After universal contraception, advocates are demanding the province confront ‘systemic failures’ in gynaecological pain management
Photo via accessbc.org.
AccessBC launched a new, province-wide campaign in November, calling on the provincial government to mandate improvements to pain management for individuals receiving intrauterine device (IUD) insertions.
This movement comes two and a half years after B.C. implemented its universal contraception policy, a success that AccessBC says removed financial barriers, but inadvertently put a harsh spotlight on other long-overlooked systemic failures in patient care.
The campaign demands four key actions from the B.C. government. First, AccessBC seeks the adoption of province-specific clinical guidelines for addressing pain management planning for IUD insertions. Second, they call for appropriate MSP billing mechanisms for pain control interventions to remove the existing financial deterrents for providers.
AccessBC also urges the government to work with post-secondary and training institutions to implement mandatory training requirements for all practitioners who offer IUDs, and calls for strategies to ensure equitable access to comprehensive pain management across all regions, particularly targeting remote and rural communities.
AccessBC is now mobilizing B.C. residents to join a coordinated, province-wide letter-writing campaign directed at their MLAs, demanding they meet these four key actions.
Although the universal contraception policy successfully increased access to prescription contraception, leading to significant growth in IUD usage, many patients continue to face preventable and sometimes severe pain because adequate pain management methods remain inconsistent, optional, or simply unavailable.
Sara Sunderji, a researcher for the campaign who helped develop the briefing paper, noted that the initial success of free contraception was unable to achieve “full reproductive justice.” Sunderji said that, while removing cost addressed one barrier, “there are so many other barriers, indirect barriers and direct barriers … and one of those is pain.”
According to AccessBC, many patients face inconsistent standards of care, and endure a system that minimizes or normalizes gynaecological pain. AccessBC says that national guidelines, which are often the primary reference point for B.C. providers, frequently either omit or downplay pain management recommendations.
Sunderji said that the absence of a standardized pain management protocol reinforces a historical bias, stating that it “doesn’t necessarily lead to additional marginalization” but reinforces an existing marginalization instead.
AccessBC asserts that a default of little or no pain management “is not evidence-based care,” but systemic failure –– a conclusion seemingly reflected in the testimonies shared with AccessBC by patients.
Jasmine, from Courtenay, B.C., recalled being told that her insertion “would be just a pinch,” yet she lost consciousness multiple times during the procedure. She stated that she was not informed of the invasive nature of the procedure, and expressed a lasting fear of being unable to trust a medical professional not to “just effectively rip it out of [her] without caring about the pain.”
Another patient, Lexi, recounted an IUD replacement where she was offered no pain management beyond being told to “just take Advil,” which was ineffective for the intense discomfort she felt. During the removal, Lexi described a feeling “like sharp metal dragging along the inside of [her] uterus.” Despite feeling dizzy and lightheaded, she said the gynaecologist “brushed it off as ‘normal,’” –– exemplifying what many, including AccessBC, see as a clear disconnect between patients’ severe pain and professionals’ concern.
AccessBC says its research reveals that, while some specialized clinics in B.C. offer enhanced pain management options, most patients receive a “one-size-fits-all approach.” This inconsistency, Sunderji said, stems from a lack of standardized training. She added that, although many different providers are now licensed to perform IUD insertions due to an expanded scope of practice, there is no mandatory, standardized training framework to ensure equal quality of care.
The campaign identified significant financial barriers continuing to impact the quality of care, including the current billing structures, which Sunderji said create a “financial disadvantage” for providers who offer comprehensive care. If a provider spends time providing a local anesthetic or conducting an extensive consult to reduce anxiety, she continued, they may not be compensated for that time, or may even be paid less.
The U.S.A. and Australia have both adopted comprehensive pain management protocols, Sunderji said, noting that the U.S. Centers for Disease Control and Prevention (CDC) advocates for a standardized guideline on offering patient-centred, comprehensive pain management to every IUD patient.
She also contrasted B.C.’s policies, or lack thereof, with Australia’s, noting that while B.C. lacks guidelines encouraging the use of agents like Pentharox for IUD procedures, “Australia has said that Pentharox should be used. It can be used. It’s safe to be used in procedures like IUDs.”
Until these measures are in place, the organization says, systematic failures in care will continue to minimize and normalize gynaecological pain across the province.
