Expanding access to contraceptive choice in Canada

Every woman should possess the power to decide whether or not she chooses to become pregnant at any given point in her life. Unplanned pregnancy may have a huge impact on a woman’s health, economic, and social well-being, and yet an estimated 41% of pregnancies worldwide are unintentional. There are a multitude of reversible contraceptive options available and many factors that contribute to a woman’s decision regarding which method is right for her. Efficacy, effort and side effect profile are important considerations and vary widely between methods. Surprisingly, condoms and the oral contraceptive pill, which have relatively high typical use failure rates at 21% and 9% respectively and require frequent user action, are the most popular reversible contraceptive options in Canada. In contrast, intrauterine contraceptive devices, with failure rates of <0.8% and almost no user action, have extremely poor uptake. Recognizing that the variation of side effect profiles will also impact use, this disconnect between efficacy, effort and use suggests that forces beyond the intrinsic merits of a contraceptive system play a role in these decisions. Cost and accessibility can both inhibit the use of intrauterine systems, which are a large upfront investment and require physician insertion. Peers, the media and providers all influence contraceptive decision-making and may also contribute their own bias. We advocate for providing public funding for all contraceptive options as well as engaging in open discussion with both patients and the public to improve our delivery of reproductive health care.