Contraception and Abortion
Contraception in Canada:
- Condom: a sheath made of animal membrane or latex that covers the penis during coitus and serves as a
barrier to sperm following ejaculation – was first introduced in the 18 century.
- 2009 study: 14.9% of Canadian women who’d had sex in the last 6 months didn’t use contraception.
Majority (54.3%) used condoms and oral contraceptives (43.7%). Withdrawal was the 3 most popular
- 2005-2006 Canadian study: ¼ of Grade 10 students had sex. Contraceptive method used most often was the
condom (male, 47%. Female, 40%), the pill (male, 25%. Female, 33%) and withdrawal (male, 8%, female,
- As teenagers get older and form longer-term relationships, they switch from condoms to the pill.
Methods of contraception:
- Oral contraceptive: consists of sex hormones and is swallowed – there are two kinds:
o Combination pills: contains synthetic estrogen and progesterone (progestin).
Fools the brain into thinking the women is already pregnant, so no additional ova mature are
released, no ovulation.
The estrogen inhibits FSH (follicle-stimulating hormone) production, so follicles don’t
mature. The progestin inhibits secretion of LH (luteinizing hormone), which would
otherwise lead to ovulation.
Progestin increases the thickness and acidity of the cervical mucus which impedes passage
of sperm even if egg was released. Also, inhibits development of the endometrium, which
means fertilized ovum couldn’t become implanted in the uterus.
This pill is taken for 21 days of a 28-day menstrual cycle. Remaining 7 days, the drop in
hormone levels causes endometrium to disintegrate and menstruation to occur.
o Minipills: contain synthetic progesterone, but no estrogen.
1) Thicken cervical mucus which impedes passage of sperm. 2) Render inner lining of the
uterus less receptive to a fertilized egg which prevents implantation.
Taken all 28 days.
- Failure rate of birth control is very low – 0.5% or less, depending on the pill type. When women forget to
take the pill for 2 days or more failure can occur. Also when women switch from brand to brand. And when
women don’t have backup method when they first go on the pill.
- If you miss a pill, according to WHO, you are to take the pill as soon as you remember. If she misses 3 or
more combination pills, she should use condoms or refrain from sex, only until she has taken 7 pills for 7
- Reversibility: women may temporarily experience reduced fertility the next 3 months after discontinuing
oral contraceptive. Clomiphene can be used to induce ovulation.
o It is nearly 100% effective, and it doesn’t interfere with sexual spontaneity (cause pausing) or
sensation. o Treats iron-deficiency anemia and facial acne.
o Reduce risk of pelvic inflammatory disease (PID), benign ovarian cysts, fibrocystic breast growths.
o Regularizes menstrual cycles and reduce cramping and premenstrual discomfort
o Eg. Seasonale approved by Health Canada to be the only oral contraceptive for extended cycle of
91 days. Take for 84 days which contains ethinyl estradiol and levonorgestrel, and no pill/placebo
pill for 7 days. Leads to lesser periods (4 in a year).
o No protection against STI’s (Reduce effectiveness even of antibiotics treating STI)
o If you have existing health conditions (hypertension, diabetes, migrane, fibrocystic breast tissue,
uterine fibroids and high cholesterol levels), the pill may not be safe.
o The estrogen in combination pills can produce side effects such as nausea, vomiting, irritation,
tenderness, headaches, discharge, dizziness, weight gain, and bloating. Similar to pregnancy
o Risk of blood clots (in the veins, lungs, strokes and heart attacks).
o Not for women who smoke over 35 years old, nursing mothers (who may pass the hormons to their
babies through breast milk), or circulatory problems, blood clots, coronary disease, heart attacks,
strokes, breast or uterine cancers, undiagnosed genital bleeding, liver tumours or sickle-cell anemia.
o Psychological effects such as depression and irritability.
o Linked to cervical cancer.
- Emergency contraception: the morning after pill – is taken ASAP after unprotected sexual intercourse or
when contraception fails (condom breaks). Most effective when taken within 72 hours, though it may be
effective if within 120 hours. As there is a higher hormone content, nausea is a common side effect.
Available without prescription.
o Examples (Canada):
1) Two 0.75mg tablets of levonorgestrel (Plan B) taken together – prevents the joining of sperm
and egg and preventing a fertilized egg from attaching to the uterine wall. More effective than
(2) – 1-3%
2) Yuzpe regimen is a hormonal method combining multiple birth control pills.
- The contraceptive patch: worn weekly for 3 weeks, then the 4 week is patch-free to allow bleeding.
When used correctly, 99% effective. Side effects are same as the pill
- The vaginal ring (NuVa Ring): inserted into the vagina and is worn for 3 consecutive weeks and can be
left in during sex – delivers hormones (estrogen and progestin) through the skin. Removed in last week to
allow menstruation. As effective as birth control pill.
- Injectable contraception (Depo-Provera): 99.7% effective – administered by needle into muscle of arm
or buttocks every 12 weeks and prevents pregnancy for 3 months. Side effects: vaginal bleeding, headaches,
naursea, bloating, weight gain and vomiting. Prolonged use – bone loss.
- Intrauterine devices (Copper IUDs and Levonorgestrel-releasing IUDs): a small object is inserted into
the uterus and left in place to prevent contraception. Plastic string hangs down so that women can check if
it’s still in place. Prevents sperm from reaching the egg, and implantation of fertilized egg. They are 99%
effective for up to 5 years. It is not very popular because of its side effects: cramping, spotting, heavier period, and pelvic inflammatory disease (which can cause scar tissue blocking fallopian tube and infertility
may occur), ectopic pregnancies.
- Diaphragm: a shallow cup or dome made of thin latex rubber. It is coated with a spermicide and inserted
before intercourse to prevent contraception. It stays in at least 6 hours after intercourse to allow spermicide
to kill all sperms and its failure rate is 6-18% with typical use. Con: disruptive to sex, high rate of
pregnancy (1 in 5).
- Cervical cap: smaller than the diaphragm and is meant to fit snugly over the cervical opening. It is filled
with spermicide. The failure rate is from 18(who haven’t borne children)-36% if you have already borne
children. Side effects: uncomfortable, urinary tract infections, allergic reactions or sensitivities to the rubber
- Spermicides: coat the cervical opening, blocking the passage of sperm and killing sperm by chemical
action. Many forms: gel, cream, foam, suppositories. Suppositories should be inserted 10-15 minutes before
intercourse unlike the others which are effective immediately.
- Contraceptive sponge: soft, disposable device that has spermicide built in. Inserted several hours before
intercourse People are often irritated by the spermicide and it is not available in pharmacies in Canada.
- Male condom: Can prevent pregnancy and STIs. Polyurethane ones are available for those allergic to latex.
Have nipples to catch semen. 12% failure rate, drops if used