Canadian Women Opting for Less Effective Birth Control
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NEWS Canadian women opting for less effective birth control n Cite as: CMAJ 2017 July 10;189:E921-2. doi: 10.1503/cmaj.1095446 ore Canadian women are rely- women in their 20s, 12.5% of single 1.69 among those married or common ing on less effective methods of women and 22.3% of those who are mar- law. birth control and are using ried or in common law relationships were Black says the results are a wake-up Mthem less consistently than they did a not using any method of birth control, up call for women’s health providers. “If decade ago, according to the Society of from 9.1% and 19.3% respectively. things haven’t changed in 10 years, what Obstetricians and Gynaecologists of Can- Not surprisingly, “the number of are we doing wrong and how can we do ada (SOGC). women surveyed who reported an unin- things better?” The SOGC surveyed more than 3200 tended pregnancy was essentially Contraception misuse or failure Canadian women aged 15 to 50 about unchanged,” says Black. One in five Cana- appears to be a factor, since almost half their awareness and use of contraceptive dian women had an unplanned preg- the women who reported unintended methods, first in 2006 and again in 2016. nancy in 2016, the same as in 2006. One in pregnancies in 2016 were using some The latest results, presented June 21 at three of these women had abortions, up method of birth control, compared to less the SOGC’s annual conference in Ottawa, from one in four a decade earlier. The than a third of women the decade before. show there’s been little progress and a average number of unintended pregnan- There also seems to be a perfect storm possible backlash against oral contracep- cies also increased slightly, from 1.58 to of ignorance about contraceptive options, tives in recent years. 1.84 among single women and 1.55 to increasing concern about adverse effects Condoms, the pill and “pulling out” are still the most popular methods of birth control among Canadian women. However, oral contraceptive use dropped among women over 30 from 39% in 2006 to 15.7% in 2016. Meanwhile, reliance on condoms alone increased across all age groups, with a marked uptick among teens from 21% to 50.1%. “It’s concerning that we’re still using methods of contraception that have a higher failure rate with typical use when we have other more effective methods available,” like intrauterine devices (IUDs), says Dr. Amanda Black of the SOGC’s Contraception Awareness Pro- gram Working Group. Although four out of five women use some form of birth control at least some of the time, one in four uses those meth- ods inconsistently, “more so than we’d seen in the previous survey,” says Black. More worrying is the increasing number of women under 30 who don’t use any form of contraception. Nearly one in 10 sexu- ally active teens surveyed in 2016 said spukkato/iStock they do nothing to prevent pregnancy, up Canadian women are ditching the pill in favour of condoms, or sometimes even less reliable contra- from less than one in 20 in 2006. Among ception, according to a national survey. © 2017 Joule Inc. or its licensors CMAJ | JULY 10, 2017 | VOLUME 189 | ISSUE 27 E921 and eroding trust in health providers as discussion about what else could be used adverse effects of contraceptives, or their more women seek advice online. in the interim,” Costescu says. desire to use natural alternatives, she “There’s still a lot of misinformation Fifty-one percent of women using says. Doctors tend to default to prescrib- out there which may limit women’s ability hormonal birth control reported adverse ing oral contraceptives or other hor- to choose a contraceptive method that’s effects in 2016, up from 46.8%. The most monal contraception, “but they do a poor right for them,” explains Black. common adverse effects — weight gain job of acknowledging and hearing young The SOGC tested women’s awareness and headaches — were also listed among women who say they don’t want to do NEWS of 24 types of contraception, including the top reasons for discontinuing a that.” forms of sterilization, hormonal birth con- current method of contraception. But For some women, “100% pregnancy trol, device and barrier methods, and instead of switching to more effective prevention isn’t the be all and end all,” “natural” options like breastfeeding, alternatives, a quarter of women who Wershler adds. “Physicians and sexual withdrawal, abstinence and the rhythm stopped birth control for any reason health clinics should be honoring these method. Most women were unaware of turned to withdrawal or had unprotected women’s choices.” more than half of these methods, includ- sex. Costescu argues that physicians who ing some of the most effective options How doctors counsel their patients are dismissive of less effective methods such as IUDs and contraceptive implants. about contraceptives may be the crux of may be setting up their patients for con- In fact, less than a quarter of women the problem. Family doctors are still the traceptive mishap. “Women who dislike thought hormonal IUDs were “very effec- top source of contraceptive information, their contraceptive care providers are tive,” while fewer than one in five said the but only 58.8% of women turn to them for more likely to experience a failure or dis- same about contraceptive implants. advice, down from 71.3% in 2006. More continuation of their method, so quality Women also underestimated their troubling, only 54.2% consider them of counselling is very important.” chances of getting pregnant. More than a trustworthy. That may mean taking more time to third of those who had unplanned pregnan- Meanwhile, the internet has become understand, rather than change a cies said they didn’t use contraception at the second most used source of informa- patient’s perspective, and instead of the time because they didn’t think they tion, with half of women seeking advice steering her away from certain methods, could get pregnant. Notably, 27% said they online up from a quarter in 2006. supporting her to use them as effectively were unprepared in the heat of the moment Although only one in five women trust the as possible, he explains. and 17.8% said they didn’t use contracep- information they find online, they use and Black says that it may be time to tives because of the adverse effects. trust sexual health clinics, pharmacists rethink the primacy of the pill in these “It’s common for women to take pill and nurses even less. discussions. “Women are concerned and breaks or discontinue birth control The reason for this shift is a simple rightly because there have been issues assuming they will have time to restart one, says Laura Wershler, a Calgary- with safety in the past,” she says. “Proba- it,” says Dr. Dustin Costescu, a family based women’s health advocate and bly we need to flip things around and talk planning specialist at McMaster University member of the Society for Menstrual about methods starting at the most effec- in Hamilton. Health providers often rec- Health Research. “Women have not felt tive and work our way down.” ommend breaks when women complain heard,” particularly when it comes to of contraceptive adverse effects “with no their concerns about the safety and Lauren Vogel, CMAJ E922 CMAJ | JULY 10, 2017 | VOLUME 189 | ISSUE 27 .