Dr. Sheila Dunn

Moving Beyond the Pill

Improving contraception access and promoting use

Unintended pregnancy can have profound impacts on an individual’s physical and emotional health, educational attainment and career aspirations. Globally, there is a large body of evidence to support that the use of contraceptives provides both personal and societal cost savings by preventing unplanned pregnancies, abortions, reliance on social services and more.

While the importance of using contraception to promote women’s health is evident, many individuals face significant barriers in accessing these medications or devices. Research from Dr. Sheila Dunn, scientist at Women’s College Research Institute (WCRI) and research director of the Family Practice Health Centre at Women’s College Hospital (WCH) is investigating the barriers that impact contraception access and its use, particularly for groups like youth who are at risk for unintended pregnancy.

“Personal and societal determinants both strongly affect equitable access to contraception, and the impacts of these factors need to be addressed to reduce barriers for all women and girls,” says Dr. Dunn. “A lot of discussions about contraception are layered with shame, so it’s important for us to start these conversations in order to reduce the stigma and promote knowledge about safe sexual health.”

By the age of 24, 86 per cent of Canadians have had sexual intercourse, yet Dr. Dunn found that 15.5 per cent of youth at risk for unintended pregnancy didn’t use contraception during their most recent intercourse – equal to approximately 300,000 Canadian youth. Dr. Dunn and her colleagues also found that rates of non-use of contraception varied considerably across regions of Canada.

“Non-use of contraception comes with consequences, so it’s important for us to determine which factors are associated with non-use to inform the development of health policies and services to better address the sexual health needs of youth,” adds Dr. Dunn.

One of the most significant factors impacting access is the cost of contraceptives. Unlike many other countries around the world, contraceptives are not paid for under a universal healthcare plan in Canada. For many youth, the cost can add another layer of difficulty in accessing contraceptives.

“If you can’t afford contraceptives, you may not use them or choose to use one that is not as effective because of the price,” notes Dr. Dunn. “For youth who have coverage under a parent’s private insurance plan, there can still be barriers to access because they don’t want their parents to know they are using contraceptives. This is particularly true among certain cultural groups, where sex outside of marriage is unacceptable within the family dynamic.”  

A recent study from Dr. Dunn found that younger teens and youth who are at a financial disadvantage, born outside Canada and/or Indigenous were at high-risk for unintended pregnancy as a result of sexual activity and most likely to be non-users of contraception. Providing and promoting the use of various methods of contraception beyond the birth control pill, like intrauterine devices (IUDs), which received support from the Canadian Paediatric Society last year, are needed to close these gaps. Working with communities to start the conversation with youth and develop pathways to access sexual healthcare through sexual health clinics, school nurses or pharmacists is also essential in ensuring equitable contraception access.

“There is a strong need for targeted outreach, culturally-tailored sexual health education and easily accessible sexual health services for youth across Canada,” Dr. Dunn emphasizes. “By ensuring healthcare providers are educated on the most up-to-date information and developing new strategies for outreach, we will be able to improve knowledge about and increase the use of contraception among some of our most vulnerable populations including youth.”