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Contraception
Sharon McMahon, MA; Lisa Hansen, MSc, MHSc; Janice Mann, MD; Cathy Sevigny, RN;
Tom Wong, MD, MPH, FRCPC; and Marlene Roache, MA (Health Canada)
Health Issue
Contraception choices affect the long-term sexual health and fertility of women and
men. Women's ability to control their fertility has enhanced their ability to control
their lives, and with this power has come a higher responsibility for contraception
in relationships. The context in which men and women make decisions related to
contraception changed with the advent of oral contraception (OC) some 40 years
ago and, more recently, with the increased risk of HIV and other sexually transmitted
infections (STIs). Choice of contraceptive method was previously based on the considered
efficacy of the method, ease of use, cost, and availability. Through the 1990s, prevention
of STIs has become as important - if not more important - for many men and women
as prevention of pregnancy. Data from the 1998 Canadian Contraception Study and
the 2000-2001 Canadian Community Health Survey are used in this chapter to examine
recent trends in contraceptive use among Canadian women and their familiarity with
various methods, including emergency contraception. Also considered are factors
that influence contraception choice across the life stages and women's and men's
different perceptions of contraception.
Key Findings
- Oral contraception is the dominant method of contraception for women in Canada: more than 43% of sexually active women use it.
- Women today seem to be better informed than they were in the past about how to protect themselves against HIV/STI.
- Canadian women have a high awareness of the condom, which offers an effective method of birth control and currently provides the most capable barrier method for protection against HIV/STI.
- Seventy-five percent of Canadian women have not heard of the female condom. Of those who had, only 3% had a favourable opinion of it.
- Contraception use in sexually active, younger women in the 15-17 age group is quite high (80% report using contraception the first time they had intercourse). However, consistency of use is a problem: only 60% of unmarried teens report always using contraception over the previous six months.
- Adolescents' dual use of condoms and OC is low. Canadian and U.S. studies show that, among youth, condom use drops as use of OC increases, especially in sexual activity with a main partner.
- Adolescent girls who are sexually active report high awareness of emergency contraception but low awareness of the time limits within which it is effective.
- Women aged 35-44 report a higher level of familiarity with sterilization than do younger women, and indicate lower familiarity with reversible methods of sterilization than in the past. There has been a notable shift in sterilization practices, with a move away from tubal ligation and an increase in vasectomy. Twenty-three percent of married women aged 35 to 44 report using sterilization as their method of contraception, 10% of themselves and 14% of their partners.
Data Gaps and Recommendations
The authors identified the following data gaps and made the following recommendations:
- In spite of two excellent sources, the Canadian Contraception Studies and the Canadian Fertility Studies, national data to guide policy and program development are limited. Data are needed on men and contraception use, and on factors that affect accessibility, adherence and negotiation of choice.
- Increased efforts on sexual health promotion and education in Canadian women are required.
- Younger women and men, as well as physicians, health care providers, and educators, need heightened awareness about the importance of dual protection.
- Adherence to the contraceptive method chosen should be promoted.
- Women need increased awareness of emergency contraception methods.
- Conduct research and trials associated with new, reversible contraceptive methods for men and the development of safe and effective microbicides.
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