher than a device that can provide excellent contraception for eight years. The economics and the finances of it are so clear.

 

[1:30 p.m.]

 

Beyond that, just the gratitude of the patients - all of us who work at the clinic get such sincere thanks from our patients when we tell them that we can actually provide them with their preferred method of birth control at no cost. I think that, to me, on a personal level as an abortion provider, is the most powerful part of what we're able to do.

 

LISA LACHANCE: You talked about the economics of being able to provide this. Dr. Strang, we understand from a Department of Health and Wellness FOIPOP that the cost of delivering free access to birth control in Nova Scotia is estimated to be $8.5 million per year. Do you think that cost would be offset by other public health savings?

 

DR. ROBERT STRANG: We have to look into that and do the health economics around that. I can't answer that off the top of my head.

 

LISA LACHANCE: At this point, I'm going to pass things over to MLA Wilson.

 

THE CHAIR: MLA Wilson.

 

ROD WILSON: Good afternoon. Thank you, everyone, for joining us. I know the work you do, and I also know your impacts, so I'm grateful that you're able to speak to your experience today.

 

My questions are related to PrEP. I guess the first question would be for Dr. Wilby. You mentioned previously in other conversations that only an estimated 8 per cent of PrEP eligible users in Nova Scotia take the medications. You explained some of the barriers. Can you explain who this population might be and what other reasons are that the 8 per cent are not taking it or accessing it?

 

THE CHAIR: Dr. Wilby.

 

KYLE WILBY: The statistic was from a few years ago where only 8 per cent of people were taking it. There's a major gap in people who are eligible for PrEP who aren't able to take it for the reasons that I described: one, was prescribers; two, was really the funding model. These people are from many different populations.

 

It is important to know that HIV PrEP users are not a major population. When you're thinking of doing widespread funding or changing the funding model, the cost associated with that will not be that significant. The people who are not taking PrEP who would benefit are students. Again, I'm the director of the College of Pharmacy. I have students in my program who aren't able to access PrEP. It's gay, bisexual, men who have sex with men, and transgender women, a population who doesn't really have a major voice in health care and also suffers from other aspects of health inequalities and inequities. People who inject drugs are another major population.

 

The interesting thing, too, about PrEP is that it's not just the medication itself but it comes with a program of STI testing and treatment. We completed another study called SWAB-Rx where we found large pockets of chlamydia and gonorrhea inside the community that would have been actually discovered if we had had those patients on PrEP, but they weren't taking PrEP at that time. It's people all throughout the province, through all corners of the province who don't have a loud voice as, again, there are not all that many people out there who would qualify. However, those who would qualify would greatly benefit, and those who would qualify are currently not taking the medication.

 

ROD WILSON: Could you tell me what the out-of-pocket cost is for someone who's not covered by pharmacare for PrEP in Nova Scotia?

 

KYLE WILBY: An out-of-pocket cost for three months' supply is about $700. Again, unaffordable for many patients who are students, who are not in well-paying jobs, or do not have private insurance. It's important to note that if you break that down per month, it's about $200 to 250 a month. That translates into a cost of treating HIV which can be between $1,500 and $2,000 or more per month. By having people on PrEP, we are actually creating a good ratio in terms of preventing an HIV infection that would then cost the health care system even more money.

 

ROD WILSON: A question for Dr. Strang: In 2018, PrEP was introduced in Nova Scotia under the pharmacare or means test. Can you tell me what's happened to the HIV rates in Nova Scotia, the incidence rate since 2021?

 

THE CHAIR: Dr. Strang.

 

DR. ROBERT STRANG: I have the data in front of me. Certainly, overall incidence - new cases of HIV have increased from 2021 to the latest data we have in 2024. In 2020, we were about 1.5 new cases of HIV for 100,000 population, and now we're roughly three cases per 100,000 population.

 

ROD WILSON: Can you tell me, either yourself or Dr. Wilby: How much does a single case of HIV cost the public health care system over a person's lifetime?

 

ROBERT STRANG: I'd have to do the math, but when we looked at this - and I looked this up last night - in 2019, when we did health economics around this, for somebody who was uncomplicated or HIV, it was roughly $9,600 a year for them for the cost of their treatment for their HIV.

 

ROD WILSON: According to my research, Dr. Strang, the evidence is overwhelming - support in the literature and other jurisdictions - that universal access to PrEP, as in B.C., significantly reduces HIV incidence rates in the population. Is that true?

 

ROBERT STRANG: Certainly, my understanding from the evidence is that increasing access to PrEP is one of a number of factors that are important in reducing HIV rates as low as possible.

 

ROD WILSON: Have you done any estimates on how much it would cost to deliver PrEP as a universal access program in Nova Scotia?

 

ROBERT STRANG: In Public Health, we have not done that. We partnered with our pharmacare program. I don't have those numbers in front of me based on today's costs.

 

ROD WILSON: On the face of it, it appears, both evidence and common sense, that it would be cost-effective. Based on your knowledge and experience in the Department of Health and Wellness, do you know if there've been any recent proposals put forward to the Department of Health and Wellness for full funding of universal access to PrEP?

 

ROBERT STRANG: I am aware that pre-COVID, there was at least one time where we did develop a proposal for universal access to PrEP through part of the annual business planning cycle in the department.

 

ROD WILSON: I think those were the bulk of the questions I have. Thank you.

 

THE CHAIR: MLA Lachance.

 

LISA LACHANCE: Speaking of the annual budgeting and planning process that happens in government, we also have received documents that show the Department of Health and Wellness had a plan to make birth control free for Nova Scotians under the age of 25, and that this was being developed for the purpose of being included in the provincial budget, developed in the Fall prior to the election being called. I'm wondering if any of the witnesses here today were consulted on that plan or were aware of it.

 

THE CHAIR: Who do you want me to ask that to? That's kind of broad. MLA Lachance.

 

LISA LACHANCE: I was looking for volunteers broadly. I see a hand raised over there by Ms. Graham.

 

THE CHAIR: Ms. Graham.

 

KARI ELLEN GRAHAM: I wasn't consulted, and our pharmacy association wasn't consulted, but I would like to talk a little bit about the economics that you brought up with Dr. Strang earlier. I just wanted to highlight that there are a ton of economic data out there already that we can easily extrapolate to Nova Scotia. B.C. has been really good at being transparent with their numbers.

 

Again, for every dollar spent, we can expect $90 in public expenditure savings. That's through social supports that moms who have unwanted pregnancies might not have to rely on, through community supports, the cost of raising a baby - all of those supports and expenditures would decrease, obviously, if we had funded birth control in place. We know that provinces are receiving money through this federal grant in the tens of millions - B.C. P.E.I. just signed on for $30 million, which is about $7 million per year. We can extrapolate maybe $15 million per year in Nova Scotia, but we know that we're going to save, in another silo of money, triple or quadruple that amount when it comes to social expenditure savings.

 

Again, I want to highlight our very high health budget here in Nova Scotia and our pharmacare budget. We are simply looking for one line, maybe 1 per cent of our budget up front, but, again, we know we're going to save quadruple or triple that in the long term. Very good question that I wanted to address.

 

LISA LACHANCE: That is very helpful. The B.C. numbers are helpful, real-time data, for sure. Thinking about this proposal that we understand was alive in the provincial government last Fall, as a parent of young adults, I can tell you that I have lots of first-hand experience with their friends not being able to access adequate contraception. Because I'm willing to talk about it, we get to talk about it a lot at home. I can understand a little bit why the proposed program would have capped that at the age of 25 - and maybe I'll start with Ms. Graham and come back in the second round of questioning - does it make sense to you? Is there a need to be hesitant and to just focus on the under-25s? What would you have to say to a proposal like that?

 

KARI ELLEN GRAHAM: Of course not, no. It just creates more inequities in our health care. It should be wide open. There should be no age. It could be 10-year-olds, 11-year-olds, 12-year-olds up to 67-year-olds who require this medication. Enough with inequalities, and caps, and restrictive formularies, and restrictive money. Make it universal; it's a no-brainer. It makes sense. It's easy to do. We're ready to do it, and B.C. has already shown us that any restrictions that they have put on their birth control - they had a strict formulary of what they would approve out west, and they've since reversed that. Their advice to our Province is to go wide open: all ages, all forms of birth control, no copays, no deductibles. Make it universal; do it right the first way.

 

THE CHAIR: MLA Lachance with 33 seconds.

 

LISA LACHANCE: With those 33 seconds, is there any other witness who wants to pop in for a couple of seconds around that question?

 

THE CHAIR: Ms. Hines.

 

NATASHA HINES: I did want to speak to the age gap of the proposed coverage for under-25-year-olds. I will say that in abortion care, we do see that many of the unplanned pregnancies tend not to be in youth. They're usually in their 20s, 30s, even up to 40s. We do see that unplanned pregnancy isn't necessarily an issue that only impacts youth.

 

THE CHAIR: Order. Perfect timing. The next 20 minutes will be for the Liberal caucus. MLA Mombourquette.

 

HON. DEREK MOMBOURQUETTE: Thank you, Chair. I want to thank everyone for coming to present to us today and to committee. I'm going to start my questions off with the ROSE Clinic. In the last year, we heard that the ROSE Clinic was running low on donated funds to provide free contraception. For many Nova Scotians who can't afford IUDs and don't qualify for public pharmacare, this program has been one of the only ways to access care. It raises an important question: Should access to essential reproductive health care really depend on donations?

 

My first question to Ms. Stockman from the ROSE Clinic: What is the current situation at the clinic? Are donated contraceptive devices still being used, and has new funding or coverage streams been secured?

 

THE CHAIR: Dr. Brooks.

 

DR. MELISSA BROOKS: Most of our funding has come from donations through the foundation. They've kind of fluctuated with time, and sometimes when things happen in the U.S., it gives us a little boost in how much people donate to us, which is great. You're right, we shouldn't have to depend on donations in order to provide good health care for our patients.

 

We have been working with DHW to try to secure some more consistent funding, and that's kind of in the works. We're working on more consistent funding for that program. I think if we were able to get universal access to contraception for everyone in the province, then our program wouldn't even be necessary which would be the perfect situation.

 

DEREK MOMBOURQUETTE: Thank you, and you're absolutely right. As elected representatives on this side, we've also advocated that as they negotiate a new health care agreement with Ottawa this is part of it. This is something that we plan on talking to our Liberal colleagues about as well at the federal level. You make an interesting point. If you could elaborate on that relationship with the Department of Health and Wellness: Have you seen additional funding come? Has anyone reached out? We're hearing that you shouldn't have to rely on donations; donations come in waves.

 

[1:45 p.m.]

 

You mentioned in your comments about the Department of Health and Wellness and potential funding with them. Could you elaborate on that a bit? Are you having those conversations with them now? Until there's a new deal negotiated, which we're all pushing for, have you received any additional funding, knowing full well that the donation system is important - thankfully, we have wonderful organizations that will donate - but are you receiving any additional funding or hopeful of receiving any additional funding from Department of Health and Wellness until that deal is signed?

 

THE CHAIR: Dr. Brooks, or . . .

 

MELISSA BROOKS: I think Stacy Burgess.

 

THE CHAIR: Ms. Burgess.

 

STACY BURGESS: My team and the ROSE Clinic have been working very collaboratively in the last year and a half. We have given a one-time grant, and we continue to work with the team to think about long-term funding. As well, we have a very open relationship that if the funding is starting to deteriorate, there is a call to us to have more of a discussion of what that will look like while we continue to wait, what the future will look like around universal contraceptives.

 

DEREK MOMBOURQUETTE: That's really the key. We see that with organizations across the province that are supporting our vulnerable population in many ways, that the ability to be able to pick up the phone if resources are starting to decrease is critical. Hopefully, as I've said, we're going to continue to push that a deal is signed.

 

Sticking on the same topic with the ROSE Clinic, you've said this; you can elaborate on it - how many patients typically are accessing the service, and have any been turned away or delayed in receiving care due to limited funds?

 

MELISSA BROOKS: In terms of how many patients we provide abortions to, it's usually five or six per day, Monday to Friday. As far as we've started the program, I don't think we've turned away anybody who's required long-acting, reversible contraception. We've been able to keep funds through our donations to supply those. We have not had to turn anybody away, thank goodness.

 

DEREK MOMBOURQUETTE: My next question is again around the ROSE Clinic: With each device costing an average of $400, what kind of short-term funding solutions could you use now to close any gaps? Are you seeing any gaps now? Are there any other solutions that government could be providing to help provide that support?

 

MELISSA BROOKS: As Dr. Yoshida said, we're only able to provide long-acting, reversible contraception, so IUDs and contraceptive implants, which not everyone actually wants or there are some reasons that people can't use those devices. For people who want to use things like birth control pills or injections, we can't help with funding for that.

 

We could cross-reference with Sexual Health Nova Scotia, and sometimes they can be helpful for our patients. Really, as I think everyone has talked about, those working-poor patients, people who don't have community services, pharmacare, don't have private drug insurance or their drug insurance doesn't really provide good coverage: There really is not a lot to do for those patients. Those are the people who do get lost in our current system. From what we see, I think from what they would see at the North End Community Health Centre, and from what I see as a gynecologist: those people who really can't afford prescribed medications, there is not a safety net for them currently.

 

THE CHAIR: Ms. Ferguson.

 

ABBEY FERGUSON: I'd love to jump in there. The Halifax Sexual Health Centre provides compassionate contraceptives. We're around that $17,000-a-year's worth. I want to highlight the fact that your access to free contraceptives is coming in these very siloed places. If you're accessing an abortion, that's where you can access your long-acting form of contraceptives, or if you come through Halifax Sexual Health. If you don't have those options, or if you have a family care provider who would love to offer you a contraceptive option, you are then forced to replicate your appointment and come to Halifax Sexual Health so that we can see you and prescribe that medication, because we are not a pharmacy.

 

We're not only seeing restrictions in terms of the cost. We're also seeing restrictions in where you're required to get an appointment.

 

I'm not sure if folks are familiar, but getting an appointment with Halifax Sexual Health is a bit of a battle royale. We can serve generally anywhere between 11,000 to 12,000 patients every single year and we receive thousands and thousands more calls than that. Then you are duplicating that appointment - even if you had a primary care provider, we are then doing that same consultation so that we can write you that script. That is a huge waste of health care resources.

 

DEREK MOMBOURQUETTE: That's a great point, and it kind of leads into my next question. I can completely appreciate if the information isn't available - I think everybody would have to go back and kind of track it - but it leads to the question. You make the point that you support 11,000 or 12,000 patients a year but you're getting thousands of calls more. It really kind of begs an important question for me - and I come from Cape Breton. I come from an area where I know there are some great organizations on the ground that are helping to support folks every day.

 

In your opinion - and this could really go out to anyone, and if there's data around it - how many people are being denied? That could be because of health care coverage or because of capacity to support. Is there an average out there? Statistics have been used today around the percentage of people who have pharmacare or have a health plan versus people who do not. In your opinion, how many Nova Scotians who are looking to access this support are being denied?

 

ABBEY FERGUSON: I would say that it's deeply challenging to put numbers on a void. What we're talking about is addressing a gap. How do you count the folks who are living in that gap? I can tell you about the thousands of calls we get every single year from folks looking to get appointments but we're full; but that doesn't speak to the folks who never got through on the phone, or who thought about it but have heard from friends about how challenging it is. Or if you're talking about something like rural access - if you are someone seeking a birth control prescription and you're calling from Cape Breton and we can do that virtually - I can't mail you that free contraceptive. I can't send a fancy voucher to your pharmacy that says, “Trade this in for free contraceptives.” That doesn't solve the problem of rural access as well.

 

I know numbers are very desirable, but I think it's deeply challenging, when this is a void that we're talking about, to put a number on what that is.

 

At Halifax Sexual Health we have not turned anybody away for free contraceptives since 2017. We had a huge budget - operational budget (inaudible) - during that time, in which we were cutting literally everything to stay alive. One of those things - the first thing to go was our Compassionate Contraceptives Program, because that is funded by individual donations. Individual donations are something that I can use to pay staff. Without program funding to sustain it, it is something that will go away. If something happened to our private donations and that $17,000 is not available - again, I would have to scrape that out of how I turn the lights on and pay my staff and buy specula.

 

DEREK MOMBOURQUETTE: I guess that's another part of the fact of - you raised - I'm sorry. Dr. Brooks, did you want to respond to my last question?

 

THE CHAIR: Dr. Brooks and then Ms. Graham.

 

MELISSA BROOKS: I was just going to add - again, it's hard to put numbers on it, but when you look at Canada in general, our rate of unintended pregnancy is about 40 per cent - so 40 per cent of pregnant people become pregnant not meaning to. When you compare us to other high-resource countries, we're not doing great in terms of the number of people who end up having unplanned pregnancies every year. We certainly could improve vastly. Really, when you compare us to other countries like the U.K., where people have more free access to contraceptives, those are the places where they have more reasonable rates of unplanned pregnancy.

 

We don't have data specifically for Nova Scotia, but Canada in general has a fairly high rate of unplanned pregnancies if you compare us to other high-resource countries.

 

THE CHAIR: Ms. Graham.

 

KARI ELLEN GRAHAM: That's exactly what I wanted to highlight, Dr. Brooks. At least 40 per cent to 50 per cent of pregnancies are unplanned. We know that there are about 10,000 babies born in Nova Scotia a year, so maybe about 5,000 babies are born as unwanted pregnancies, if you want to extrapolate that data.

 

I also just want to highlight that everyone up here is so keen and amazing. The ROSE Clinic, of course, they bend over backwards, and the Halifax Sexual Health Centre - trying to help the patients who walk through their door because they're so amazing. They do an excellent job.

 

It's all of the patients who don't walk through their door who aren't getting served, again, highlighting what you've already mentioned, MLA Mombourquette, all the calls that you're getting, but even people who don't have the resources to make those phone calls or to get themselves to the clinic in rural Cape Breton and rural mainland Nova Scotia, all of those patients who don't have The Red Door, who don't have the Halifax Sexual Health Centre, who don't have the ROSE Clinic just a walk up the block. Amazing job on the efforts of these people on the patients they see, but there are so many patients whom they don't see who aren't getting the services that they need.

 

DEREK MOMBOURQUETTE: I really appreciate the responses to the questions. You're absolutely right. I see it on the ground in Cape Breton too - amazing organizations really stepping up with limited resources, relying on community advocates, and organizations that really step up to help support these organizations that are helping folks each and every day.

 

We talk about unplanned pregnancies and the percentages around unplanned pregnancies. Are you seeing the provinces that have implemented - whether they've signed a deal or they've made this universal access for everyone - do you have any information on the percentages in those provinces? Have they declined when it comes to that rate of the unplanned pregnancies?

 

THE CHAIR: Ms. Hines.

 

NATASHA HINES: I don't have numbers on the unplanned pregnancy rates, but I do have a few numbers from B.C. about the success of implementing their program. The program was implemented in B.C. independently from the federal government in April 2023, and from April 2023 to December 2024, 306,000 people in B.C. received free contraception. The Contraception and Abortion Research Team found that as of June 2024, the number of people using any form of prescription contraception increased by 10 per cent. I know that doesn't directly answer your question to the rate of unplanned pregnancies, but it certainly goes a long way to see the need that this program has filled and the uptake in using contraception to prevent pregnancy.

 

DEREK MOMBOURQUETTE: Again, thank you for that. You're right - your percentages around people who have access to it and are using contraceptives obviously is going to support folks in the community.

 

One question I have because we talk about Nova Scotia signing a new deal with Ottawa - that this be part of it. I guess this is an open-ended question as well, and I think my colleague brought it up too. The key to this for government is going to be consultation with experts like yourselves. As Nova Scotia's been negotiating this deal with Ottawa, which we're hopeful will come to a conclusion that is positive, have your organizations been consulted at any point throughout the negotiation?

 

THE CHAIR: Ms. Graham and then Dr. Yoshida.

 

KARI ELLEN GRAHAM: Yes, in direct consultation, particularly with the New Brunswick government who are trying to push the funding with the federal program through and have had some resistance, and who are considering maybe doing their own internal thing. I want to say that hesitancy from New Brunswick has been surrounding the diabetes part of the funding, not the birth control part of the funding - the contraception. That's their bit of hesitancy there. They have been reaching out indirectly through some leads there. Of course, Mark Holland was making the rounds last year and was reaching out for indirect comments and what's going on here in Nova Scotia. I know the helm has been passed to Kamal Khera and they have been reaching out indirectly for what's going on on the ground in Nova Scotia and what we can extrapolate from the western provinces.

 

THE CHAIR: Dr. Yoshida.

 

DR. LIANNE YOSHIDA: I was just going to say that we have not been consulted.

 

THE CHAIR: Ms. Ferguson.

 

ABBEY FERGUSON: We have also not been consulted.

 

[2:00 p.m.]

 

THE CHAIR: Ms. Hines.

 

NATASHA HINES: I want to say that since Wellness Within is part of the Access Now Nova Scotia coalition, Access Now has been trying to get face time with the provincial government to discuss this issue for a long time, and we have yet to be successful until today. This is the most meaningful dialogue we've had, but there hasn't been any consultation.

 

THE CHAIR: Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: I would say that it's also part of our conversations every time that we're having government consultations, is to advocate for this, but at this point, we haven't had any success.

 

THE CHAIR: Ms. Benoit.

 

JENNIFER BENOIT: I can affirm what others are saying. The Nova Scotia Health Coalition has not been consulted on this as well. It's not from lack of trying. We've reached out many times.

 

THE CHAIR: MLA Mombourquette with two minutes.

 

DEREK MOMBOURQUETTE: I find it very alarming that we're about to sign a multi-year historic agreement negotiated with our federal government - and this is the importance of these committees, that's for sure - and it's showing up again today. It's a theme consistent with many of these committees that we're on. We have wonderful advocates and experts coming into this committee who are pressing an important issue around supporting Nova Scotians, and no consultation has been done by the government. There are many words I can use for that. That's discouraging. That is absolutely wrong, and I hope that decision-makers are watching this.

 

For you to come here to this committee today - it's an honour for us to sit here as MLAs in this committee, and I learned a lot by just listening. I've been around for a couple of years now as an MLA, but this is something that is evolving in our communities. I'm learning about donations covering the supports that many Nova Scotians are accessing. I can't thank you enough for the work that you're doing on behalf of families right across this province. I don't have a question. I'll have another round, but we just went around this room in the committee, and everybody said they weren't consulted, and we're negotiating a new deal with the federal government. To me, that's appalling.

 

I'll stop now and pass the rest of my time on, but I just want to reiterate that I really appreciate your answering my questions. We'll have some more in the next round. I really learned a lot, and I can't thank you enough for the work that you do to support people across the province.

 

THE CHAIR: The next 20 minutes will be for the PC caucus. MLA Corkum-Greek.

 

HON. SUSAN CORKUM-GREEK: I would genuinely like to thank all of you. One of the difficulties of these committees, particularly when we have such a robust and large group of clearly passionate people about what you are doing, for which our province is really lucky, we're really grateful - I think I could sit down with any of you for two hours. I have been making more notes, and I have colleagues who also want to ask questions. I sit here as a Nova Scotian, as a woman, completely aligned with the case that you've made.

 

We want to empower women, we want to empower gender-diverse individuals, families, to be able to make choices about their lives, including when or perhaps if to have children, when they might wish to start a family. We know that when unintended pregnancies happen, it can be very disruptive, and it can disrupt their education. I realize that right now, I'm preaching to the choir of how disruptive, if not destructive in terms of tying them, perhaps, to partners who are abusive and so forth. Absolutely, hearing your arguments, there are decision-makers - all of us, arguably, in this room.

 

I would like to take a moment to focus on this pharmacare situation, the offer of the federal government. At the end of the previous government's term in 2021, they signed a child care deal that, in our view, was a bit short-sighted. Among other things, it excluded private operators in a province where private child care was very important to the mix of being able to provide child care. Our government has been working steadily since that time to address that gap, yet we face a federal government that to this point has been rather inflexible. We hope we continue to work to get to a better place.

 

This is another situation where the federal government has put forward the offering of funding, and we are very interested. We don't want to leave money on the table, but it does highlight that the devil truly is in the details. My question is to Dr. Strang, possibly to others here on behalf of the Department of Health and Wellness: Can you explain a bit of why there's value in not rushing into a deal and, perhaps, some of the considerations on the table?

 

THE CHAIR: Dr. Strang.

 

DR. ROBERT STRANG: I'm not involved in this in any way, shape, or form. I'm going to pass that to my colleague Stacy Burgess.

 

 

THE CHAIR: Ms. Burgess.

 

STACY BURGESS: First and foremost, I want to say that I hear you. I definitely hear all of your comments today, so thank you for that. I will be taking it back to the department.

 

As I said at the beginning, I am with system integration, so not directly in the pharmacy department. What I can tell you is that, as Dr. Strang mentioned in his opening comments, the minister is looking to get the best deal for Nova Scotians. We are interested in going back to the table - we are waiting for that invite - and to really look at ensuring that what we sign or do is financially responsible for Nova Scotia, it doesn't change any of our current programs that we have in place, and that we have long-term funding for it.

 

SUSAN CORKUM-GREEK: I think what I am taking from your answer - and I do understand the arm's-length per the negotiations, but there is a sustainability issue that is amongst some of the considerations. There were references earlier that we are living in extraordinary times. I believe the reference was made to donations to the ROSE Clinic's programs perhaps being positively influenced by what we're watching in the United States. As a woman of a certain age, it seems impossible that we are in a world where Roe v. Wade has been overturned.

 

I'm hoping that representatives from the ROSE Clinic could give me a little insight in terms of what access to abortion looks like in Nova Scotia and the improvements that have been made in recent years to access.

 

THE CHAIR: Dr. Yoshida.

 

DR. LIANNE YOSHIDA: In terms of access to abortion, it really changed a lot in 2018 when we were able to remove a significant barrier, which was that patients needed to be referred from a physician to access an abortion at our clinic. We were able to remove that barrier in 2018. We also have a toll-free phone number and online form for patients who are facing an unplanned pregnancy - whether or not they've even decided if they want an abortion, can just contact our clinic directly. In 2018, that's when the medical abortion option, the medical abortion pill, also came into Canada. It was a perfect time to provide easy access to any abortion that the patient preferred, whether a procedure or the pill.

 

That has changed significantly. Since then, we've also been able to expand the access to prescribers - nurse practitioners, physicians, family doctors, and gynecologists - throughout the province who can prescribe mifepristone or Mifegymiso, which is a trade name for the medical abortion pill. I think we are quite proud of this.

 

So the changes since 2018 have been significant. We hear that from patients all the time - patients who have tried to access abortion care before 2018 and after 2018. They've noticed a difference and they've given us the feedback. We're very proud of that.

 

To speak to this issue here, of course we're very proud to be Canadian and have no laws about abortion. We're very proud to work with the ROSE Clinic, which we think provides excellent care, but as we say to every patient, we also would prefer not to see them again. As much as we get such sincere thanks for the care that we provide, we all know - all of us working there and all the patients we see - that an unplanned pregnancy, even if they are able to access excellent care, is still disruptive, as you had mentioned, to their life.

 

For the patients whom we see are choosing to have an abortion, patients whom Dr. Brooks would see at the IWK Health Centre who are choosing to continue their pregnancy, an unplanned pregnancy can become a wanted pregnancy, but it still was initially unplanned. I think that we don't want patients to have to be in that situation when such effective contraception is there. It's right there, and the only barrier is a few hundred dollars per device. Again, it's just so obvious.

 

I always say that it would be lovely if we could close the doors of the ROSE Clinic because there are no unplanned pregnancies, but we all know that to get to that stage is impossible. Even these actual methods of birth control are not 100 per cent. We all, at the ROSE Clinic, have seen every method of birth control - even surgical methods - fail. That goes without saying, but why not at least give people the option to have access to the best that has been invented.

 

THE CHAIR: Ms. Hines.

 

NATASHA HINES: I just wanted to add to what Dr. Yoshida was saying. Providing excellent abortion care is extremely important. It should be noted, too, that abortion is publicly funded by our health care systems, and so are medication abortions - Mifegymiso is publicly funded and free for anybody with provincial health care. Modelling that in the prevention of unplanned pregnancies as well only makes good sense.

 

I would also say, kind of to your previous comments about wanting to navigate a fair deal: We should lean on our other provinces who have done this before us and have had success. We aren't the first province that would be attempting to do this, so I think we do have good resources from other provinces across the country as well.

 

THE CHAIR: Ms. Graham.

 

KARI ELLEN GRAHAM: First of all, I just want to say thank you. We have been advocating from Access Now Nova Scotia for two years. We have sent multiple letters to the government, Premier Houston, our Minister of Health and Wellness, Kathleen Coleman. We've had very little response. You are the first person to voice your support for this, so thank you for the government and representing them so well here today.

 

I also want to circle back to any hesitancy that the government would have to signing this federal bill. I know it just became proclaimed about nine months ago or 10 months ago, but really, we've been looking at this issue here in Nova Scotia when it was first introduced in our Legislature as Bill No. 80 almost seven years ago by the NDP. It's been out for decades before that, looking at this. We have a ton of data. We have a ton of research, mostly spearheaded by the NDP, backed at some points by the Liberals. We've been looking at this not for 10 months, but for years and decades. Other countries have been doing this for decades. Other provinces have been doing this for a year or more, or months. I know we want the best deal for Nova Scotia, but for goodness sake, we've been looking at it and we have the data. It's a no-brainer.

 

I also want to say that B.C. was funding this intraprovincially, and then they signed onto the federal deal. It was an easy transfer for them. We can sign onto this federal deal, and if we don't like the strings attached, we can move it to an intraprovincial funding thing. Right now, it makes sense, and of course we sign onto deals in lots of different things. You brought up child care where, in the long term, we find out maybe the specifics weren't exactly what we wanted, but we can address that at a different time. Right now, it is working well for other provinces and territories. Again, I think Nova Scotia is clearly lagging behind.

 

[2:15 p.m.]

 

SUSAN CORKUM-GREEK: Again, this is one of the challenges of having so many not just passionate, but deeply knowledgeable front lines of these issues. It is not easy to say. We see more hands, but I'm going to move on with one more question myself, or my colleagues are going to give me the heave-ho. A lot of us represent rural areas, as well as marginalized communities, where access to services can have challenges. MLA Mombourquette referenced Cape Breton Island. I'm down on the South Shore.

 

While I deeply appreciate services like those provided through South Shore Sexual Health and my long-ago colleague Julie - shout-out to Julie, who I'm sure is not watching Legislative TV this afternoon - or the Second Story Women's Centre, I wanted to ask our partners here about the role in making sexual health services more accessible beyond the very present issue of contraception - either drug or methodology - the advice and support, and if there are those who can speak to that matter.

 

THE CHAIR: Dr. Brooks.

 

DR. MELISSA BROOKS: That actually speaks to what I was going to comment about. Dr. Yoshida did talk about the advances we've made in abortion care, but we still have issues with access - one of which is access to procedural abortion in Nova Scotia. Currently, we provide it in Halifax, there are gynecologists who provide it in Kentville - and that is it for the province. If you live on the South Shore, if you live in Cape Breton, you have to drive to Halifax if you want a procedural abortion.

 

There are hospitals in this province with gynecologists who want to do abortion, and they are prevented by the hospital from providing that abortion. That is certainly something that we can do to improve access to abortion in this province.

 

The other thing is gestational age. Currently at our clinic, we provide access to 15 weeks and six days. We'd love to advance that. We were currently declined an increase in our funding in order to support that. For increasing access, we're probably one of the lowest in the Atlantic provinces right now for how high we go for abortion. We could definitely improve that with a bit of additional funding to our clinic.

 

SUSAN CORKUM-GREEK: I will pass the remaining time over to MLA Fadare.

 

THE CHAIR: MLA Fadare.

 

ADEGOKE FADARE: I think I'll echo the thoughts of everyone. It's great to have everyone here today. I think it's a very important conversation. My first child is a girl, so I'm very concerned about female well-being. I believe in the power of choice because that determines - I always say that a decision determines your destiny, so I think it's important that people have the opportunity to make those decisions.

 

I know we've spoken a lot about finances today, and we've talked about other types of barriers. I'm just wondering, to any witness who wants to talk about, apart from finance, apart from capacity, what other barriers have you noticed, and what are we doing about those barriers? For example, I know there's a bit of culture; I know there's also a bit of religion. Some believe that there's also an issue regarding systemic. For example, while I was at Dalhousie University, we did a study regarding lack of people from historical Black and the Black population with trust. I'm just wondering, what other issues have you've seen that are barriers, and what are we doing about those barriers?

 

I know that it's not just about capacity. It's also not just about money. Maybe there are more I didn't echo that you've observed. This is open to anyone who's willing to talk about it. I realize there are a lot of experts here.

 

THE CHAIR: Ms. Hines, then Dr. Brooks, and then Dr. Hawker.

 

NATASHA HINES: You're right, there are a lot of issues that impact people's access to sexual and reproductive health, some of them being culture and religion. Another big one is education, so comprehensive sexual education in schools and in communities. Certain people from marginalized populations face barriers like poverty, being unhoused, and things like that.

 

I will bring it back to a lot of these issues can be remedied or at least supported by removing cost as a barrier so that people who do face intersecting issues like stigma, systemic racism, poverty - all of these things, when you remove at least one barrier, which we're in a position to do - it helps greatly with those issues.

 

I will say that a lot of the witnesses here today are part of the Access Now Nova Scotia coalition. If you ever had time or wanted to meet with one of us, we do all communicate with one another. We'd be happy to have one representative meet with you instead of all of us.

 

THE CHAIR: Dr. Brooks.

 

DR. MELISSA BROOKS: This is very specific, but the current immigrant population in Nova Scotia - a lot of them prefer copper IUDs as contraception, and because a copper IUD is not a drug, it's actually not covered by any kind of pharmacare. So for patients who choose a copper IUD, which is more preferred among the immigrant population, they don't get coverage for that.

 

THE CHAIR: Dr. Hawker.

 

DR. LEISHA HAWKER: I agree with Natasha Hines that the primary barrier is cost. I do have a history of working with Indigenous health populations from my first five years of practice, and in that community, there has been a lot of progress. Now for urban Indigenous patients we have Wije'winen and some really fantastic colleagues of mine working there and providing very culturally safe and appropriate care.

 

In terms of the North End clinic, which serves a lot of the insecurely housed and traditionally marginalized populations - a lot of African Nova Scotians in the north end community of Halifax - the biggest thing that M-F mentioned is we really tailor the care to the patient. We go to where they are. We're very low barrier. A lot of our patients have a history of distrust with any sort of government or institution, so a lot of our nurse practitioners on the street are just in regular jeans and T-shirts. They're very approachable. We have a lot of patients whom we hire from within the community. We've worked really hard to be able to bridge that gap between a physician and a patient who might be insecurely housed.

 

In terms of the Newcomer Health Clinic, as Dr. Brooks mentioned, copper IUDs are the preferred for many of my patients. The Health Authority actually does purchase in bulk some copper IUDs, so in terms of refugee claimants and government-assisted refugees, the Newcomer Health Clinic is able to provide them. The IFHP - the Interim Federal Health Program for refugees - does cover the Mirena and the Nexplanon, but a lot of times, for cultural reasons, they prefer not to have changes in their periods or amenorrhea. Unfortunately, though, many of my patients have significant iron deficiency and the copper IUD often is not the best choice for them, so there's usually quite a bit of education around that.

 

The North End clinic and the Newcomer Health Clinic - we're blessed at both locations to have OB/GYN colleagues come and have gyne clinics. Particularly at the Newcomer Health Clinic, there is significant education from the excellent gyne residents who volunteer their evenings.

 

THE CHAIR: Order. That concludes the first round. The next round will be seven minutes. We'll start with the NDP.

 

MLA Lachance.

 

LISA LACHANCE: I wanted to look at one aspect or one impact of not providing barrier-free access to contraception in Nova Scotia. I do note - Dr. Strang mentioned it, and Ms. Burgess and I have had many conversations about gender-affirming care in this province - we still don't - for a reason that no one has ever explained to me - actually meet the WPATH Standards of Care 8^th Version. There are still about four procedures that MSI does not cover in this province. I don't know why.

 

My concern around that is that I think that really perpetuates experiences of transphobia and health disparities in the health system. It sort of says, We're going to give you some of what you need - some of what the international experts have said you need - but we kind of still doubt you and doubt your needs, so we're just going to hold back on some procedures.

 

I also think that - we talked about trans folks accessing contraception as part of their gender-affirming-care journey. I'll open it wide for one or two responses, perhaps, because my colleague has another question. What is the impact on someone's gender-affirming-care journey if they are not able to access barrier-free contraception as part of that journey?

 

THE CHAIR: Ms. Ferguson.

 

ABBEY FERGUSON: I can speak to that. The Halifax Sexual Health Centre provides gender-affirming care. We also handle contraceptives and PrEP, so pretty much anything we're speaking about today is relevant.

 

When we are talking about the cost of hormones that may or may not also be on someone's gender-affirming care journey, we are looking at anywhere around $75 a month for a vial of testosterone, for example.

 

Gender-affirming hormones also fall to the same consequences of the poor Family Pharmacare Program setup: high copays and deductibles that don't actually successfully meet people's needs. Then we're adding any type of contraceptive on top of that. We will sometimes suggest hormonal IUDs or things like Depo-Provera injection contraception as a way to prevent menstruation for folks who may be uninterested or counter-indicated to actually taking hormones like testosterone, which will also usually prevent their menstruation.

 

We are seeing the impact of gender dysphoria, which increases rates of suicidality in the gender-diverse and trans population on top of the cost barrier. All of those things are at play at once.

 

THE CHAIR: MLA Wilson.

 

ROD WILSON: You've highlighted some of the elephants in government. We know that the Eastern Zone has physicians willing to provide procedural abortions, and they're still not being provided. We asked in the Spring sitting why that was happening and we never got a clear answer, but we'll continue to ask.

 

One of the other elephants - I think I call it a pink elephant - we know that PrEP is cost-effective. The evidence supports it. The people are not getting care. It prevents HIV, yet Dr. Lachance has put in bills two years in a row asking for PrEP coverage. Dr. Wilby, there's the business case, there's the clinical case, yet we still can't convince government to provide PrEP. Do you think transphobia and homophobia have anything to do with it?

 

THE CHAIR: Dr. Wilby.

 

KYLE WILBY: It's a great question. I think if you look at the actual policies and how things are written, you do see transphobia and homophobia written, especially within how pharmacare guidance is provided. Right now, someone can have the pharmacare benefit or potentially have the pharmacare benefit if they are gay or bisexual, a man who has sex with men, a transgender woman, a person who injects drugs, or is in a heterosexual serodiscordant couple. The issue with that is non-binary people are not represented and trans men are not represented. PrEP is effective for anybody.

 

My experience, in terms of these policies and these guidelines, is that there is embedded systemic oppression within them, and we need to relook at that to make sure that all of our patients are represented and are able to actually receive that medication and benefit.

 

THE CHAIR: Dr. Hawker.

 

DR. LEISHA HAWKER: I just wanted to add that many of my patients who inject drugs similarly would benefit from PrEP, but the current pharmacare exception status criteria is too limited. Not only is there stigma around possibly people in the Pride community, but also a lot of stigma for a lot of my patients who inject drugs.

 

Lastly, I think the big theme for today is looking at all these providers and how we're making do and trying to provide the best for our patients. We're all relying on beg, borrow, and steal, and donations, and really, these are services that should be funded by the government.

 

THE CHAIR: MLA Lachance.

 

LISA LACHANCE: I think just to pick up on that, it is truly appalling that we don't provide barrier-free access to contraception and that we don't have really barrier-free access to all kinds of abortions across this province. I can't quite believe that we're sitting here talking about this in 2025. One of my dear friends is Dr. Pam Brown, who helped found the Halifax Sexual Health Clinic in the 1970s. (Laughs)

 

We've talked about this worry about sustainability of finding $8.5 million in the budget to provide contraception. To Dr. Brooks or Dr. Yoshida or someone: What's your response to the claim that the Province might not be able to afford to deliver free birth control?

 

THE CHAIR: Dr. Brooks.

 

DR. MELISSA BROOKS: I would say that we can't afford not to. We know it's going to save money. Even if we got nothing from the federal government, if we put the money in there, we will get it back plus some. The money from the federal government is a bonus, really, in this equation. When you look at the budget of health care - we put this in one of our reports from Access Now Nova Scotia - it's like 0.1 per cent of the budget in health care to do this, and it will drastically improve access to sexual health services for people with a uterus in this province. I would just say that we can't afford not to.

 

[2:30 p.m.]

 

THE CHAIR: Order. Before I go on - just to let you know - the reason I say people's names a second time is not for them to talk up; it's for Legislative TV. Dr. Hawker knows; she's been here many times. I'm actually saying, “Put her mic on.” I should have mentioned that because sometimes I have to do it multiple times.

 

MLA Mombourquette.

 

HON. DEREK MOMBOURQUETTE: I'm going to talk about reproductive coercion. As we know, free, accessible contraception - and we've heard a little bit about this today, there was an example - helps to protect people from the situation when someone tries to control their decisions around pregnancy or birth control. When cost isn't a barrier, it's easier for people, of course, to make choices that are right for them safely and privately. This is about giving people choice, ultimately, and control over their own bodies.

 

My first question is: What forms of reproductive coercion are you seeing in your work?

 

THE CHAIR: Who specifically, or are you leaving that open? Ms. Hines.

 

NATASHA HINES: We know that intimate partner violence is an epidemic here in Nova Scotia. It is said that people with a uterus in Canada who face intimate partner violence are two times as likely to experience an unintended pregnancy, and one in four Canadian women self-report not being able to freely make their own reproductive choices.

 

What that can look like, just to paint a picture for you, is, for example, if somebody has private health insurance but it's maybe through their spouse's employer - maybe they have spousal coverage for their prescriptions - then if they try to go and fill a contraception prescription, their partner will know. So they don't have that freedom, that autonomy, and that confidentiality that they may need to exercise their own right to govern their own body and make choices about their reproductive health.

 

THE CHAIR: Dr. Hawker.

 

DR. LEISHA HAWKER: I'd just like to add to that. I see reproductive coercion and intimate partner violence on a fairly regular basis. It's certainly a lot more common than I would like to see. I actually had a patient a few years ago where the partner forcibly removed the IUD. When talking with patients, sometimes we're talking about maybe not what's the best option for that patient, but what's the option that the partner will be unaware of? Can you get to the clinic every 13 weeks to get a Depo injection? If you have an IUD, is the partner going to feel the strings and does that put that person at risk? Or the implant, for example, is easily palpable and there's a small scar there so the partner might know.

 

At the Newcomer Health Clinic, sometimes we see partners insisting on coming and acting as the interpreter for their female partner. We are sometimes creative in giving that space so our patients can have privacy so that we can ensure that they're speaking for themselves, and that they have professional interpreters at all times.

 

DEREK MOMBOURQUETTE: I guess I have some questions here, but I have other questions that have popped up since you gave your answers. I guess it comes to sufficient protections and reporting mechanisms around this. Is there anything the government can be doing to help strengthen those protections and reporting mechanisms to support folks who are going through this?

 

THE CHAIR: Ms. Graham.

 

KARI ELLEN GRAHAM: Bear the cost of contraception. (Laughter)

 

DEREK MOMBOURQUETTE: (Laughs) Yes.

 

THE CHAIR: Anyone else? Dr. Hawker.

 

LEISHA HAWKER: One thing I would add is that a limiting factor for many of my patients is housing. We have a housing crisis here as well, and many times, people stay in relationships longer than they would like to or longer than is safe due to lack of housing.

 

DEREK MOMBOURQUETTE: Again, I appreciate this. It's something that we hear more of. Are you seeing a rise in your work? I asked some questions around what you're seeing at work, but are you seeing a high volume of people coming through who are facing this? You've provided a number of examples. We know that any time it happens, it's a problem. We always look for ways that we can support our communities and the organizations that may be facing this. Are you seeing numbers rise where people are coming in who are dealing with the situation?

 

KARI ELLEN GRAHAM: I'm a long-time community pharmacist and I have lots of colleagues right across the province. I'm also working in a coalition of pharmacists in the Maritime provinces, advocating for no-cost contraception. We are definitely seeing across the Maritime provinces, and in Nova Scotia specifically as you've heard time and time again, an increase in this epidemic of intimate partner violence, but also an increase of unintended pregnancies due mostly to cost.

 

I thank you, MLA Fadare, for asking that question earlier: What are the barriers? The Number 1 barrier is cost. We see that day in and day out at pharmacies all across the province. People show up with their prescriptions, we say that's going to be $50, and they walk out with nothing. We are trying to bend over backwards like the ROSE Clinic and the Halifax Sexual Health Centre as well. In pharmacies, it's a little bit harder to give things out for free, which I will do, but it's a stopgap. I can only do that for so long.

 

We are seeing a huge rise in the front line of the intimate partner epidemic and violence, reproductive coercion, and unintended pregnancies due to, Number 1, this cost barrier and, Number 2, due to inaccessibility in rural Cape Breton and in rural mainland Nova Scotia. That's the second thing we want to work on, accessibility for contraception, but the Number 1 barrier is cost, for sure. Then, of course, there are all the other barriers that we've mentioned as well in terms of health inequities and marginalized patients, but cost is the Number 1 concern. We see it day in and day out at pharmacies across Nova Scotia.

 

NATASHA HINES: Sorry, I'm aware of the time. I will just say that pregnancy is also extremely dangerous for people who are in situations where they're facing intimate partner violence. It's also another form of control. An unplanned pregnancy, should it continue, does tie this person to their abuser in many ways. Unplanned pregnancies have significant implications for people who are facing intimate partner violence and puts them at higher danger.

 

THE CHAIR: MLA Mombourquette with five seconds left.

 

DEREK MOMBOURQUETTE: Thank you all very much. I appreciate today and the work that you do.

 

THE CHAIR: Order. I like better doing it on you. MLA Hilton.

 

NICK HILTON: I appreciate your time here today, and I'm taking notes throughout and really enforcing the meaning of the work being done here today. Last Wednesday, Yarmouth hosted a Day of Awareness on Domestic Violence and Gender-Based Violence where we dedicated five purple benches through the Barb's Bench project - not just one, five across the county so that we could raise awareness, show support, and direct people to where support was available. It was a touching day. We had Barb Baillie's family in town, along with a number of other survivors. Of course, we continue to grieve and heal after the events of last November at home. Again, I appreciate all the time that you've given us here today and the amount of information that you've shared.

 

This government continues to work on cutting red tape, which we've talked about today - eliminating the silos and the barriers that exist. Those are some of the things that I'm taking away from today: working on accessing the work across all departments of government that's happening to better care, decrease wait times, increase rural access to care - again, things that I'm hearing today that I want to take from today, and of course, the amazing partnerships that we have with all of you who make this great work possible.

 

Just knowing that the financial barriers to contraceptives, PrEP, and sexual health care services are still an issue - and this is to anyone who would like, maybe non-government witnesses who would like to comment - what are some of the non-financial barriers that the government could look to address as we move forward?

 

THE CHAIR: Ms. Benoit.

 

JENNIFER BENOIT: The Number 1 that we could think of off the top of our heads that we've already spoken about this afternoon is access. If you can only access abortions in Halifax and Kentville, where does that leave the rest of the province? We're not just talking about access and getting to it; it is an affordability in itself. If you live in Canso or you live in Sydney and you have to drive to Halifax, that's an affordability cost of a completely different sort just to access the care you deserve.H

 

THE CHAIR: Dr. Brooks.

 

DR. MELISSA BROOKS: I think the other thing that comes into play in rural areas for things like IUDs and implants is that you do have to have somebody to put it in. Across the country, and including Nova Scotia, women's health services tend to be poorly compensated when you compare them to services that are equally time-consuming but only occur in men. Ensuring that providers who provide these kinds of services to women or gender-diverse people who need LARCs or IUDs or subdermal contraceptive implants are compensated well for their time and that these procedures aren't underfunded compared to ones that occur in men or male-identifying people.

 

THE CHAIR: Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: I was wondering what you were going to say next. We talked about access, and I think it's just as much about having the proper care in the proper places. Community health centres are very few and far between around this province. It's something that we've been working really hard to rectify in working with the government. The community health centres are really the places where people who are marginalized, people who are underserved, trust to go in order to receive sexual health care, in order to talk about contraception, in order to talk about intimate partner violence. You need to trust where you're going, and there aren't enough community health centres and care facilities like ours, like the ROSE Clinic, like the people who are all around here, where (inaudible) people can go for help.

 

We tend to be not-for-profits, and we tend to be always on a shoestring. We've talked a lot about donations here today. It's very sad that we're talking about donations in order to support things that are needed. We don't have enough to provide programming, so we go out and get donations in order to provide programming. I heard one of my colleagues say that they would have to cut costs for staff in order to provide these things. We do that on a daily basis, make that assessment.

 

I think when you're asking about barriers and what we can do, ultimately it is a money thing, but really, it's about a commitment to providing these services, providing them in the proper way, and talking to the experts like ourselves to say, If we make this commitment, if we sign this deal and we make contraceptives free, that's great, but then how do we make sure that people are accessing them? How do we make sure that people have the education and have the opportunity? That's a whole other conversation that we'd all love to have, I'm sure. I think that would be something that needs to be at the top of the list when we're talking about some of the barriers and some of the things that can be done.

 

NICK HILTON: In our last minute, Dr. Wilby, I'm just going to shorten the question, because we're short on time. Can you speak about who is accessing PrEP and where gaps still may exist? Maybe make a comment on the pilot project that allowed Nova Scotian pharmacists to be amongst the first in Canada to prescribe PrEP.

 

THE CHAIR: Dr. Wilby.

 

KYLE WILBY: People who are accessing PrEP currently are people like me who have third-party insurance and are able to receive it for about $12 for every three months. There is that major gap with people who really do need the medication, no matter what age group you are, no matter what background you come from, in particular students, gay, bisexual, men who have sex with men, transgender women, non-binary folks, and others at risk of - as my colleagues said, persons who inject drugs. Also, we're really proud that pharmacists were the first in Canada to prescribe PrEP, and we hope to continue that onward in increasing access to sexual health services overall.

 

THE CHAIR: Three seconds left. That concludes the questions. For closing statements, I do it a little differently, because I actually ask everybody. Dr. Wilby, do you have any closing comments?

 

[2:45 p.m.]

 

KYLE WILBY: I just want to thank you all very much for having me here and for accommodating me, again, from Toronto. I think this was a great conversation and I strongly encourage you to look at funding of sexual health and contraception and these services across the board and improving access, not just for the patients but for the communities as a whole in Nova Scotia.

 

THE CHAIR: Ms. Benoit.

 

JENNIFER BENOIT: I just wanted to thank everyone for the opportunity to be here this afternoon. Thank you to all the presenters for their knowledge.

 

Lastly, I want to urge everyone to consider how we can possibly not provide this service on a go-forward basis with full coverage for contraceptive care and PrEP across this province. The arguments have been made. The points were well-taken. We cannot afford not to do this.

 

THE CHAIR: Dr. Hawker.

 

DR. LEISHA HAWKER: Thank you for having us today. One thing I haven't had the chance to mention is that Access Now Nova Scotia is publicly supported by Doctors Nova Scotia, Maritime Resident Doctors, the Nova Scotia College of Family Physicians, and Dalhousie University's Departments of Family Medicine, Pediatrics, and Obstetrics and Gynaecology. Overwhelmingly, the experts agree that universal contraception is what this province needs. It's the best medicine. It would improve gender and healthy equity. It's smart public policy and a smart investment. As Dr. Brooks said, we can't afford not to do it.

 

THE CHAIR: Ms. Burgess.

 

STACY BURGESS: I just want to echo thank you to everyone here for sharing your expertise and your stories. Thank you for having the department here.

 

THE CHAIR: Dr. Yoshida.

 

DR. LIANNE YOSHIDA: I'd also like to thank the committee for spending this much time listening to us about this very important issue. I'll just repeat again what my colleague said: We can't afford not to do this.

 

THE CHAIR: Dr. Brooks.

 

DR. MELISSA BROOKS: Thanks for having us. I was here in 2022 speaking to a similar topic - a little bit more broad - and then I got to encourage Nova Scotia to be leaders. We would have been leaders then in universal contraception.

 

We're no longer leaders, but let's not be laggards, right? Other provinces are doing this. Let's not drag our feet.

 

It sounds like we could be leaders in the PrEP field. That's not my expertise, but it sounds like Dr. Wilby is doing some amazing work and amazing research. Let's be leaders there. We can do that. We can show the rest of the country what's possible. But let's not drag our feet.

 

THE CHAIR: Ms. Graham.

 

KARI ELLEN GRAHAM: I want to say thank you as well. I'm so pleased to hear positive comments from MLAs from the government. I implore you to reach out to us if you have further questions or if you have any hesitancies whatsoever in signing on to this bill or creating our own intraprovincial bill. Please reach out to us. Please encourage our Premier to reach out to us, or our Minister of Health and Wellness, or Kathleen Coleman. We would love to speak with them. We've already extended multiple invitations. I really feel strongly that if we could have some one-on-one conversations - as Natasha mentioned, please reach out to Access Now Nova Scotia.

 

We have thought about this for decades. We know the data. We know the policies around it. We've spoken to many politicians across the country on a federal level and on a provincial level. We know how to do this. Let's not hesitate any longer. It's already done. There's lots of precedence. We can do this in Nova Scotia. Please reach out if you have further questions.

 

THE CHAIR: Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: I would thank you for inviting us. I would urge you to look at this in a bigger picture. Sexual and reproductive health is one portion of the whole health of a province - the whole health of an organization. We talk a lot about the social determinants of health. Funding this will have so much more of an impact on all the other pieces that we're looking at. We're looking at housing. We're looking at all the social impacts of not supporting this. The ripple effect is large.

 

As a government, as a province, we've talked a lot about how we have to look at our health care system through the social determinants of health. That's something that the North End Community Health Centre has been doing for 54 years. I would urge you to look at this from that lens. This is $8.5 million that will have so much of a bigger impact in a positive way on our health care system. Thank you for listening to us.

 

THE CHAIR: Ms. Hines.

 

NATASHA HINES: I'll echo everything that the other witnesses are saying. Thank you so much for having us and listening to our points today. I will say that when we worry about parts of the population that fall through the cracks - marginalized populations, unhoused, youth and things like that - if this benefit covered everybody, we would have to worry far less about the people whom we're missing and the people who are falling through the cracks. I hope that you will consider implementing this benefit because it really will mean a lot to a lot of different people.

 

THE CHAIR: Dr. Strang.

 

DR. ROBERT STRANG: In my 30 years as a public health physician, sexual health - today is a reminder of this - has always remained underappreciated in terms of overall health system approaches for many reasons we could talk a lot about. It highlights lots of inequities and lots of power disparities, et cetera, in society - lots of discussion and lots of gaps, but also opportunities identified today.

 

I want to end by thanking all my colleagues around here for the work that they do with limited resources, addressing the sexual health needs of Nova Scotians, and also using their opportunity and their voices today to raise these issues on behalf of Nova Scotians.

 

THE CHAIR: Ms. Stockman.

 

CYNTHIA STOCKMAN: I just want to echo what everyone is saying and thank you very much for having us here today. Wouldn't it be great if we didn't actually need a ROSE Clinic and didn't need to expand abortion services across the province? Wouldn't it be great if people didn't have to have an abortion to actually be able to access contraceptives? That really is the message: providing access before they get to the point that they see us at the Nova Scotia Health Authority would be absolutely amazing for the Province.

 

THE CHAIR: Ms. Ferguson.

 

ABBEY FERGUSON: Thank you all for your questions and thank you to my colleagues for being here today. I am really looking forward to a day in which my $17,000 is reinvested into other programming and services to meet the health needs of Nova Scotians. I really hope that weighs on you, that we've already been providing free contraceptives for over 40 years. That clearly shows that the need has been in existence for a long time.

 

THE CHAIR: I want to thank you all for coming. It's been great questions. You're excused. I'm going to give us a two-and-a-half-minute break. We'll be back in two-and-a-half minutes. We're in recess.

 

[2:53 p.m. The committee recessed.]

 

[2:56 p.m. The committee reconvened.]

 

THE CHAIR: Order. Okay, we're back. Order. I'm going to go through committee business as quickly as I can because we've got some things.

 

There were some requests for information. Everyone would have received the response from Executive Council on the request that happened at the last committee. Any discussion on that letter? Okay.

 

Department of Seniors and Long-term Care follow-up for inquiries from the meeting on April 8^th: The document's been received. Any discussion? Great.

 

The next thing is the deferred motion. MLA Rankin.

 

HON. IAIN RANKIN: I did check my emails today before I came in and was pleasantly surprised to see that the government has come out with supporting the motion. This is a win for advocates. I'll officially retract the motion because it becomes moot. The government has indeed gone forward with a round table, so I want to thank government. I won't celebrate it yet until I see action come from the round table, and I just want to say that the credit does go out to the advocates who pushed government for this. I was simply a voice for those advocates at committee, and I think it's a great day that we'll be moving forward with the round table.

 

THE CHAIR: Can I have unanimous consent to have the motion removed?

 

I see the unanimous consent.

 

The motion is removed.

 

Legislative Library research: They were going to attend. Thank gosh they didn't because we wouldn't have had time again. They will be here in July. Since the witnesses are not long, I expect we'll be able to get them done.

 

There's no other committee business; I haven't received any notice. The next meeting is July 8^th, 1:00 p.m. to 3:00 p.m. - Expansion of Multidisciplinary Care Teams. Witnesses are the Department of Health and Wellness and the Nova Scotia Health Authority, and we will have the librarians in to do that.

 

We're adjourned. See you next month.

 

[The committee adjourned at 2:58 p.m.]