Canadian Women Opting for Less Effective Birth Control

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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 methods 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 NEWS E922 of contraceptiveadverseeffects“withno ommend breakswhenwomencomplain in Hamilton.Healthprovidersoftenrec- planning specialistatMcMasterUniversity it,” says Dr. Dustin Costescu, afamily assuming theywillhavetimetorestart breaks ordiscontinuebirthcontrol tives becauseoftheadverseeffects. and 17.8%saidtheydidn’tusecontracep- were unpreparedintheheatofmoment could getpregnant.Notably,27%saidthey the timebecausetheydidn’tthink cies saidtheydidn’tusecontraceptionat third ofthosewhohadunplannedpregnan- chances ofgettingpregnant.Morethana same aboutcontraceptiveimplants. tive,” while fewer than one in five said the thought hormonal IUDs were “very effec- In fact,lessthanaquarterofwomen such asIUDsandcontraceptiveimplants. ing someofthemosteffectiveoptions more thanhalfofthesemethods,includ- method. Mostwomenwereunawareof withdrawal, abstinenceandtherhythm “natural” optionslikebreastfeeding, trol, device and barrier methods, and forms ofsterilization,hormonalbirthcon- of 24typescontraception,including right forthem,”explainsBlack. to chooseacontraceptivemethodthat’s out therewhichmaylimitwomen’sability more womenseekadviceonline. and erodingtrustinhealthprovidersas “It’s commonforwomentotakepill Women also underestimated their The SOGCtestedwomen’sawareness “There’s stillalotofmisinformation

CMAJ their concernsaboutthesafetyand heard,” particularly when it comes to Health Research.“Women have notfelt member oftheSocietyforMenstrual based women’shealthadvocateand one, saysLauraWershler,aCalgary- and nursesevenless. trust sexualhealthclinics,pharmacists information they find online, they use and Although onlyoneinfivewomentrustthe online upfromaquarterin2006. tion, withhalfofwomenseekingadvice the secondmostusedsourceofinforma- trustworthy. troubling, only 54.2% consider them advice, down from 71.3% in 2006. More but only58.8%ofwomenturntothemfor top sourceofcontraceptiveinformation, the problem.Familydoctorsarestill about contraceptivesmaybethecruxof sex. turned towithdrawalorhadunprotected stopped birthcontrolforanyreason alternatives, aquarterofwomenwho instead of switching to more effective current methodofcontraception.But the top reasons for discontinuing a and headaches—werealsolistedamong common adverse effects — weight gain effects in2016,upfrom46.8%.Themost hormonal birthcontrolreportedadverse in theinterim,”Costescusays. discussion about what else could be used | The reasonforthisshiftisasimple Meanwhile, theinternethasbecome How doctorscounseltheirpatients Fifty-one percent of women using JULY 10,2017 | VOLUME 189 | ISSUE 27

Lauren Vogel,CMAJ tive andworkourwaydown.” about methods starting at the most effec- bly weneedtoflipthingsaroundandtalk with safetyinthepast,”shesays.“Proba- rightly because there have been issues “Womenareconcernedand discussions. rethink theprimacyofpillinthese as possible,heexplains. supporting hertousethemaseffectively steering herawayfromcertainmethods, patient’s perspective,andinsteadof understand, ratherthanchangea of counsellingisveryimportant.” continuation oftheirmethod,soquality more likelytoexperienceafailureordis- their contraceptivecareprovidersare traceptive mishap.“Womenwhodislike may besettinguptheirpatientsforcon- are dismissive of less effective methods women’s choices.” health clinicsshouldbehonoringthese Wershler adds.“Physiciansandsexual prevention isn’t the be all and end all,” that.” women who say they don’t want to do job of acknowledgingandhearing young monal contraception,“buttheydoapoor ing oralcontraceptivesorotherhor- says. Doctorstendtodefaultprescrib- desire tousenaturalalternatives,she adverse effectsofcontraceptives,ortheir Black saysthatitmaybetimeto That may mean taking more time to Costescu argues that physicians who For somewomen,“100%pregnancy