Contraception – how to get it, why to use it, and what to know
This week in sexual (re)education I’m covering contraception, barriers to accessing contraceptives, and why everyone should have adequate knowledge on contraceptive measures.
“Everyone should be educated on birth control methods and their functions,” said Taryn Wahl, Education Coordinator for Planned Parenthood Regina. “It’s so important for people to know that if there is a possibility of pregnancy, that if someone gets pregnant, it’s the person who is pregnant that 100 per cent gets to decide what to do with that. Legally, it’s that person. If adoption is the choice, then you need both people to legally sign off on that. If you’re the person with a penis then legally you could be taken to court for child support.”
None of those are necessarily easy circumstances to get through, and having adequate knowledge on contraceptives regardless of whether or not you personally can get pregnant will lessen the chance that you wind up in one of those situations before you want to.
There are barrier, hormonal, and non-hormonal types of birth control, which all work a little differently to interrupt the process of pregnancy. The most common barrier method is a condom – one of the best methods for preventing STI exposure, but one of the worst for birth control. Perfect use where the condom is on throughout all penetration and does not break has 97 per cent efficacy, but typical use is closer to 86 per cent effective at preventing pregnancy.
The most commonly used hormonal method is the pill, which when used perfectly is 99.7 per cent effective, but is difficult to use perfectly as the pills must be taken at the same time every day to really regulate hormones. Typical use sits closer to 91 per cent efficacy.
“Throughout a menstrual cycle your hormones are changing, and that signals different things to happen in your body. The steady dose of hormones that you get with hormonal birth control actually stops ovulation,” explained Wahl. “Once someone ovulates there’s a cascade of hormones that happen in the body, so it’s tricking your body into thinking it’s already ovulated.”
Wahl added that hormonal birth control has uses outside of preventing pregnancy, including managing symptoms of polycystic ovary syndrome, endometriosis, acne, premenstrual dysphoric disorder, and can help painful periods be easier to manage.
Unfortunately, hormonal birth control can come with serious side effects for people with uteruses.
“It can exacerbate things like anxiety or depression, it can decrease arousal and lubrication, it can decrease the ability to orgasm, and it just totally depends on the person,” said Wahl. “So when you know that that’s a possibility, that might be something that you’re looking out for… We have sex-positive clinicians (at Planned Parenthood) so if someone were to call us and say ‘I’m not sure if I’m happy with my birth control because I don’t feel like I can orgasm anymore.’ that is absolutely something that our practitioners would be willing to have a conversation about.”
One of the best non-hormonal methods (and my personal favourite) is the copper intrauterine device (IUD), which can also be used as an emergency contraceptive method if inserted within seven days after sex. These change the ionic environment to make it less hospitable for sperm, they thicken vaginal mucus to make it harder for sperm to swim up, and can even make sperm tails fall off so they have nothing to swim with; essentially, they work to stop fertilization. Copper IUDs are inserted in a person’s cervix, and can safely stay there for 3-10 years depending on the model. Once inserted, the individual has 24/7 protection with 99.7 per cent effectiveness, and there’s no maintenance involved – all that users have to remember is to get a replacement in 3-10 years.
While abortions are covered with a Saskatchewan health card, birth control and emergency contraceptives are not. Three types of emergency contraceptives accessible in Saskatchewan are Plan B, Ella, and the copper IUD. To get Plan B or Ella, both of which come in pill form, you need a prescription in Saskatchewan, which raises accessibility issues.
Wahl explained that “Plan B is most effective within 72 hours, Ella can be used up to five days after, and copper IUDs can be inserted up to seven days after, but if you’re someone in a rural community that would be challenging. To get the copper IUD you need to be able to get an appointment with a practitioner willing to insert it. At any time that’s a challenge to do in 3-7 days, but especially because COVID can make it harder to get in right now.”
Other potential barriers that Wahl mentioned that make accessing contraceptives difficult are the lack of family doctors, transportation to appointments, wait lists, a lack of practitioners with adequate knowledge on sexual health, stigma, sex negativity, language barriers, disabilities, and discrimination by health care practitioners. “A really fun fact about pharmacies is that technically pharmacists are able to deny prescriptions based on their own belief systems,” said Wahl, which shocked me. “I’m not saying that to make you afraid, just so that you’re aware – you have the right to access this stuff, but sometimes it can be hard to actually get.”
Pharmacies generally have a wider range of hours, but can also turn away people without a Saskatchewan health card – Planned Parenthood will not.
“One thing I really want people to know,” said Wahl, “is that when it comes to birth control they have the right to have choices, they have the right to accurate information, they have the right to be respected by healthcare providers, and if that is ever not the case come to us so we can advocate for you or give you better treatment.”
So, when and how should you talk to a potential partner about how contraceptives will be used? Wahl mentioned it can be as easy as saying “Hey, if we’re going to be having sex in the future, I’d like to talk about ways to do it safely first.” This communicates your expectations and gives the other person the opportunity to show you if they care about your well-being and priorities. Wahl suggested tying it into the conversation on consent, because “Everyone needs to be responsible for their own sexual health, but consent is about a collaboration and consent needs to be informed and specific. That means that everyone involved has the information that they need to be able to consent. So if you’re engaging in sexual activities where pregnancy could be possible and you don’t want to roll the dice, you don’t want to worry about pregnancy or having children, then absolutely have that conversation.”
That’s the scoop on contraceptives! I hope it shed some light on the subject for you, and if it brought to mind any misunderstandings about sex, puberty, birth control, or the ways bodies function, I’d love to hear about the misunderstanding to include in the last piece of this series! If you’re interested in submitting your story, you can follow this link which will direct you to the survey: You can take the survey by clicking here.