Women's Health Surveillance Report
Contraception
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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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